What is Aspirin Exacerbated Respiratory Disease (AERD)?
AERD, also known as Samter’s triad, is a chronic illness that consists of asthma, recurrent nasal polyps, and a sensitivity to aspirin (salicylates) and other non-steroidal anti-inflammatory drugs (NSAIDs). In AERD, there is an inherent flaw in the way that a naturally occuring pro-inflammatory enzyme, called COX-2, is blocked by particular anti-inflammatory medications. When NSAIDs are ingested in patients affected by AERD, respiratory distress and nasal symptoms are triggered. Additionally, salicylates (as found in aspirin) can be found in relatively high concentrations in certain foods, like tomatoes. Ingesting alcohol, in particular, has also been described to trigger symptoms in up to 75% of people.
What causes AERD?
Not much is known about how people develop AERD, but it tends to develop in middle-aged adults. According the American Academy of Allergy, Asthma, & Immunology, AERD is present in approximately 9% of adults with asthma and present in 30% of adults that suffer from both asthma and nasal polyps.
What are symptoms are associated with AERD?
Generally, the main symptoms of AERD is a characteristic respiratory reaction to aspirin and other NSAIDs. These symptoms include:
- Increased nasal congestion
- Sinus pain or pressure
- Thick nasal discharge
- Wheezing
- Tightness in the chest
- Coughing
What is the treatment for AERD?
Initial, primary treatment comes from discovering the presence of the disease and avoiding the ingestion of aspirin or other NSAIDs. Many foods, like tomatoes, are high in salicylates and can exacerbate symptoms in certain patients. Understanding which foods may be problematic is another step in controlling disease severity. Aspirin desensitization therapy is a method in where one is given a small, yet steady dose of aspirin over a long period of time, forcing the body to “get used it” and cause less severe symptoms. Aspirin desensitization therapy has its risks and benefits, but has been shown to be effective in many people.
Beyond this, controlling the asthma with steroid and bronchodilator inhalers will likely be required with assistance from a board certified pulmonologist. Treatment of nasal polyp disease is also necessary, which involves surgical removal in order to maximize medication delivery throughout the nose. Both the lungs and nose require equal care, as poorly controlled asthma or sinus disease can worsen symptoms of the other.
