Aspirin Exacerbated Respiratory Disease

A proportion of patients with sinusitis have a characteristic triad of nasal polyps, asthma, and aspirin sensitivity, known as Samter’s triad or aspirin-exacerbated respiratory disease (AERD). The mechanism of AERD is not perfectly known. It is believed that all the above changes happen due to anomaly in the arachidonic acid cascade. This results in abnormal production of leukotrienes, the chemicals involved in the body’s inflammatory response. Aspirin blocks production of prostaglandin, resulting in further increased production of leukotrienes and consequently, severe allergy-like effects.

Patients are typically aware of such sensitivity, where prior use of aspirin has resulted in symptoms of varying severity. Mild symptoms include sneezing, runny or itchy nose, nasal congestion. However, the aspirin reaction can also be severe, resulting in asthma attack, anaphylaxis, or urticaria. Patients typically react to other NSAIDS such as ibuprofen. If you have polyps and severe asthma but have not previously taken aspirin or ibuprofen, you may want to avoid these medications.

Patients with AERD typically require more aggressive therapy, which may include more medications and multiple surgeries to remove polyps. Anti-inflammatory medications used for AERD typically have more side effects, which need to be balanced against the benefit of long-term use.

Aspirin desensitization treatment may be effective for severe cases. This is accomplished by purposely exposing the affected patient to increasing doses of oral aspirin. However, this treatment can have serious complications such as asthma attacks and should only be performed under the care of a specialist in a regimented fashion. The benefit of such therapy, which typically outweighs the risks, includes significant reduction in asthma and sinusitis symptoms as well as reduced need for medications and surgery.