Asprin-Exacerbated Respiratory Disease

Some 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).

Causes

The cause of AERD is unknown.

It is believed that it occurs because of an 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.

Symptoms

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 and nasal congestion.

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.

Treatment

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 in severe cases. This is accomplished by exposing the affected patient to increasing doses of oral aspirin. This treatment can have serious complications such as asthma attacks, so it should only be performed under the care of a specialist.

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.