Aspirin-exacerbated respiratory disease

Abstract

Aspirin/acetyl salicylic acid (ASA)-exacerbated respiratory disease (AERD) is characterized by the combination of chronic rhinosinusitis, nasal polyps, bronchial asthma, and hypersensitivity reactions involving upper and/or lower airways after the exposure to ASA and other nonsteroidal antiinflammatory drugs (NSAIDs). It is a sub-endotype of T2 asthma in which dysregulation of arachidonic acid metabolism with an overproduction of cysteinyl-leukotrienes occurs after NSAIDs intake, although the underlying mechanisms are not fully understood. The confirmatory diagnosis is crucial for an adequate management, being ASA challenge the gold standard. The management of these patients is complex and should be multidisciplinary. It encompasses avoidance of ASA and other NSAIDs as well as treatment of asthma and rhinosinusitis including pharmacological and non-pharmacological measures according to the currently guidelines. ASA desensitization followed by daily ASA therapy has shown to be useful when standard medical treatments are not effective.