Does aspirin desensitisation work in N-ERD?

Abstract

Aspirin (ASA, acetylsalicylic acid) has the most widespread use of any medication in the world. It plays a key role in the management of cardiovascular disease, especially acute coronary syndromes (ACS) and chronic ischaemic heart disease (CIHD). It is used to prevent stroke and in the management of certain chronic rheumatological disorders. Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD), also referred to as Samter's triad, affects both the upper and lower airways and involves sinusitis of eosinophilic type, severe nasal polyp formation, asthma and hypersensitivity to COX-1-inhibiting drugs. It is an inflammatory disease of escalating severity. Of N-ERD sufferers, 75% are also sensitive to alcohol. N-ERD has a frequency of between 0.6% and 2.5% in general and is seen in 40% of cases where the patient develops asthma in adulthood and has chronic sinusitis with nasal polyposis (CRS(+)NP). The disorder is classified as progressive. The most common age for it to occur is age 30-34, and it is more usual in females than males. The initial presentation of N-ERD is frequently a flu-like illness that develops into persistent rhinosinusitis; then, asthma signs develop and finally frank respiratory system sensitivity to aspirin and NSAIDs. In this chapter, aspirin desensitisation and N-ERD are reviewed.