What is it?
Aspirin-exacerbated respiratory disease is a condition in which asthma, nasal polyps, and sensitivity to aspirin or similar anti-inflammatory pain medicines occur together.
People with this condition often have significant inflammation of the nose and sinuses, and nasal polyps may be more likely to return after treatment.
Common symptoms
- Nasal polyps that may be extensive or keep returning.
- Chronic nasal and sinus symptoms.
- Asthma, often beginning in adulthood.
- Wheezing, chest tightness, nasal symptoms, or other reactions after taking aspirin or similar anti-inflammatory medicines.
How is it diagnosed?
Diagnosis is usually based on the combination of asthma, nasal polyps or chronic sinus disease, and a history of reactions to aspirin or similar anti-inflammatory medicines.
If the history is unclear, referral to an allergist-immunologist may be recommended. A supervised aspirin challenge can sometimes be used to confirm the diagnosis.
Treatment
Treatment usually focuses on controlling both the sinus inflammation and asthma.
Endoscopic sinus surgery is often recommended when nasal polyps or sinus disease are significant. Surgery removes polyps and opens the sinuses, improving access for postoperative sinus rinses and topical steroid treatment such as budesonide (Pulmicort) irrigation.
In more extensive disease, a wider or more extensive sinus surgery may be needed to fully open the affected sinuses and improve access for ongoing topical treatment.
Ongoing medical treatment after surgery is important because inflammation and polyps can return.
Asthma treatment may be coordinated with a lung specialist when needed.
Some patients may also benefit from aspirin desensitization, which is typically considered and supervised by an allergist-immunologist.
In selected cases, a low-salicylate diet may also be tried under the guidance of an allergist-immunologist, often with dietitian support because the diet can be restrictive. A low-salicylate diet means reducing foods that are naturally high in salicylates, compounds found in some fruits, vegetables, herbs, spices, and other foods, to see whether symptoms improve.
Biologic therapy may be considered in selected cases when symptoms remain difficult to control despite appropriate medical and surgical treatment.