The term aspirin exacerbated respiratory disease (AERD) – also known as aspirin triad or Samter's Triad – is a complex medical condition that causes asthma, chronic sinusitis, and nasal polyps , as well as a sensitivity or allergy to aspirin products.
If you have AERD, you typically cannot take aspirin or aspirin-containing products since they can cause severe asthma attacks, runny nose, facial/chest/back flushing, and swelling in the throat or skin. Aspirin products also worsen chronic nasal and sinus inflammation (chronic sinusitis), which progresses to blistering of the mucus membranes of the nose and sinuses, known as nasal polyps. The blistering occurs due to the release of chemicals (called cytokines) that produce inflammation. It is the release of these chemicals that your specialist is trying to control with various anti-inflammatory oral or topical medications, or allergy treatment.
AERD-related asthma occurs in less than one percent of patients with AERD, and is more common in women than men. Typically, patients are in their 30s when they notice the onset of this condition. Patients who have severe asthma are more likely to be aspirin sensitive than patients with mild asthma. Similarly, patients with polyps and asthma are more likely to be aspirin sensitive than are patients with only nasal polyps.
AERD-related asthma may run in families and, as with many other causes of chronic sinusitis, is not curable. However, like chronic sinusitis, the asthma may be controllable with appropriate individualized treatments from your sinus specialist working closely with your allergist and pulmonologist. Sometimes this requires endoscopic surgery in addition to aggressive allergy and pulmonary medical management.
Your ENT doctor will ask you for your thorough medical history and examine you closely in making a diagnosis of aspirin sensitivity. Patients with severe asthma, chronic sinusitis, nasal polyps, and previous problems taking aspirin or non-steroidal anti-inflammatory drugs (NSAIDs such as Advil, Motrin, and Aleve) may have aspirin sensitivity. Your rhinologist may refer you to an allergist for further evaluation and consideration of aspirin desensitization.
In this test, you are given a small dose of aspirin to determine your reaction. After you’ve taken the aspirin, your allergy specialist will order certain laboratory tests. This must be done in a strictly controlled setting, so that any reaction can be treated appropriately.
Treatment of aspirin sensitivity begins with education and establishing a list of drugs that contain aspirin or other NSAIDs, such as ibuprofen.
Endoscopic Sinus Surgery
In patients with chronic sinusitis and nasal polyps, endoscopic sinus surgery can help if their asthma is worsened by their nasal problems. This procedure improves nasal symptoms and allows you to begin a long-term topical medical treatment to control inflammation.
In this treatment, you’ll take a regular oral (by mouth) dose of aspirin with the end goal of eliminating the sensitization. This begins at very small doses until you can tolerate 650 mg of aspirin. The typical amount in one tablet of aspirin is 325 mg.
This is usually done under very close observation by an allergist that is experienced in this treatment, so as to avoid a severe allergic reaction that could be life-threatening. You should not try aspirin desensitization, without specialist supervision.
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Highly specialized rhinology doctors. The experts at University of Miami Health are here to help you breathe easier, smell better, and rest better with an accurate diagnosis and leading edge treatments in a compassionate setting. Our fellowship-trained providers specialize in the nasal airway, and our rhinology specialists have completed specialized training in nasal and sinus disorders. They have dedicated their clinical and research careers to caring for nasal and sinus disorders.
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