What is aspirin-exacerbated respiratory disease (AERD)?
Diagnosis of AERD can be difficult and is often delayed unless your doctor has expertise and experience in recognizing and treating it.By Mayo Clinic Staff
Aspirin-exacerbated respiratory disease (AERD), also called Samter's triad, includes three features:
- Asthma, though only a small percentage of people with asthma will develop AERD.
- Nasal polyps that recur, even after removal by surgery.
- Sensitivity to aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen. Keep in mind that aspirin or NSAIDs may be ingredients in cold medicines and other medicines.
Typically, signs and symptoms of AERD don't show up until people have reached their 30s or 40s, but AERD can occasionally occur in children.
What happens when people with AERD take aspirin or NSAIDs?
Reactions usually start suddenly and can be serious. Signs and symptoms may include difficulty breathing (which could be an asthma flare-up), wheezing, coughing, sneezing, or stuffy and runny nose. Some people with AERD also have these types of reactions if they drink alcohol, such as beer or wine.
What causes AERD?
At this time, the exact cause of AERD is not known, but it is not an allergic reaction. There is no evidence to suggest that it's genetic or inherited. The disease is not caused by taking aspirin or NSAIDs, but AERD sinus or asthma symptoms get worse when taking these medications.
How is AERD diagnosed?
There is no specific test to detect AERD. Lab tests that can help in making the diagnosis include a blood test to look for higher than normal levels of white blood cells called eosinophils, and a urine test to look for elevated leukotrienes, inflammatory substances in the body. A clinical diagnosis of AERD can be made if all three of these features are present: asthma, nasal polyps, and respiratory reactions to aspirin and NSAIDs.
When it's not clear whether the person has had a reaction to aspirin or NSAIDs, an aspirin challenge (desensitization) is sometimes done to confirm the diagnosis. Aspirin is given in a safe medical environment where the doctor and health care team follow specific guidelines.
How is AERD treated? Is there a cure?
There is no cure for AERD, but several treatment options are available, depending on symptoms and the results of a clinical evaluation. A combination of treatments often works best. Options include:
- Avoiding aspirin and NSAIDs, unless your doctor specifically prescribes desensitization to aspirin
- Taking medications to manage asthma, such as inhaled corticosteroids
- Surgery to remove nasal polyps, though recurrence is common
- Taking medication such as montelukast (Singulair) or zileuton (Zyflo) to block the effects of leukotrienes
- Taking biologic medications, given by injection, for asthma or polyps when other medications don't work (although these drugs may be expensive)
- Undergoing desensitization to aspirin, in which aspirin is initially given in the doctor's office in gradually increasing doses over two days and then taken daily at high doses, which may help reduce the need for oral steroids and possibly reduce the recurrence of nasal polyps
May 14, 2020
Aspirin-exacerbated respiratory disease (AERD)
See more In-depth
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- Laidlaw TM. Clinical updates in aspirin-exacerbated respiratory disease. Allergy and Asthma Proceedings. 2019; doi:10.2500/aap.2019.40.4188.
- Walgama ES, et al. Aspirin-exacerbated respiratory disease. Otolaryngologic Clinics of North America. 2017; doi:10.1016/j.otc.2016.08.007.
- Adappa ND, et al. Outcomes after complete endoscopic sinus surgery and aspirin desensitization in aspirin-exacerbated respiratory disease. International Forum of Allergy & Rhinology. 2018; doi:10.1002/alr.22036.
- American Academy of Allergy, Asthma & Immunology. Aspirin-exacerbated respiratory disease (AERD). https://www.aaaai.org/conditions-and-treatments/library/asthma-library/aspirin-exacerbated-respiratory-disease. Accessed March 9, 2020.
- O'Brien EK (expert opinion). Mayo Clinic. March 9, 2020.
- Singulair (prescribing information). Merck & Co., Inc.; 2020. https://www.merck.com/product/usa/pi_circulars/s/singulair/singulair_pi.pdf. Accessed March 24, 2020.