Aspirin-Exacerbated Respiratory Disease (AERD)

Aspirin-exacerbated respiratory disease (AERD), also known as Samter’s Triad, is a chronic medical condition that has three clinical features: [I] asthma, [II] sinusitis with recurrent nasal polyps, and [II] sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) that inhibit an enzyme called cyclooxygenase-1 (or COX-1).

This sensitivity usually manifests as respiratory reactions that occur upon taking an aspirin or related drug, though the exact cause of the reactions is not known. Approximately 9% of all adults with asthma and 30% of patients with asthma and nasal polyps have Aspirin-Exacerbated Respiratory Disease. Other, less common symptoms may include a loss of smell, skin flushing, rashes, abdominal pain, occasionally vomiting.

Usually, Aspirin-Exacerbated Respiratory Disease develops quite suddenly in adulthood, usually between the ages of 20 and 50, and there is no clearly understood trigger that triggers the disease.

About 75% of all patients with Aspirin-Exacerbated Respiratory Disease develop mild-to-moderate respiratory reactions when they drink alcohol[1]. These reactions are not always specific to just one type of alcohol and often occur after consuming less than one glass of alcohol.

There is no one specific test or blood result that alone can be used to diagnose the disease. The triple symptoms of asthma plus nasal polyps plus respiratory reactions to NSAIDs is all that is needed for the diagnosis.

Most patients with Aspirin-Exacerbated Respiratory Disease will need to use daily medications to control their symptoms and often need to use daily inhaled corticosteroids for asthma. Intranasal steroid sprays or steroid sinus rinses can help to control the nasal symptoms, and nasal polyps can also be treated with occasional courses of oral steroids. Several non-steroid medications are also available, specifically medications that inhibit the production of leukotrienes (zileuton) or block the function of leukotrienes (montelukast and zafirlukast). Despite intensive medical therapy, the need for surgical removal of nasal polyps in Aspirin-Exacerbated Respiratory Disease is very common, though unfortunately the rate of recurrence of nasal polyps after surgery is high.

Aspirin desensitization in patients with Aspirin-Exacerbated Respiratory Disease can be performed by administering gradually increasing doses of aspirin in a hospital setting. The goal of aspirin desensitization is to have the patient begin long-term daily aspirin therapy, which in some patients can decrease the regrowth of nasal polyps.

[1] Candelo et al: Relationship Between Alcohol Intolerance and Aspirin-Exacerbated Respiratory Disease (AERD): Systematic Review in Otolaryngology: Head and Neck Surgery - 2023