Aspirin Exacerbated Respiratory Disease

What is AERD (Aspirin Exacerbated Respiratory Disease)?

According to AERD.org, AERD is a combination of 3 different medical problems: Chronic sinusitis with nasal polyps, Asthma, and Aspirin allergy.  It almost always starts in adulthood.  In general, it does not run in families.  Many patients are previously healthy, and then in their 20-30s start to have problems with their sinuses.  They might start to get some problems with asthma. But the signature of this disease is the reaction to aspirin.  Every patient with AERD has a reaction to aspirin (or other non-steroidal anti-inflammatory drugs).  If you don’t react to aspirin, then you don’t have AERD.

For most patients, nasal polyps are the worst part of the disease.  Nasal polyps are slowly growing bumps of tissue that start in the sinus cavities and grow down into the nose.  They almost always cause patients to lose their sense of smell.  They cause blockage, discomfort, and recurrent infections.  Medications can help slow the growth or temporarily lead to improvement in symptoms. But most patients at some point will need surgery to get the polyps out.

What are the potential benefits of aspirin desensitization and aspirin therapy?

The most effective known treatment for AERD is aspirin therapy. In 1980, Dr. Stevenson at the Scripps Clinic first reported that patients with AERD who were desensitized to aspirin and treated with aspirin therapy twice daily for a year experienced improvement in nasal symptoms, reduction in episodes of sinusitis and reduced need for steroid medications. Since then, many studies have shown that after aspirin desensitization and daily aspirin treatment, the majority of patients with AERD experience the following benefits:

• Improvement in asthma symptoms and fewer asthma attacks
• Less requirement for medication to treat respiratory symptoms
• Improvement in sense of smell and taste
• Delayed regrowth of nasal polyps and fewer polyp surgeries

What can you expect during the aspirin desensitization?

Brigham and Women’s Hospital (https://aerd.partners.org) has a program for AERD:

You will initially be given a very low dose (20-40 mg) of aspirin, and gradually higher doses of aspirin are given every 1.5 – 3 hours while you are closely monitored. The symptoms and severity of reactions vary from person to person, and therefore the exact protocol for each desensitization procedure is determined individually for each patient.

During the reaction your symptoms are likely to include one or more of the following:

• Increased nasal congestion or stuffiness
• Eye tearing, watering, itchiness or redness
• Frontal headache or sensation of sinus pain
• Headache or facial pain/pressure
• Cough, wheezing, or “tightness” in the chest

Less commonly, you may experience:

• Hives or a rash
• Flushing of the face and upper body
• Nausea and abdominal cramping or abdominal pain
• Generalized feeling of being unwell

Throughout the desensitization procedure, the nurses and doctors will monitor your progress and evaluate your lung function by recording your peak expiratory flow/FEV1. For this breathing test, you breathe into a mouthpiece attached to a recording device so that we can measure your response to each step. Following an aspirin-induced reaction and after you have been treated with any medications needed to stabilize your condition, further doses of aspirin will be given, starting with repeating the dose that you reacted to. Generally, there is no additional reaction to the same dose when it is repeated. The desensitization is complete once you have received 325mg of aspirin (one “adult” aspirin tablet) without further reaction. After desensitization, you will go home on a regimen of 325mg or 650mg of aspirin twice a day, depending on your individual case.

Is aspirin desensitization safe?

Yes. Even if you have had a severe reaction after taking aspirin or an NSAID, oral aspirin desensitization can be done safely. Many patients experience only minor symptoms, especially if they are given montelukast/Singulair as a pretreatment before beginning the desensitization, which would be determined individually for each patient. You will be closely observed throughout the desensitization and multiple breathing tests will be done to ensure your safety. As soon as you begin to have symptoms, you can be given treatments to quickly and effectively reverse the reaction.

Long-term risks from daily aspirin therapy may include abdominal pain or bleeding of the stomach or stomach ulcers. Taking an antacid may lessen stomach pain and medications that decrease acid production by the stomach like omeprazole/Prilosec can also prevent stomach pain. Aspirin also limits blood clotting, so you may note that you bruise more easily and bleed longer if you cut yourself or have surgery. If you start bleeding uncontrollably from anywhere in your body, you should immediately stop taking aspirin.

You should not undergo an aspirin desensitization procedure if you are pregnant, and if you become pregnant, you should immediately stop taking aspirin.