AERD – Aspirin-Exacerbated Respiratory Disease

April 05, 2016
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As many as 1.5 million Americans live with a little-known and often overlooked condition called aspirin-exacerbated respiratory disease, or AERD. Despite the fact that AERD was first identified nearly a century ago, the lack of research and awareness regarding the condition means that nearly 20 percent of cases go undiagnosed. Surprisingly, the very thing that triggers the disease can be used to treat the condition.

Characteristics of AERD:

Individuals with AERD typically have the unique triad of recurrent nasal polyps, asthma, and adverse reactions to alcohol and aspirin. Many people with AERD struggle for years before finally receiving the diagnosis. They are often told that their symptoms are due to chronic sinus infections or allergies. They are prescribed multiple rounds of antibiotics and decongestants, which do little to ease their symptoms. They may undergo multiple surgeries to remove nasal polyps only to have them reappear within a few months.

The cause of AERD has not been determined. It is not an allergy, and research indicates that the condition is not genetic or linked to environmental toxins. According to one theory, AERD may be triggered by an infection. The infection stimulates the body’s immune response that somehow never gets turned off. This means that the body is flooded with white blood cells meant to fight the infection but that can also inflame the airway and impair the sense of smell. Patients with AERD also have abnormally high levels of inflammatory molecules known as leukotrienes, which may be responsible for some of the symptoms.

Treatment of AERD:

Patients with AERD are strongly advised to avoid alcohol and other substances that can make symptoms worse. The primary treatment for AERD is aspirin desensitization. This involves overloading the patient with large doses of aspirin. It is unclear exactly why aspirin therapy works; however, over time the patient no longer has an adverse reaction to the aspirin, and the respiratory symptoms are significantly improved. It is important to note that this process should only be attempted under the careful supervision of a medical professional due to the risk of a significant reaction. Individuals who use aspirin therapy to treat AERD must continue the regimen for the rest of their lives. Since aspirin thins the blood, they also have an increased risk of serious bleeding.

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Dr. Chacko and Dr. Sanjay Gupta on CNN. See the video here.