What Is Aspirin-Exacerbated Respiratory Disease?
AERD is a chronic inflammatory condition affecting the airways, triggered by aspirin and other NSAIDs, and characterized by three key features: asthma, recurring nasal polyps, and chronic sinusitis. Also known as Samterâs Triad, it doesnât show up in kids-it starts in adulthood, usually between ages 20 and 50. About 7% of adults with asthma have it, and if you have nasal polyps too, that number jumps to 14%. Women are slightly more likely to be affected, making up about 60% of cases.
Unlike a simple allergy, AERD isnât caused by IgE antibodies. Instead, itâs a metabolic mess. When you take aspirin or ibuprofen, your body overproduces inflammatory chemicals called cysteinyl leukotrienes. These flood your sinuses and lungs, causing swelling, mucus buildup, wheezing, and nasal congestion. The result? You canât breathe well, you lose your sense of smell, and you end up needing surgery over and over again.
How Do You Know If You Have AERD?
Thereâs no single blood test or scan that confirms AERD. Diagnosis comes down to three things: your symptoms, your history, and sometimes, a controlled challenge.
- Asthma-youâve had it for years, maybe since your 20s, and itâs gotten worse over time. It doesnât respond well to standard inhalers alone.
- Nasal polyps-youâve had them for a while, and they keep coming back even after surgery. Your nose is always stuffed, you snore, and you canât smell your coffee or your partnerâs perfume.
- Reaction to NSAIDs-within an hour of taking aspirin, ibuprofen, naproxen, or even some cold medicines, you get wheezing, nasal congestion, or even a full asthma attack.
If your story matches this pattern, your doctor will suspect AERD. But if youâre not sure whether a past reaction was real-or if youâve avoided NSAIDs for so long you canât remember-you might need a supervised aspirin challenge.
This isnât something you do at home. Itâs done in a hospital or allergy clinic with doctors ready to treat a severe reaction. You start with a tiny dose of aspirin-20 to 30 milligrams-and every 90 to 120 minutes, the dose doubles. Youâre watched closely for breathing changes. If you react, they stop and treat you. If you donât, they reach 325mg-the standard adult dose-and confirm you have AERD. About 98% of people who try this under supervision complete it safely.
What Happens If You Donât Treat It?
Left alone, AERD gets worse. Nasal polyps grow back faster than you can get them removed. Youâll need repeat surgeries-sometimes every year. Your asthma gets harder to control. Youâll rely more on oral steroids, which cause weight gain, bone loss, and mood swings over time.
Many patients lose their sense of smell completely. A 2022 survey of 190 people with AERD found that 78% said nasal congestion made daily life unbearable. Nearly half had at least one sinus surgery within two years of diagnosis. Without proper management, your quality of life plummets.
First-Line Treatments: Medications That Help
Even before considering surgery or desensitization, you need strong medical control.
- Steroid sinus rinses-using a neti pot with 50-100mg of budesonide twice a day reduces polyp size by 30-40% in just eight weeks. This is often the most underused tool.
- Intranasal sprays-fluticasone (two sprays per nostril twice daily) improves nasal symptoms by 35% on the SNOT-22 scale after 12 weeks.
- Asthma inhalers-a combination of fluticasone and salmeterol (250/50Îźg, two puffs twice daily) boosts lung function by 15-20% in most patients.
These arenât cures, but they keep things stable. Many people think avoiding NSAIDs is enough. Itâs not. AERD keeps progressing even if you never take another aspirin.
Second-Line Options: Leukotriene Modifiers and Biologics
If steroids and rinses arenât enough, you move up the ladder.
Zileuton blocks the enzyme that makes leukotrienes. Taken four times a day, it cuts urinary leukotriene E4 levels by 75% in two weeks. About 28% of users say itâs âextremely effective.â The downside? You need liver checks every few months.
Montelukast (Singulair) is easier-just one pill a day-but itâs less powerful. Only 15% of AERD patients report big benefits.
For the toughest cases, biologics are changing the game:
- Dupilumab (Dupixent)-injected every two weeks, it shrinks polyps by 55% and improves quality of life scores by 40% in 16 weeks. Itâs now FDA-approved for nasal polyps, even without asthma.
- Mepolizumab (Nucala)-monthly shots that slash eosinophil counts by 85%. It cuts the need for future sinus surgeries by 57% over a year.
These drugs are expensive. If your income is under $50,000 a year, cost is often the biggest barrier. But many patients qualify for patient assistance programs.
Aspirin Desensitization: The Game-Changer
This is where things get powerful. If youâre a candidate, aspirin desensitization can transform your life.
The process starts with the same challenge used for diagnosis-but instead of stopping when you react, you keep going until you hit 325mg. Then, you start taking 650mg of aspirin every day, twice a day. It sounds crazy-how do you take the thing that makes you sick? But your body adapts. Over time, your airways stop reacting.
Studies show that after desensitization:
- Oral steroid use drops from 4.2 bursts per year to just 1.1.
- Nasal polyp recurrence after surgery falls from 85% to 35% within two years.
- Smell function improves dramatically-scores on smell tests jump from 12.4 to 23.7 out of 40.
One patient on a popular forum said, âI smelled my granddaughterâs birthday cake for the first time in 12 years.â Thatâs not hype-itâs science.
But thereâs a catch: you have to take aspirin every day, no breaks. Miss two or three doses, and your body forgets itâs desensitized. Youâll need to go through the whole challenge again. About 68% of people who miss doses have to restart.
Side effects? Stomach upset happens in 22% of users. Taking aspirin with food helps. Some need a proton pump inhibitor like omeprazole to protect their stomach lining.
Surgery + Desensitization: The Gold Standard
Doctors who treat AERD agree: the best results come from combining surgery with daily aspirin.
Functional endoscopic sinus surgery (FESS) clears out polyps and opens your sinuses. Alone, it gives you 70-80% symptom relief-but 60-70% of people get polyps back within 18 months.
Add aspirin desensitization after surgery, and recurrence drops to 25-30% at two years. Thatâs a 65% reduction in polyp return compared to medical treatment alone.
Dr. Tanya Laidlaw from Brigham and Womenâs Hospital says, âComplete sinus surgery followed by aspirin desensitization represents the gold standard.â Itâs not just about breathing better-itâs about avoiding endless surgeries and steroid side effects.
Who Shouldnât Try Desensitization?
Itâs not for everyone. If you have:
- Severe heart disease or unstable angina
- Active peptic ulcers or a history of GI bleeding
- Difficulty remembering to take daily meds
Then itâs too risky. About 15% of people who might benefit are ruled out for safety reasons.
Also, if youâre not near a specialized center, itâs hard to access. There are only 35 AERD centers in the U.S. Most are in big cities. Rural patients often canât get care within 100 miles.
What About Hidden NSAIDs?
Many patients donât realize how many products contain aspirin or NSAIDs. Cold medicines, pain patches, topical gels, even some toothpaste and mouthwashes have them. Always check labels for:
- Aspirin
- Ibuprofen
- Naproxen
- Diclofenac
- Indomethacin
Some people think âNSAID-freeâ labels mean safe-but they donât. Always ask your pharmacist or doctor if a product is okay. Reddit users on r/SamtersTriad swear by keeping a list of safe OTC meds in their wallet.
Future Treatments on the Horizon
The field is moving fast. A new drug called MN-001 (tipelukast), a dual blocker of leukotriene and inflammation pathways, is in early trials. Early results show a 60% drop in leukotriene E4 after 12 weeks-with no major side effects.
Dupilumab combined with aspirin is also showing synergy. In a 2023 trial, 78% of patients on both treatments hit a meaningful improvement in symptoms, compared to 52% on aspirin alone.
Health economists estimate that if more patients get full AERD care-surgery, desensitization, biologics-the lifetime cost per patient drops by $87,000. Thatâs because you avoid repeated surgeries, ER visits, and hospital stays.
Where to Get Help
If you think you have AERD, donât wait. Most general allergists arenât trained in this. You need a specialist.
Look for:
- Academic medical centers with allergy-immunology departments
- Centers listed by the American Rhinologic Society
- Telemedicine consults with AERD experts (now available at 35% more centers since 2020)
Ask for the âAERD Management Toolkitâ from Penn Medicine-itâs free, has patient guides in 8 languages, and includes dosing charts and emergency plans.
Join the AERD Warriors community (2,500+ members) or r/SamtersTriad on Reddit. Real people share tips: using tea tree oil in saline rinses to fight fungal growth, timing aspirin with meals to avoid stomach pain, or how to talk to your pharmacist about hidden NSAIDs.
Final Thoughts
AERD isnât rare. Itâs underdiagnosed. If youâve had asthma and nasal polyps for years, and NSAIDs make you sick, youâre not just unlucky-you might have AERD.
Thereâs no cure. But thereâs a path to control. Steroid rinses, biologics, surgery, and aspirin desensitization can turn a life of constant congestion and surgery into one where you breathe, smell, and sleep normally again.
It takes work. It takes time. But for thousands of people, it works.
Can you outgrow AERD?
No. AERD is a lifelong condition that starts in adulthood and doesnât go away. Even if symptoms improve with treatment, stopping aspirin therapy or skipping follow-ups can cause a return of inflammation and polyps. Management, not cure, is the goal.
Is aspirin desensitization safe?
Yes, when done under medical supervision. Over 98% of patients complete the challenge without life-threatening reactions. The procedure is done in a facility with immediate access to emergency equipment. Risks include temporary worsening of asthma or nasal symptoms, but these are managed on-site. Long-term daily aspirin is safe for most, though stomach issues occur in about 22% of users.
Do I need to avoid all NSAIDs forever?
After successful desensitization, you can usually tolerate most NSAIDs because your body has adapted. But you must keep taking daily aspirin (650mg twice daily) to maintain the effect. If you stop aspirin for more than 48 hours, you lose protection and may need to restart the desensitization process.
Can children get AERD?
No. AERD is strictly an adult-onset condition. It almost never appears before age 20. If a child has asthma and nasal polyps, other conditions like cystic fibrosis or primary ciliary dyskinesia should be ruled out first.
How long does aspirin desensitization take?
The initial desensitization process usually takes 2 days. On day one, you start with a tiny aspirin dose and increase every 90-120 minutes until you reach 325mg. If you tolerate it well, youâll be sent home with a prescription for daily aspirin. You return the next day for a final check and to confirm you can safely continue on your own.
Are biologics better than aspirin desensitization?
They serve different roles. Biologics like dupilumab are powerful for reducing inflammation and polyps without requiring daily pills. But they donât change the underlying sensitivity to NSAIDs. Aspirin desensitization addresses the root cause and reduces the need for surgery and steroids long-term. Many patients use both: biologics to get control, then aspirin to maintain it.
What if I canât afford aspirin desensitization or biologics?
Start with steroid sinus rinses and nasal sprays-theyâre low-cost and highly effective. Many drug manufacturers offer patient assistance programs for biologics. Aspirin itself is inexpensive (under $10 a month). Ask your doctor about sliding-scale clinics or nonprofit programs. Some academic centers offer free or reduced-cost desensitization for qualifying patients.
Can I take Tylenol (acetaminophen) if I have AERD?
Yes. Acetaminophen (Tylenol) does not inhibit COX-1 the same way aspirin and NSAIDs do. Itâs generally safe for people with AERD. But always check with your doctor before starting any new medication-even OTC ones.
How do I know if my sinus surgery was successful?
Success isnât just about breathing better right after surgery. Itâs about how long you stay symptom-free. If you still need oral steroids within 6 months, or polyps return within a year, the surgery alone wasnât enough. Combined with aspirin desensitization, you should see lasting improvement for at least two years. Tracking your SNOT-22 score before and after helps measure real change.
Is AERD the same as a food allergy?
No. AERD is not an IgE-mediated allergy like peanut or shellfish allergy. Itâs a metabolic disorder involving enzyme pathways and inflammatory mediators. You wonât get hives or anaphylaxis from NSAIDs the way you would from a food allergen. The reaction is delayed (30-120 minutes) and focused on the airways, not the skin or gut.
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