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Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter's Triad or Aspirin Sensitive Asthma (ASA), is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs. Patients with AERD/Samter's Triad often do not respond to conventional treatments. Many have experienced chronic sinus infections and can lose their sense of smell. The characteristic feature of AERD/Samter's Triad is that patients develop reactions to aspirin or other NSAIDs.
The cause of AERD/Samter's Triad is not well understood, although extensive research is underway to learn more. AERD is not a genetic or inherited disorder. People with AERD/Samter's Triad often have high levels of cells called eosinophils in their blood and in their sinuses, which may lead to chronic inflammation of the airways. It has also been found that people with AERD/Samter's Triad have an impaired cyclooxygenase enzyme (COX) pathway, and produce high levels of leukotrienes. Leukotriene overproduction is a major cause of inflammation in asthma and allergic rhinitis and levels are further increased after ingestion of aspirin or NSAIDS, which is why patients develop reactions to these medications, and why anti-leukotriene medications are sometimes helpful as treatments.
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The diagnosis is made with a clinical history and sometimes an aspirin challenge. If aspirin/NSAID sensitivity is obvious from the patient's history an aspirin challenge may not be necessary. For those in whom aspirin sensitivity is suspected but not definite, an aspirin challenge is the only definitive method of diagnosis.
If the patient has a history of a very severe reaction, such as anaphylaxis, the test may need to be performed in a hospital setting.
First and foremost, NSAIDs and aspirin, in all their forms, should be avoided. Singulair may control symptoms however many AERD patients end up on multiple medications. Even when aspirin and NSAIDs are completely avoided patients often continue to have symptoms of asthma, nasal congestion and sinusitis, and growth of polyps in the nose, called "nasal polyps".
If medical therapy fails, as can often happen, the patient should be referred to an otolaryngologist (ENT specialist) for consideration of surgery. AERD patients tend to have a large amount of polypoid tissue (polyps) with significant re-growth following surgical removal; the average time to repeat surgery is just three years.
If a patient's symptoms are mild, avoiding NSAIDs and aspirin may be all that is necessary. However, if the symptoms remain problematic, if nasal or sinus surgery is required, or if the patient needs aspirin or NSAIDs for another medical reason, then he/she should be referred for aspirin desensitization. Aspirin desensitization is a process where patients gradually take progressive amounts of aspirin starting from a dose of just 10mg. The aim is often a dose of 325mg but can be up to 650mg twice daily. Multiple studies have demonstrated the efficacy of aspirin desensitization.
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