Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 147, Issue 3, Pages 827-844Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2020.10.043
Keywords
Aspirin-exacerbated respiratory disease; AERD; NSAID-exacerbated respiratory disease; Samter triad; aspirin desensitization
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AERD is characterized by chronic rhinosinusitis with nasal polyps, asthma, and intolerance to cycloxgenase-1 inhibitors, but most patients benefit from aspirin desensitization and maintenance therapy. This approach improves clinical symptoms and quality of life in AERD patients.
Aspirin-exacerbated respiratory disease (AERD) is characterized by the clinical triad of chronic rhinosinusitis with nasal polyps, asthma, and an intolerance to medications that inhibit the cycloxgenase-1 enzyme. Patients with AERD on average have more severe respiratory disease compared with patients with chronic rhinosinusitis with nasal polyps and/or asthma alone. Although patients with AERD traditionally develop significant upper and lower respiratory tract symptoms on ingestion of cycloxgenase-1 inhibitors, most of these same patients report clinical benefit when desensitized to aspirin and maintained on daily aspirin therapy. This Work Group Report provides a comprehensive review of aspirin challenges, aspirin desensitizations, and maintenance aspirin therapy in patients with AERD. Identification of appropriate candidates, indications and contraindications, medical and surgical optimization strategies, protocols, medical management during the desensitization, and recommendations for maintenance aspirin therapy following desensitization are reviewed. Also included is a summary of studies evaluating the clinical efficacy of aspirin therapy after desensitization as well as a discussion on the possible cellular and molecular mechanisms explaining how this therapy provides unique benefit to patients with AERD.
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