Overview

Aspirin-exacerbated respiratory disease (AERD), also known as Samter’s Triad, is a chronic medical condition that consists of three clinical features: asthma, sinus disease with recurrent nasal polyps, and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) that inhibit an enzyme called cyclooxygenase-1. This sensitivity usually manifests as respiratory reactions that occur upon ingesting or inhaling an NSAID, though the exact cause of the reactions is not known. Approximately 9% of all adults with asthma and 30% of patients with asthma and nasal polyps have AERD. In general, AERD develops quite suddenly in adulthood, usually between the ages of 20 and 50, and there is no clearly understood trigger that causes the disease.
 

Symptoms
People with AERD usually have asthma, nasal congestion and recurrent nasal polyps, and their symptoms often do not respond to conventional treatments. Many have experienced chronic sinus infections and a loss of sense of smell is common.

The characteristic feature of AERD is that patients develop reactions to aspirin and other NSAIDs. These reactions classically involve both upper respiratory symptoms (increased nasal congestion, frontal headache or sinus pain, and sneezing) as well as lower respiratory symptoms (cough, wheezing, chest tightness), but they can also induce skin flushing, rash, abdominal pain and occasionally vomiting.

It has been noted that about 75% of all patients with AERD develop mild-to-moderate respiratory reactions when they drink alcohol. These reactions are not always specific to just one type of alcohol and often occur after consuming less than one glass of alcohol.

Diagnosis
The diagnosis of AERD is a clinical one, meaning that there is no one specific test or blood result that alone can be used to diagnose the disease. The symptom triad of asthma plus nasal polyps plus respiratory reactions to NSAIDs is all that is needed for the diagnosis. However, for patients in whom their history of possible reaction to an NSAID is not clear, it is often helpful to do a formal aspirin challenge to confirm the diagnosis. This can be done either as an oral challenge, or as a combination of an intranasal and oral challenge, and the procedure is done in a hospital or clinic with an experienced doctor and medical team.

Additionally, people with AERD have large numbers of eosinophils in their nasal polyps and often have elevated levels of eosinophils in their blood. Eosinophils are a type of immune cell that is involved in inflammation. Though the presence of an elevated eosinophil level is not required as part of the diagnosis, it can be a helpful additional insight for these patients.