Nonsteroidal anti-inflammatory drugs exacerbated respiratory disease – the role of aspirin desensitisation in patients with nasal polyposis

Nonsteroidal anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (N-ERD) is defined as a chronic eosinophilic, inflammatory disorder of the respiratory tract, occurring in patients with asthma and/or chronic rhinosinusitis with nasal polyps. The symptoms become exacerbated by NSAIDs, including aspirin [1, 2]. This clinical syndrome was first described by Widal et al. [3] in 1922 and then revisited by Samter and Beers in 1968 [4]. In 2019, the panel of EAACI experts stated that the term N-ERD is more proper to describe the syndrome of respiratory hypersensitivity to NSAIDs and that previously used names like aspirin-exacerbated respiratory disease (AERD), aspirin-induced asthma, and aspirin triad should be abandoned. According to the experts, “NSAID” is a more inclusive term to replace “aspirin” in descriptions of this subtype of hypersensitivity to medications inhibiting cyclooxygenase [1].
N-ERD affects 0.3–0.9% of the general population, with much higher prevalence in asthmatics (10–20%), and even higher in asthmatics with nasal polyposis (30–40%) [5]. The onset of N-ERD is observed particularly in the third or fourth decade, although aspirin or NSAID sensitivity may develop at any stage of the disease process. The condition has a male predominance (2.3 : 1); however, when diagnosed in women, the disease is usually more severe [6]. Clinical features of N-ERD comprise initial nasal congestion with anosmia, with progression to chronic pansinusitis and nasal polyposis. Asthma may precede the upper airway disease or develop later (1–5 years) [7].
As observed in computed tomography (CT) scans of N-ERD patients, pansinusitis is some of the worst seen in chronic sinus disease, and complete or near-complete opacification of the sinuses takes place. Depending on the disease stage, surgery consists of polypectomy, functional endoscopic sinus surgery, or ethmoidectomy of particularly persistent cases – treatment with topical steroids is also necessary afterwards [6, 8]. Unfortunately, due to the progressive nature of the inflammatory process in N-ERD, surgery is unlikely to be curative, and even when followed by proper medical care patients require multiple revision surgeries during their lifetime. A history of having an asthma attack after ingestion of aspirin or other NSAIDs is highly suggestive and may be diagnostic. It is worth emphasising that there is no in vitro test that can be reliably used for the diagnosis of N-ERD. Therefore,...


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