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Aspirin-exacerbated respiratory disease: NSAID challenge and desensitization

Ronald A Simon, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


Patients with aspirin-exacerbated respiratory disease (AERD) present with one or more of the following disorders:


Chronic rhinosinusitis with nasal polyposis

Reactions to aspirin (acetylsalicylic acid [ASA]) and other cyclooxygenase-1 (COX-1)-inhibiting nonsteroidal anti-inflammatory drugs (NSAIDs), in which symptoms begin 30 minutes to 3 hours after ingestion and characteristically involve the upper and lower airways (eg, nasal congestion and bronchospasm)

AERD is also called NSAID-exacerbated respiratory disease (NERD). NSAID challenge protocols involve cautiously administering gradually increasing doses of an NSAID, usually aspirin, in an appropriately monitored medical setting. These procedures are used to diagnose NSAID pseudoallergy and also to desensitize AERD patients to NSAIDs, when indicated. The safety and technical aspects of these protocols, as well as the efficacy of aspirin therapy for AERD, are discussed here. The clinical manifestations and management of AERD and a general discussion of allergic and pseudoallergic reactions to NSAIDs are reviewed separately. (See "Aspirin-exacerbated respiratory disease" and "NSAIDs (including aspirin): Allergic and pseudoallergic reactions".)

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Literature review current through: Nov 2017. | This topic last updated: Apr 13, 2017.
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