What Is Aspirin-Exacerbated Respiratory Disease (AERD)?

Aspirin-exacerbated respiratory disease (AERD) is a condition that develops in adults, often in their 20s or 30s. It involves problems with the sinuses and lungs that worsen in reaction to medications like aspirin. 

Sinus problems usually come first with nasal congestion and changes in your sense of smell. This is caused by growths inside the nose and sinuses, called nasal polyps. Breathing symptoms from asthma tend to start a few years later. Taking aspirin or a non-steroidal anti-inflammatory drug (NSAID) like aspirin will worsen both sinus and breathing symptoms.

AERD can be hard to recognize because sinus problems and asthma are very common. So, here we will review what causes AERD, how to tell if you might have it, and how to treat it.

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What causes aspirin-exacerbated respiratory disease (AERD)? 

At this time, experts still don’t understand exactly why people develop AERD. But inflammation seems to be an important part of the condition.

Inflammation is a normal reaction for everyone when there is an infection or injury. But people with AERD have higher than normal levels of inflammatory cells that line their nose, sinuses, and airways. These cells are called mast cells and eosinophils. 

For reasons we don’t fully understand, the number of these cells increases even more anytime someone with AERD takes specific anti-inflammatory drugs. Medications like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn) all work by blocking a process in the body known as the cyclooxygenase pathway. And any medication that affects this pathway can cause AERD symptoms to worsen.

The reason that some people develop AERD is unknown. But researchers are trying to understand why it happens.

Here’s what they have found so far:

• AERD and genetics: AERD is not a genetic condition and does not seem to run in families.

• AERD and allergies: People with AERD often have allergies, but it is not an allergic condition. It works through very different pathways than a typical allergic reaction like anaphylaxis.

• AERD and tobacco smoke: There seems to be some relationship between AERD and tobacco smoke, but it’s complicated. Children who grow up around tobacco smoke seem more likely to develop AERD in the future. But in adults with AERD, smoking might actually decrease their breathing symptoms and quitting might make symptoms worse.

More research still needs to be done on the possible causes of AERD.

How common is AERD? 

AERD is a somewhat rare condition. It affects 1% to 2% of the general population. In comparison, around 8% of the U.S. population has asthma. And around 5% of the U.S. population struggles with chronic sinus problems. 

But AERD is more common in people with asthma and chronic sinus problems. It affects up to 10% of this population.

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How do you know if you have AERD? 

Asthma and sinus problems are quite common. But not everyone with these conditions necessarily has AERD. AERD is different because it also involves a sensitivity to aspirin and other similar medications. 

An AERD diagnosis does not need any medical testing. Someone is diagnosed with the condition when they have the following three things:

1. Asthma

2. Sinus problems

3. A past reaction to aspirin, ibuprofen, naproxen, or another NSAID

There is also a test that can be done to find out if you have AERD. This is called an aspirin challenge. It is a procedure that is done with a healthcare provider. You take a very small dose of aspirin and wait to see if you have a reaction. If you don’t, you are then given larger doses until you have a reaction. Because the test is done in a medical setting, your reaction can be treated appropriately.

How is AERD treated?

There are many treatment options for AERD. Many of these are the same medications used to treat asthma and sinus problems. Inhalers and other asthma medications can treat asthma symptoms caused by AERD. And sinus surgery can treat the sinus symptoms of AERD. Medications used for chronic sinusitis and nasal polyps — such as steroid nasal sprays like fluticasone (Flonase, Xhance) — can also treat these symptoms. 

There are also medications that can help with both asthma and sinus symptoms at the same time. These medications work by treating the underlying inflammation that leads to AERD. They include:

• Leukotriene receptor antagonists, like montelukast: This is helpful with the overactive inflammation in AERD. 

• Corticosteroids, like prednisone and Medrol: These medications help with any kind of inflammation, including the kind in AERD. But these medications can have serious side effects and are generally used only for severe symptoms over short periods of time.

• Biologic medications, like Dupixent: These are injected medications that can be very helpful for asthma, sinus symptoms, and nasal polyps. But they are generally very expensive. 

Can AERD be cured?

There is no cure for AERD, but there is a procedure called aspirin desensitization. This procedure can help decrease the chronic symptoms of AERD. It also stops them from flaring up with medications like aspirin. This is important if someone needs to take aspirin for another health condition, like arthritis or heart disease. 

Like an aspirin challenge, aspirin desensitization involves taking higher and higher doses of aspirin with the help of a healthcare provider. But, an aspirin desensitization is different because it is done more slowly and has a different goal.

Aspirin desensitization is done to gradually raise your body’s tolerance to aspirin. The procedure can take anywhere from 1 to 3 days. Unlike a challenge, a desensitization should go smoothly — hopefully without reactions. And it is especially important for your asthma symptoms to be well-controlled before starting the process. An aspirin desensitization procedure is complete when someone can tolerate at least a full dose of aspirin (325 mg).

Aspirin desensitization is an affordable and effective treatment for AERD. Around 85% of people report some benefit from it. 

The procedure is not quite a cure though. After desensitization, it is important to keep taking at least the same dose of aspirin (325 mg) every day. If you stop taking aspirin for more than 2 or 3 days, the sensitivity will start to return. And it will need to be restarted at a provider’s office. If you miss more than 5 days, then the entire desensitization process will need to be repeated.

But aspirin desensitization is not for everyone. Aspirin can cause other side effects, like stomach problems and easy bleeding or bruising. Around 15% of people with AERD on daily aspirin will eventually stop because of side effects.

Why trust our experts?

Written by:

Fonda Jiang, MD

Dr. Fonda Jiang is a practicing allergist in Long Beach, California. At her current practice, Dr. Jiang is committed to working as a team with her adult and pediatric patients to diagnose and treat a wide range of allergic conditions.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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