Aspirin Exacerbated Respiratory Disease (AERD) is also known as Samter’s Triad or Type 2 Inflammatory Disease.
There are 3 main criteria that patients suffer from with AERD, namely:
- asthma;
- long-standing sinus disease and nasal polyps; and
- sensitivity to aspirin and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
As part of this condition, most will also be aware of a worsening of their chest symptoms and breathing with alcohol, and a permanently reduced sense of smell.
Up to 10% of patients with asthma will have AERD, and around 25% of those patients with nasal polyps and asthma will have it.
What causes AERD?
In recent years it has been recognised that this condition is usually due to overactivity of a normal part of the body’s defence mechanism to parasitic worms, the type 2 inflammatory response. The main circulating white blood cell responsible for this overactivity is the eosinophil, and the presence and quantity of these blood cells in both a blood test and any tissue samples / polyps that we send off for laboratory examination can be used as a marker of the severity of this condition.
How is it treated?
The inflammation of the lining of the lungs, nose and sinuses that this condition causes is often difficult to control, and is resistant to treatment. Patients often will need repeated sinus surgery to clear the nose of polyps and long-term treatment with both topical (i.e. nose sprays and drops) and oral (tablet) steroids.
There is now also a new group of ‘biologic’ drugs that specifically target chemicals circulating in the bloodstream which cause the inflammation in the lungs and nose. These are used in patients with severe uncontrolled asthma and eczema, and have recently been NICE approved in the UK for use in the NHS in patients with severe symptoms relating to their nose or sinuses. It is important to note that these drugs are only prescribed in patients who fulfil strict criteria in relation to the severity of their symptoms by multidisciplinary teams working in the NHS.
Dangerous drugs
People known to be aspirin-sensitive must not take aspirin or drug products containing aspirin or aspirin-like drugs (see below), which are usually used for rheumatism, pain or fever. These all may cause a severe and sudden exacerbation of your chest problems, and significant shortness of breath and wheezing.
Common drugs containing aspirin
Alka-Seltzer, Analgesic Dellipsoids D6, Anodyne Dellipsoids D4, Antoin, APC Mixture, Asagran, Aspav, Aspellin, Broprin, Caprin, Claradin, Co-Codaprin, Codis, Dolasan, Doloxene Co, Equagesic, Hypon, Laboprin, Levius, Migravess, Myolgin, Napsalgesic, Nu-Seals Aspirin, Onadox 118, Paynocil, Robaxisal Forte, Safapryn, Safapryn Co, Solprin, Sore Throat Mixture, Trancoprin, Veganin.
Common aspirin-like drugs (NSAIDs)
Alrheumat, Apsifen, Artracin, Benoral, Brufen, Butacote, Bulazolidin, Disalcid, Dolobid, Ebutac, Flinoril, Feldene, Fenbid Spansule, Fenopron, Froben, Ibumetin, Ibuprofen, Imbrilon, Indocid, Indoflex, Indolar, Indomod, Iorunvail, Laraflex, Larapam, Lederfen, Lodine, Motrin, Naprosyn, Nurofen, Orudis, Oruvail, Palaprin Forte, Paxofen, Ponstan, Progesic, Ramodar, Relifex, Rheumox, Surgam, Synflex, Tolectin, Voltarol.
Important: as the list cannot ever be complete, make sure that any drug you take does not contain aspirin or aspirin-like drugs by looking at the label. If in doubt ask your chemist.
There is some evidence that aspirin desensitisation can help AERD, but this is something only performed in specialist centres with expert allergy / respiratory services.
Diet and AERD
Until recently, it was thought that some aspirin-sensitive individuals reacted to foods containing salicylates, and that it was therefore advisable to exclude these from your diet.
There is now, however, a lot of debate amongst experts in AERD about whether dietary salicylates are really responsible for worsening symptoms in AERD.
This is because inhibition of the COX-1 enzyme is the mechanism by which aspirin and other NSAIDs cause AERD (Samter’s Triad) reactions. The chemical name for aspirin is acetyl salicylate. The ‘acetyl’ part of this compound is the one that inhibits COX-1, not the salicylate. Because dietary salicylates are non-acetylated and therefore do not have this chemical effect, there is no reason to think that they play any role in AERD.
The downsides of restricting your diet and excluding a lot of healthy foodstuffs would probably therefore be far greater than the small benefit that you may derive from excluding all salicylate-containing foodstuffs.
Instead, experts now agree that a diet high in Omega 3 and low in Omega 6 is far more beneficial for patients with AERD.
There is more information on diet and many other matters regarding AERD on the Samter’s Society website at www.samterssociety.org.