Diagnosis
There is no one specific test or blood result that alone can be used to diagnose AERD. 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.
Treatment
People with AERD who have not been desensitized to aspirin should avoid all NSAIDs in order to prevent reactions. However, complete avoidance is not feasible. In that case, they will need to use daily medications to control their symptoms and often need to use daily inhaled corticosteroids for asthma. The following are some of the recommended medications.
- Intranasal steroid sprays or steroid sinus rinses. It can help to control the nasal symptoms, and nasal polyps can also be treated with steroid injections directly into the polyps.
- Non-steroid medications. Specifically medications that inhibit the production of leukotrienes (Zileuton) or block the function of leukotrienes (Montelukast and Zafirlukast) can help to treat some of the symptoms.
- Surgical removal of nasal polyps. It is very common in AERD though unfortunately the rate of recurrence of nasal polyps after surgery is high.
- Aspirin desensitization– It can also be used as a steroid-sparing treatment in some patients to have the patient begin long-term daily aspirin therapy, which in some patients can decrease the regrowth of nasal polyps and reduce the need for corticosteroid medications.
