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Aspirin or Nonsteroidal Drug-Exacerbated Respiratory Disease (AERD or NERD)

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Abstract

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) is a chronic eosinophilic inflammatory condition of the airways characterized by chronic severe asthma, rhinosinusitis, and nasal polyposis in which symptoms are aggravated by the intake of aspirin or NSAIDs. Its pathogenesis is not completely understood, although alterations of the metabolism of arachidonic acid with decreased production of prostaglandin E2 (PGE2) and increased release of cysteinyl leukotrienes are proposed as responsible for the immediate respiratory symptoms induced by NSAIDs. In addition, abnormalities of the immune system with generation of particular cytokine profiles result in the chronic eosinophilic inflammation observed in the disease. A role for chronic viral infections and specific IgE to Staphylococcus aureus enterotoxins may be involved in the maintenance of the chronic stages of N-ERD. The diagnosis of N-ERD is based on a medical history suggestive of the typical clinical manifestations, and in some patients, confirmation by an oral provocation test with aspirin can be performed when necessary. Treatment of N-ERD includes patient education for careful avoidance of COX-1 inhibitors, the use of alternative non-COX-1-inhibitor NSAIDs for relief of pain and inflammation, treatment of asthma and chronic rhinosinusitis according to current guidelines, and sinus surgery and aspirin (ASA) desensitization when indicated.

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Authors and Affiliations

  1. Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad and Clínica El Avila, Caracas, Venezuela

    Mario A. Sánchez-Borges

Authors
  1. Mario A. Sánchez-Borges
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Correspondence to Mario A. Sánchez-Borges .

Section Editor information

  1. Division of Allergy & Immunology, University of South Florida, Tampa, FL, USA

    Dennis K. Ledford

  2. Milton S Hershey Med Ctr, Penn State University, Hershey, PA, USA

    Timothy Craig

  3. Division of Allergy & Immunology, Dept. of Internal Medicine, University of South Florida Morsani College of Medicine, James A Haley Veterans' Hospital, Asthma and Immunology Associates of Tampa Bay, Tampa, Florida, USA

    Dennis K. Ledford

  4. Department of Medicine and Pediatrics, Penn State College of Medicine, Hershey, PA, USA

    Timothy Craig

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Sánchez-Borges, M.A. (2019). Aspirin or Nonsteroidal Drug-Exacerbated Respiratory Disease (AERD or NERD). In: Allergy and Asthma. Springer, Cham. https://doi.org/10.1007/978-3-030-05147-1_15

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  • DOI: https://doi.org/10.1007/978-3-030-05147-1_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-05146-4

  • Online ISBN: 978-3-030-05147-1

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