Aspirin Exacerbated Respiratory Disease (AERD)

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WHAT IS ASPIRIN-EXACERBATED RESPIRATORY DISEASE (AERD)? Aspirin Exacerbated Respiratory Disease (AERD), also known as “Santer’s triad”, is a clinical tetrad of nasal polyps, asthma, chronic hypertrophic eosinophilic sinusitis, and sensitivity, to any medication that inhibits cyclooxygenase-1 [COX-1] enzymes, namely aspirin and other nonsteroids and inflammatory drugs [NSAIDs].  This condition usually occurs as a respiratory reaction […] Read More

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Aspirin Exacerbated Respiratory Disease (AERD)

WHAT IS ASPIRIN-EXACERBATED RESPIRATORY DISEASE (AERD)? Aspirin Exacerbated Respiratory Disease (AERD), also known as “Santer’s triad”, is a clinical tetrad of nasal polyps, asthma, chronic hypertrophic eosinophilic sinusitis, and sensitivity, to any medication that inhibits cyclooxygenase-1 [COX-1] enzymes, namely aspirin and other nonsteroids and inflammatory drugs [NSAIDs].  This condition usually occurs as a respiratory reaction that springs up upon ingesting or inhaling an NSAID. However, the exact cause of the reaction is not known. About 9% of all adults suffering from asthma and 30% of patients with both asthma and nasal polyps have AERD. Generally, AERD develops quite suddenly in adulthood, mostly between 20 and 30 years of age, without any clearly understood trigger that can be said to be the cause of the disease. RISK FACTORS AERD is a respiratory disorder. Approximately 40% of patients with asthma, nasal polyps, or chronic sinus infection will have AERD. People with AERD always develop nasal polyps and in most cases suffer from persistent asthma.  Another peculiar aspect of this condition is a sensitivity to any medication that inhibits the cyclooxygenase-1 enzyme. Aspirin and other nonsteroids and inflammatory drugs (NSAIDs) pose serious risks to patients with AERD.  The Center For Disease Control (CDC) projects that about 1 in 12 people (approximately 25 million) have asthma, and the numbers are going up every year. Studies conducted show an estimate of 5% to 10% of asthmatics (1.25 to 2.5 million people) are AERD patients.  Therefore, be on the safe side by quitting smoking. Smokers are at a high risk of aspirin-induced asthma triad. Try your best to avoid exposure to second-hand smoke.  COMPLICATIONS Sensitivity to aspirin and NSAIDs may include serious side effects, including:
  • Kidney failure.
  • Liver failure.
  • Gastrointestinal bleeding.
  • Stomach ulcer.
  • Abnormal constant ringing in the ears.
  • Constipation.
  • Loss of appetite.
Asthma can be minor or sometimes interfere with daily activities. In most cases, it can lead to a life-claiming attack. Frequent respiratory infections can breed serious complications. DIAGNOSIS Blood tests cannot reveal the existence of AERD. To diagnose for AERD, your doctor can check for Santer’s triad, which includes:
  • Asthma.
  • Nasal polyps.
  • Respiratory reaction when you take aspirin or NSAIDs.
If these three conditions are confirmed, then your doctor may diagnose it as AERD. TREATMENT AERD has no cure, but there are ways to manage it.
  1. Via Medications
  • Take inhaled steroids daily (to treat asthma).
  • Intranasal steroid sprays (to clear airways).
  • Steroid rinses can help symptoms.
  • Injections of steroids into the nasal polyps (to shrink or remove them).
  • Acetaminophen (not an NSAID); take it for fevers and pain. This medication will not trigger AERD.
  • Use of NSAIDs (Aspirin Desensitization)
For AERD aspirin is the main trigger. However, non-steroidal and inflammatory drugs can be used safely by some people with AERD through the process called aspirin desensitization. While your doctor watches, a small dose of aspirin is taken, for a start.  Each day, the dosage is slightly increased, until you have symptoms. You will then maintain that dose daily until you do not react. Then your doctor will increase the dose again. When you experience a reaction, you’ll stay on that dose until you can handle it easily. The whole process is repeated.  Observation has shown that aspirin desensitization works in nearly 9 of every 10 people (a 90% estimation). They can then take NSAIDs without triggering nasal polyps asthma triad related symptoms. Even a daily low-dose aspirin can flare up symptoms, without aspirin desensitization.
  • Restoring Sense of Taste and Smell
Nasal polyps can affect your sense of smell and taste. At times removing polyps and keeping your nasal passage free help in restoring your sense of smell. Also, spice up your food to make it flavorful.  AERD DIET  Every AERD patient dreams of finding a natural treatment. Most of them were perfectly healthy until they suddenly developed AERD in their mild adulthood.  Unfortunately, there is no natural care for this disease, but some patients have report benefits while maintaining a healthy lifestyle.  Eating a nutritious diet, getting plenty of exercises, and maintaining a healthy body weight is great advice for anyone suffering from chronic illness. Some specific things may be beneficial for AERD patients.
  • The Unfriendly Alcohol
Avoiding or limiting alcohol can likely help reduce symptoms for most patients. Research reveals that 83% of AERD patients have sinus or asthma reactions attributed to alcohol, even beer or wine causes worse reactions than clear liquor, like vodka.
  • Vitamin D
There is evidence that vitamin D plays a vital role in respiratory health, It has been discovered that many patients with asthma and nasal polyps have low vitamin D levels. Secondly, most aspirin asthma triad (AERD) patients take corticosteroid medications long term, which is a risk of developing bone loss, Healthy, Vitamin D level can prevent this, If you take vitamin D supplements, you should have your vitamin D levels checked regularly.
  • Mint and Spice
The Scripp’s AERD patient survey found out that 27% of AERD patients reported respiratory reactions to mint flavorings in toothpaste and chewing gum, there have been case studies that indicate that mint reactions exist in some patients. It has also been said that the physical stimuli caused by mint and spice may activate malt cells in some patients, there are alternatives to mint-flavored toothpaste, children’s toothpaste comes in fruit flavors, also there is toothpaste available with no flavoring.
  • The Low Omega- 6 Diet
This diet has been studied in AERD Santer’s triad patients butter, coconut oil, lard, palm oil are all relatively low in omega 6. Avoid vegetable oils, sunflower, even soybean, and cottonseed oils, they contain a very high amount of omega 6. Omega 6 fatty seeds are used for reducing the risk of heart disease, lowering total cholesterol levels, lowering ‘bad’ (LDL) cholesterol levels, raising ‘good’ (HDL) cholesterol levels, thus reducing the risk of cancer.
  • The Low Salicylate Diet
Eat food that contains no or low salicylate, and avoid foods high in salicylate. These symptoms of salicylate intolerance, low salicylate foods include, cereal drinks, decaffeinated coffee, milk, pear juice (homemade), bread and cereals, noodles and pasta, peas, and rice, butter, and margarine, cashes and poppy seeds, apples, bananas, pawpaw, pears, cabbage, celery, and Brussels sprouts.  Others are salt, malt vinegar, carob, and cocoa. Avoid foods, such as beer, tea, avocados, peanuts,  mayonnaise, olive oil, apples, apricots, berries, currants, lemons, melon, oranges, pineapple, beetroot, broccoli, cucumber, peppers, tomatoes, pickles, vinegar, curry, nutmeg, bay leaf, and basil, Consult your doctor before removing some food from your diet to avoid malnutrition.



Nasal polyps aspirin triad or asthma triad symptoms are often triggered when aspirin is ingested or inhaled. 

Signs and symptoms of AERD include:

  • Difficulty in breathing.
  • Wheezing.
  • Coughing.
  • Sneezing.
  • Stuffy nose (nasal congestion).
  • Running nose.
  • Recurrent nasal polyps.
  • Headaches.
  • Sinus pain.
  • Tightness in the chest area.
  • Flushing.
  • Rashes.
  • Abdominal pains.
  • Vomiting (occasionally).
  • Respiratory reaction to alcohol.



    The exact cause of AERD, as mentioned earlier, is not known. 

    • It is not an allergic reaction.
    • No evidence shows it is genetic.
    • It is not caused by aspirin or NSAIDs, but AERD sinus or asthma symptoms get worse when these medications are taken.


    • Can aspirin case breathe problems?

    Nasal polyps asthma aspirin sensitivity is a harmful reaction to aspirin. Such reactions include breathing problems like shortness of breath, nasal or sinus problems, wheezing, sneezing, skin problems, AERD, etc.

    • What causes Santer’s triad?

    Santer’s triad (also called AERD) is a condition in which a person has asthma, nasal polyps, chronic sinus diseases, and a sensitivity to aspire and other NSAIDs (non-steroidal and inflammatory drugs). People with Santer’s triad show severe reactions with both upper and lower respiratory symptoms.

    What are the side effects of taking aspirin daily?

    The possible side effects of daily aspirins therapy include:

    • Stroke is caused by a burst blood vessel. It may increase your risk of hemorrhage stroke.
    • Gastrointestinal bleeding
    • Allergic reaction
    • Risk of AERD symptoms.

    What should I avoid in asthma?

    Foods to avoid with asthma include:

    • Eggs
    • Soy
    • Tree nuts
    • Fish
    • Peanuts
    • Cow’s milk
    • Wheat
    • Shrimp and other shellfish

    Is there a cure for Santer’s triad?

    Many are looking for a natural cure for Santer’s triad (AERD). Most patients have been dependent on medications to feel well for a long. Unfortunately, there is no natural cure for this disease, however, may have lived a fulfilled lifestyle changes, Avoid alcohol can be the most helpful step take to help reduce AERD symptoms.