Aspirin-Exacerbated Respiratory Disease: Understanding Asthma and NSAID Sensitivity

For many people with asthma, taking a simple pain reliever like ibuprofen or aspirin can trigger a sudden, scary reaction: nasal congestion so bad it feels like your sinuses are closing, wheezing that comes out of nowhere, and a headache that pounds behind the eyes. This isn’t just bad luck or an allergy. It’s Aspirin-Exacerbated Respiratory Disease, or AERD - a condition that affects nearly 1 in 10 adults with asthma and up to 3 in 10 people who have both asthma and nasal polyps.

What Exactly Is AERD?

AERD, sometimes called Samter’s Triad, isn’t one problem - it’s three happening at once: asthma, chronic nasal polyps, and a severe reaction to aspirin and other NSAIDs like ibuprofen and naproxen. It doesn’t show up in childhood. It hits adults between 20 and 50, often out of nowhere. One day you’re fine taking Advil for a headache; the next, you’re gasping for air after a single pill.

The real issue isn’t the drug itself. It’s how your body reacts to it. When you take aspirin or NSAIDs, they block an enzyme called COX-1. In most people, that’s harmless. In people with AERD, it throws the immune system into chaos. Your body starts flooding your airways with inflammatory chemicals called leukotrienes - the same ones that make asthma worse - while shutting down protective molecules like prostaglandin E2. The result? Swollen sinuses, polyps that grow back faster than you can remove them, and asthma that doesn’t respond well to standard inhalers.

The Symptoms Are More Than Just Asthma

If you think AERD is just bad asthma, you’re missing half the picture. The upper airway symptoms are often worse than the lower ones. Ninety-eight percent of people with AERD have constant nasal congestion. Nearly everyone has nasal polyps - soft, noncancerous growths that block your nose and steal your sense of smell. More than 90% lose at least part of their ability to smell, and many can’t taste food properly either.

When exposed to aspirin or NSAIDs, reactions hit fast - usually within 30 to 120 minutes. You’ll feel your nose stuff up, your sinuses ache, your eyes water, and your chest tighten. About 75% of people also react to alcohol, sometimes after just one drink. That’s not just a hangover. It’s the same inflammatory cascade triggered by the alcohol’s natural salicylate content. Many patients report flushing, nausea, or even vomiting after wine or beer.

And unlike regular asthma, AERD doesn’t respond well to standard treatments. Only about 35% of patients get decent control with inhalers alone. That means most are stuck with frequent flare-ups, emergency room visits, and repeat sinus surgeries - which often fail because the polyps grow back within months.

Why Is AERD So Often Missed?

Doctors aren’t to blame - they’re just not trained to connect the dots. Most primary care providers see asthma as a lung issue and nasal polyps as an ENT problem. They don’t realize these two things together, especially with a reaction to painkillers, point to one condition: AERD.

Patients wait an average of 7 to 10 years before getting the right diagnosis. One Reddit user shared it took 11 years and four ENT specialists before someone finally said, “This isn’t just allergies - it’s AERD.” That delay is dangerous. Every time you take an NSAID, you’re not just triggering a reaction - you’re fueling the inflammation that makes your polyps grow and your asthma worsen.

Even some allergists miss the alcohol connection. If you’ve had unexplained reactions to wine or beer and you have asthma and polyps, that’s a red flag. Yet, many patients are told they’re just “sensitive to sulfites” or “have a wine intolerance.” It’s not. It’s AERD.

The Only Treatment That Actually Changes the Course

Avoiding aspirin and NSAIDs sounds logical - and it’s necessary. But it doesn’t stop the disease from progressing. Your polyps will still grow. Your asthma will still flare. The only treatment proven to slow or even reverse AERD is aspirin desensitization.

This isn’t a one-time shot. It’s a controlled, medically supervised process where you’re given gradually increasing doses of aspirin over 1 to 3 days, usually in a hospital. The goal? To reset your immune system’s response. Afterward, you take a daily low-dose aspirin (usually 650 mg twice a day) for life.

The results? Eighty-five percent of patients see better asthma control. Sinus surgery needs drop by 60%. Polyp regrowth slows from every 6 months to every 2 or 3 years. One patient on the Samter’s Society forum said, “After desensitization, my polyp regrowth slowed from every 6 months to every 3 years.”

It’s not risk-free. About 42% of patients have reactions during the process - sometimes severe. But with proper monitoring, serious complications are rare. And for most, the trade-off is worth it.

What About New Drugs Like Dupixent?

Biologics like dupilumab (Dupixent) are changing the game for some. Approved for chronic sinusitis with nasal polyps, it targets the same inflammatory pathways (IL-4 and IL-13) that drive AERD. Studies show it reduces polyp size by 50-60% and improves breathing and smell.

But there’s a catch. Dupixent costs $38,500 a year. Only 38% of AERD patients have insurance that covers it. And while it helps symptoms, it doesn’t fix the root problem like aspirin desensitization does. That’s why most specialists use it as a bridge - to get patients stable enough to try desensitization, or for those who can’t tolerate aspirin.

There’s also new research. A drug called MN-001 (lodadustat), a leukotriene inhibitor, showed a 70% drop in polyp recurrence in early trials. It’s not available yet, but it’s a sign that better, more targeted treatments are coming.

Where Do You Go From Here?

If you have asthma, nasal polyps, and reactions to NSAIDs or alcohol, you need to see an AERD specialist. There are only about 35 centers in the U.S. that offer full diagnostic testing and desensitization. Most are tied to major academic hospitals like Brigham and Women’s in Boston or the University of Pennsylvania.

Start by asking your doctor for a referral to an allergist/immunologist who specializes in airway inflammation. Don’t settle for a general allergist - you need someone who’s done at least 10 desensitizations. Most community practices don’t offer it. Only 12% of allergy clinics in the U.S. perform the procedure.

Once you’re diagnosed, education is key. Most patients need 4 to 6 sessions to understand what they’re dealing with - what triggers to avoid, how to read medicine labels (many cold and flu meds contain NSAIDs), and how to manage daily aspirin therapy. The Samter’s Society website has over 120 articles and 28 patient videos - free, reliable, and patient-tested.

The Hidden Inequities in AERD Care

Despite all the advances, AERD care isn’t equal. Black and Hispanic patients wait, on average, 3.2 years longer than White patients to get diagnosed. Why? A mix of factors - less access to specialists, lower referral rates, and biases in how symptoms are interpreted. One patient in Texas told her doctor her nasal congestion was “just allergies” for years - until she had a near-fatal reaction after taking ibuprofen.

Healthcare systems need to do better. But you can start by speaking up. If you’ve been told your asthma is “uncontrolled” and your polyps keep coming back, ask: “Could this be AERD?” Bring up the alcohol reactions. Mention your NSAID sensitivity. Don’t wait for your doctor to connect the dots.

Living With AERD: What Works

Living with AERD isn’t easy, but it’s manageable. Here’s what real patients do:

• Always check OTC meds for ibuprofen, naproxen, or aspirin - even in cold remedies and menstrual pain pills.
• Keep a list of safe pain relievers: acetaminophen (Tylenol) is usually fine, but talk to your doctor first.
• Carry an epinephrine auto-injector if you’ve had severe reactions - even if you’re on aspirin therapy.
• Use saline rinses daily to clear sinuses and reduce polyp irritation.
• Join a support group. The Samter’s Society forum has 2,347 active members. You’re not alone.

Most of all - don’t give up. AERD is chronic, but it’s not a death sentence. With the right diagnosis and treatment, many people go from constant ER visits to living full, active lives. The key is knowing what you’re dealing with - and finding the right specialist who does too.