Abstract
Nonsteroidal antiinflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis/nasal polyps, but is a highly heterogeneous disorder with various clinical manifestations. Two major pathogenic mechanisms are: (1) overproduction of cysteinyl leukotrienes with dysregulation of arachidonic acid metabolism and (2) increased type 2 eosinophilic inflammation affected by genetic mechanisms. Aspirin challenge is the gold standard to diagnose NERD, whereas reliable in vitro biomarkers have yet not been identified. Therapeutic approaches have been done on the basis of disease severity with the avoidance of culprit and cross-reacting NSAIDs, and when indicated, aspirin desensitization is an effective treatment option. Biologic approaches targeting Type 2 cytokines are emerging as potential therapeutic options. Here, we summarize the up-to-date evidence of pathophysiologic mechanisms and diagnosis/management approaches to the patients with NERD with its phenotypic classification.
Highlights
Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world (Doña et al, 2012); they are considered the most common causes of hypersensitivity reactions to drugs (Blanca-Lopez et al, 2018)
NERD is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis (CRS) nasal polyps (NPs) with persistent eosinophilic inflammation in the upper and lower airways (Taniguchi et al, 2019) as well as Nonsteroidal antiinflammatory drug (NSAID) hypersensitivity where cysteinyl leukotrienes (CysLTs) overproduction and chronic type 2 airway inflammation are key findings (Taniguchi et al, 2019)
NERD is characterized by chronic type 2 inflammation in the upper and lower airways; patients suffer from chronic persistent asthmatic symptoms and CRS with/without NPs, which are exacerbated by ASA/NSAID exposure and refractory to conventional medical or surgical treatment
Summary
Aspirin (acetylsalicylic acid, ASA) and nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world (Doña et al, 2012); they are considered the most common causes of hypersensitivity reactions to drugs (Blanca-Lopez et al, 2018). NERD is a major phenotype among cross-intolerant categories of NSAID hypersensitivity and had been called ASA-induced asthma, ASA-intolerant asthma, ASA-sensitive asthma; NERD and ASAexacerbated respiratory disease (AERD) are commonly used (Sánchez-Borges, 2019). NERD is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis (CRS) nasal polyps (NPs) with persistent eosinophilic inflammation in the upper and lower airways (Taniguchi et al, 2019) as well as NSAID hypersensitivity where cysteinyl leukotrienes (CysLTs) overproduction and chronic type 2 airway inflammation are key findings (Taniguchi et al, 2019). In vitro cell activation tests and radiological imaging with nasal endoscopy can aid in NERD diagnosis (Taniguchi et al, 2019).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
