Asthma and Aspirin

May 16, 2016 | Black & Kletz Allergy

Providers of Asthma Treatment Gainesville VA Patients Trust: Dr. Kletz & Dr. Gondi
Any provider of asthma treatment in Gainesville can tell you that about 10% of all adults with asthma may have a condition called Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad, or Aspirin-Sensitive Asthma.

The 3 components of the disease are:

1. Persistent asthma
2. Chronic inflammation in the nose and sinuses with polyp formation
3. Allergic sensitivity to aspirin and other non-steroidal anti-inflammatory drugs NSAID’s

The asthma associated with AERD tends to be more severe and poorly responsive to the usual treatments.  When providing the treatment for allergies and asthma Gainesville VA residents need, we see that most patients also suffer from recurrent sinus infections and often experience a reduced sense of smell and/or taste.

The adverse reactions on exposure to aspirin and/or NSAID’s can include:

1. Flushing, rash, and/or itching
2. Increased nasal congestion
3. Facial pain and headache over the forehead region
4. Coughing, wheezing, and/or heaviness in the chest
5. Abdominal cramps and/or nausea
6. Dizziness

What causes it?

AERD is not a genetic or inherited condition.  The exact cause of the disorder is not known at this time, although a lot of research is being done in order to try to find a cause.  The patients have higher than normal levels of eosinophils (i.e., a type of white blood cell that tends to be high in allergic individuals) in their blood and in the sinuses, and these cells usually play a role in causing chronic allergic inflammation.  They also have high levels of substances called leukotrienes which also cause inflammation.  Ingestion of aspirin and/or NSAID’s leads to a further increase in these leukotrienes resulting in a flare-up of asthma symptoms.

How is it treated?

1. Patients who are diagnosed with AERD and who have not been desensitized to aspirin should always avoid taking aspirin and other NSAID’s like ibuprofen (e.g., Motrin, Advil) naproxen (e.g., Naprosyn, Aleve), diclofenac (e.g., Voltaren, Arthrotec), indomethacin (e.g., Indocin), meloxicam (e.g., Mobic), piroxicam (e.g., Feldene), nabumatone (e.g., Relafen), sulindac (e.g., Clinoril), ketorolac (e.g., Toradol), oxaprozin (e.g., Daypro), etc.  Acetaminophen (e.g., Tylenol) is a suitable alternative medication for relief of pain. Certain related non-steroidal anti-inflammatory drugs called COX-2 inhibitors like celecoxib (Celebrex) may be safer alternatives to aspirin in some individuals.
2. In spite of avoiding these drugs, many patients will continue to experience frequent asthma symptoms, repeated sinus problems, and growth of nasal polyps.  They may need daily inhaled corticosteroid medications into their lungs to control asthma and daily corticosteroid nasal sprays and saline irrigations into their nostrils to control nasal congestion and polyps.
3. Medications that inhibit leukotrienes like zileuton (Zyflo), which reduce the production of leukotrienes, or montelukast (Singulair) and zafirlukast (Accolate), which block the effects of leukotrienes on tissues can be helpful in certain patients to reduce the exacerbation of symptoms.
4. Many patients also need sinus surgery and removal of nasal polyps, often more than once, as polyps tend to regrow after the surgery.  Regular use of intranasal corticosteroids and oral leukotriene modifiers after the surgery can help some patients in slowing the progression of their disease.
5. Aspirin desensitization (i.e., the administration of gradually increasing doses of aspirin under close monitoring in a hospital or clinic, followed by daily intake of a standard maintenance dose of aspirin by mouth) has been shown to reduce the need for medications and the number of surgeries in some patients with AERD who were unresponsive to other standard treatments.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults andchildren with asthma, AERD, sinus disease, nasal polyps, other allergic and immunologic disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the asthma and allergy needs of the DC metro area community for more than 50 years and we strive to administer high quality allergy and asthma care in a caring professional environment.