Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)a EAACI position paper


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Kowalski M. L., Agache I., BAVBEK S., BAKIRTAŞ A., Blanca M., Bochenek G., ...More

ALLERGY, vol.74, no.1, pp.28-39, 2019 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 74 Issue: 1
  • Publication Date: 2019
  • Doi Number: 10.1111/all.13599
  • Journal Name: ALLERGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.28-39
  • Keywords: AERD, asthma, asthma treatment, drug allergy, ENT (rhinitis, sinusitis, nasal polyps, ), sinusitis, NONSTEROIDAL ANTIINFLAMMATORY DRUGS, PERIPHERAL-BLOOD LEUKOCYTES, ASPIRIN-INDUCED ASTHMA, NEAR-FATAL ASTHMA, CHRONIC RHINOSINUSITIS, NASAL POLYPOSIS, RECEPTOR EXPRESSION, PROVOCATION TESTS, INTOLERANT ASTHMA, LEUKOTRIENE
  • Gazi University Affiliated: Yes

Abstract

NSAID-exacerbated respiratory disease (N-ERD) is a chronic eosinophilic, inflammatory disorder of the respiratory tract occurring in patients with asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP), symptoms of which are exacerbated by NSAIDs, including aspirin. Despite some progress in understanding of the pathophysiology of the syndrome, which affects 1/10 of patients with asthma and rhinosinusitis, it remains a diagnostic and therapeutic challenge. In order to provide evidence-based recommendations for the diagnosis and management of N-ERD, a panel of international experts was called by the EAACI Asthma Section. The document summarizes current knowledge on the pathophysiology and clinical presentation of N-ERD pointing at significant heterogeneity of this syndrome. Critically evaluating the usefulness of diagnostic tools available, the paper offers practical algorithm for the diagnosis of N-ERD. Recommendations for the most effective management of a patient with N-ERD stressing the potential high morbidity and severity of the underlying asthma and rhinosinusitis are discussed and proposed. Newly described sub-phenotypes and emerging sub-endotypes of N-ERD are potentially relevant for new and more specific (eg, biological) treatment modalities. Finally, the document defines major gaps in our knowledge on N-ERD and unmet needs, which should be addressed in the future.