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

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...

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Bibliographic Details
Published in:Allergy (Copenhagen) Vol. 74; no. 1; pp. 28 - 39
Main Authors: Kowalski, Marek L., Agache, Ioana, Bavbek, Sevim, Bakirtas, Arzu, Blanca, Miguel, Bochenek, Grażyna, Bonini, Matteo, Heffler, Enrico, Klimek, Ludger, Laidlaw, Tanya M., Mullol, Joaquim, Niżankowska‐Mogilnicka, Ewa, Park, Hae‐Sim, Sanak, Marek, Sanchez‐Borges, Mario, Sanchez‐Garcia, Silvia, Scadding, Glenis, Taniguchi, Masami, Torres, Maria J., White, Andrew A., Wardzyńska, Aleksandra
Format: Journal Article
Language:English
Published: Denmark Blackwell Publishing Ltd 01.01.2019
Subjects:
AERD
Algorithms
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Aspirin
Asthma
asthma treatment
Asthma, Aspirin-Induced - diagnosis
Diagnosis
Disease Management
drug allergy
ENT (rhinitis, sinusitis, nasal polyps…)
Humans
Inflammatory diseases
Leukocytes (eosinophilic)
Management
Medical diagnosis
Morbidity
Nonsteroidal anti-inflammatory drugs
Pathophysiology
Patients
Phenotypes
Polyps
Respiratory diseases
Respiratory tract
Respiratory Tract Diseases - chemically induced
Rhinitis
Rhinosinusitis
Sinusitis
asthma treatment
AERD
sinusitis
ENT (rhinitis, sinusitis, nasal polyps…)
asthma
drug allergy
ISSN:0105-4538, 1398-9995, 1398-9995
Online Access:Get full text
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Summary: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.
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ISSN:0105-4538
1398-9995
1398-9995
DOI:10.1111/all.13599