AERD

Vanderbilt AERD Clinic: (link to VASAP website here)

Vanderbilt University Medical Center AERD team is a dedicated group of physicians and research scientists offering various treatment option. Our multidisciplinary team includes allergists/immunologists, rhinology surgeons and nurses providing exceptional care for patients with AERD. We diagnose and treat more than 50 patients a year and have performed hundreds of aspirin desensitization over the past decade.

 

Our Team: 

Dr. Katherine Cahill

Dr. Ryszard Dworski

Dr. Rakesh Chandra

Dr. Justin H. Turner

Dr. Naweed Chowdhury

 

Our Mission:

Provide comprehensive care for patients with AERD in the southeastern United States.

Improve the diagnosis, treatment and quality of life for patients with AERD through basic and translational research.

Raise disease awareness and provide resources for patients with AERD and for referring physicians.

 

Clinical Services:

Diagnostic services and treatment for AERD and other allergic diseases including:

* Aspirin challenge and desensitization

* Consideration for biological therapy

* Allergen testing and treatment

* Sinus endoscopy and medical/surgical interventions for nasal polyps

* Participation in clinical trials and adjunctive therapies like dietary modifications.

* Lung function tests and various imaging studies

 

Instructions for patients and referring physicians:

The Vanderbilt Allergy, Sinus and Asthma Program clinic is located at 2611 West End Avenue, Nashville, TN,37203.

For appointments please call 615-936-2727.

For referring physicians, please contact Dr. Katherine Cahill (katherine.cahill@vumc.org) directly.

 

What is AERD?

Aspirin-exacerbated respiratory disease (AERD), which is also called NSAID-exacerbated respiratory disease (NERD), refers to the triad of:

1. Asthma

2. Chronic rhinosinusitis (CRS) with nasal polyposis and

3. Acute upper and lower respiratory tract reactions to ingestion of aspirin (acetylsalicylic acid, ASA) and other nonsteroidal anti-inflammatory drugs (NSAIDs).

 

AERD usually developes in adulthood but can develop as early as puberty with symptoms developing gradually over months to years.

AERD patient may experience:

·       Chronic sinus inflammation, nasal congestion and discharge

·       Gradual loss of sense of smell and taste

·       Classic symptoms of asthma such as cough, chest tightness, shortness of breath and wheezing

·       Itchy rash

·       Hearing loss and chronic ear discharge.

·       Reactions to alcoholic beverages like wheezing and shortness of breath.

·       Within 30 mins to 3 hours following exposure to aspirin or other NSAIDs, patients may develop flushing, rash, runny nose, redness of the eyes, increased nasal congestion, cough shortness of breath, wheezing, abdominal cramps and pain. Rarely patients develop a low blood pressure.

 

Multidisciplinary Treatment options at VUMC:

1)     Standard treatment for asthma - Most patients with AERD need medications to control their asthma symptoms.

Short acting beta-agonists, long acting beta-agonists and inhaled corticosteroids are commonly used depending on the severity of asthma.

Medications which act on the leukotriene pathway such as zileuton, moteleukast and zafirlukast have also been found to be beneficial.

2)     Standard treatment for nasal polyps – Most patient with AERD require medication to control nasal polyp growth, chronic nasal congestion and loss of sense of smell.

Topical nasal steroids in combination with surgery are often recommended.

3)     NSAID Avoidance

Avoidance of aspirin and other NSAIDS and use of alternative medications for pain is recommended. 

4)     Aspirin desensitization to initiate daily aspirin therapy:

Aspirin desensitization is carried out by delivering increasing doses of aspirin under the guidance of an experienced Allergist/Immunologist until tolerance to a full dose is established. It is then maintained with long term therapy without interruption. In patients with AERD, daily aspirin therapy is effective in improving the overall symptoms and quality of life including:

·       Improved sense of smell and taste

·       Decreased formation of nasal polyps and sinus infections

·       Reduced need for sinus surgeries

·       Decreased corticosteroid doses and improved control of asthma

5)     Dietary Modifications:

Reduced intake of foods containing Omega-6 fatty acids and increased intake of foods rich in Omega-3 fatty acids has shown benefit in a small group of patients with AERD. http://aerd.partners.org/wp-content/uploads/2018/09/Omega-Treatment-Diet...

6)     Biological agents

Monoclonal antibodies are approved to treat patients with moderate to severe asthma and/or chronic rhinosinusitis with nasal polyps. For some patients who remain symptomatic after standard asthma and nasal polyp treatments, these therapies are beneficial and include omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab.

 

What to expect during a desensitization procedure:

The procedure is generally performed in our outpatient clinic under direct supervision of a nurse and close monitoring from your physician. Before the procedure, your physician will discuss the risks and benefits and a written informed consent is obtained. Starting with low doses of aspirin, aspirin is administered every 90 minutes until the target dose is achieved. The procedure generally takes one full to 1.5 clinic days to complete. It is anticipated that patients with AERD develop symptoms following the ingestion of aspirin. The symptoms to be expected during the procedure include: cough, chest tightness, wheezing, tearing of the eyes, itching and redness, nasal congestion and runny nose, rash or generalized itching. Low blood pressure and anaphylaxis develop in rare cases.

Once you complete your desensitization, you will need to take daily doses of aspirin the maintain the desensitized state.