AERD: Quo Vadis?

It was forty years ago when researchers working at Scripps Clinic began to notice that the initial two patients they had desensitized to aspirin were having better clinical outcomes than those who were simply avoiding aspirin. That sentinel observation led to numerous studies of cytokines and other mediators which have resulted in a better understanding of the immune dysregulation which accompanies the clinical manifestations experienced by AspirinExacerbated Respiratory Disease (AERD) patients. Thirty years ago, I was fortunate to be a young fellow who was involved with some of the early research on aspirin therapy after aspirin desensitization. AERD was previously referred to as Samter’s triad, Aspirin Sensitive RhinosinusitisAsthma, Aspirin triad and Aspirin Idiosyncrasy among others. It was long thought of as a rare disease that had no other treatments except systemic corticosteroids and, prior to the age of endoscopic sinus surgery, extremely invasive surgeries like Caldwell-Luc, external ethmoidectomy and frontal sinus obliteration with osteoplastic flaps. There has been a recent surge in the interest in AERD research. In this issue, Buchheit et al. emphasize the importance of earlier diagnosis of AERD. Fragmentation of care and lack of awareness can lead to diagnostic delays of up to 10 years in some cases. Patient safety with regard to proper avoidance of COX-1 inhibitors, tailoring of disease specific therapy and proper treatment of pain syndromes are among the important reasons for proper and prompt diagnosis. They review a clear approach emphasizing appropriate history taking and the role of aspirin challenges which should improve early detection. Olfaction is the strongest contributor to quality of life for AERD patients. Improvement in olfaction correlates well with global sinonasal symptoms. In this issue of the journal, Spielman et al. reviewed olfactory outcomes with various modalities of AERD treatment. There is considerable