Updated Treatment of Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease: How to Decide on Aspirin Therapy After Desensitization or Biologics? When? How? An EAACI Task Force Report

Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NSAID-ERD) is a heterogeneous condition characterized by chronic eosinophilic airway inflammation in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma whose symptoms are aggravated after ingestion of aspirin and other NSAIDs. As a unique treatment, aspirin treatment after desensitization (ATAD) has been in use for several years after showing the inhibitory effect on CRS symptoms and nasal polyp growth as well as severe asthma. However, in recent years, biologics have also shown to cause a decrease in polyp size as well as associated outcomes such as quality of life. In this manuscript, considerations on choosing the best treatment of NSAID–ERD are laid out based on current literature.