Ep. 288 AERD: Diagnosis & Treatment Strategies with Dr. Andrew White

Aspirin or biologics? How do you choose the right treatment for AERD? On this episode of the BackTable ENT & Allergy Podcast, Dr. Basil Kahwash interviews Dr. Andrew White, Director of the AERD Clinic at Scripps Clinic, to discuss the diagnosis and management of this often underrecognized condition. They cover practical strategies for identifying AERD, the importance of a detailed NSAID history, and how treatment decisions are shaped by patient goals and disease severity. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 02:08 - What Is AERD and Prevalence 06:32 - History Taking and Mechanism 11:10 - Typical Symptom Progression and Alcohol Intolerance 16:41 - When to Do Aspirin Challenge 19:00 - Challenge Protocol And Upper Airway Reactions 24:53 - Aspirin Desensitization vs Challenge 27:58 - Aspirin therapy after desensitization and Risk of GI Bleeds 31:17 - Biologics Change AERD 33:42 - Choosing Aspirin Desensitization vs Biologics 35:52 - Patient Counseling and Motivational Interviewing 41:26 - Convenience and Cost of Therapy 44:10 - ENT Allergy Collaboration 47:22 - Rapid Fire Pearls 51:13 - Future Research & Management Direction 54:05 - Final Takeaways --- More about this episode Dr. White explains that AERD affects about 8 to 10 percent of asthmatics, with even higher rates in those with severe asthma or nasal polyps. He reviews typical adult-onset progression, alcohol-related respiratory symptoms, and the underlying pathophysiology, including imbalances in arachidonic acid mediators and leukotriene surges after NSAID exposure. The conversation includes practical questions to ask when taking an NSAID history, such as reactions to common pain relievers or alcohol, and when to consider aspirin challenge. Dr. White also details long-term treatment strategies, including the role of biologics like dupilumab and aspirin therapy after desensitization, with considerations for dosing and gastrointestinal risk. He explains how factors like asthma severity, recurrent polyp disease, sense of smell, cost, and convenience all influence therapy choice. The episode concludes with a discussion of multidisciplinary collaboration, patient counseling, and Dr. White’s insights on future research directions in AERD management. --- Resources Aspirin sensitivity and severity of asthma: evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthma https://pubmed.ncbi.nlm.nih.gov/16275362/ Polyphenolic Activation of Basophils Explains Alcohol Hypersensitivity in AERD https://pubmed.ncbi.nlm.nih.gov/41065188/ New insights into the mechanisms of aspirin-exacerbated respiratory disease https://pubmed.ncbi.nlm.nih.gov/39641750/ The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunology https://pmc.ncbi.nlm.nih.gov/articles/PMC7980229/ Safety and outcomes of aspirin desensitization for aspirin-exacerbated respiratory disease: A single-center study https://pubmed.ncbi.nlm.nih.gov/28550988/ Selection of aspirin dosages for aspirin desensitization treatment in patients with aspirin-exacerbated respiratory disease https://pubmed.ncbi.nlm.nih.gov/17208597/ Factors influencing aspirin therapy after desensitization (ATAD) tolerance in aspirin-exacerbated respiratory disease (AERD) patients https://pubmed.ncbi.nlm.nih.gov/41022281/ Feed the Good Wolf: Motivational Interviewing, Cognitive Behavioral Therapy, and Mindset https://pubmed.ncbi.nlm.nih.gov/42103433/ --- BackTable ENT & Allergy is the go-to podcast for otolaryngologists, allergists, and head and neck surgeons. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app