AERD and ETOH

Q: 32 years old male with a known history of asthma is admitted to ICU with acute asthma exacerbation after a dorm party where he consumed alcohol. He denied the use of aspirin or NSAIDs. Which disease needs to be ruled out? 

Answer: Aspirin-exacerbated respiratory disease (AERD)

AERD, popularly known as the Samter triad, consists of

• asthma
• aspirin sensitivity, and 
• nasal polyps

For reason not fully understood, most patients have high reactions when they consume alcoholic beverages. However, they have no exposure to aspirin (ASA) or Non-Steroidal Anti -Inflammatory Drugs (NSAIDs). Symptoms include nasal congestion, rhinorrhea, wheezing, and shortness of breath. Symptoms usually appear within an hour of ingestion.

#pulmonary

References:

1. Samter M, Beers RF Jr. Intolerance to aspirin. Clinical studies and consideration of its pathogenesis. Ann Intern Med 1968; 68:975.

2. Ta V, White AA. Survey-Defined Patient Experiences With Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract 2015; 3:711.

3. Cardet JC, White AA, Barrett NA, et al. Alcohol-induced respiratory symptoms are common in patients with aspirin exacerbated respiratory disease. J Allergy Clin Immunol Pract 2014; 2:208.