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PubMed This is a summary of 12 peer-reviewed journal articles Updated
Rhinology · Aspirin-Exacerbated Respiratory Disease

Building Your Care Team for AERD

At a Glance

Aspirin-Exacerbated Respiratory Disease (AERD) requires a multidisciplinary medical team for effective management. Because symptoms affect the sinuses and lungs simultaneously, patients see the best results when a specialized rhinologist and a board-certified allergist coordinate treatments.

Aspirin-Exacerbated Respiratory Disease (AERD) is an aggressive, “recalcitrant” condition—meaning it is notoriously stubborn and prone to returning even after treatment [1][2]. Because it affects the nose, the lungs, and the body’s internal metabolism all at once, a single general practitioner or even a standard ENT often lacks the specialized tools to manage it alone [1][3].

The Multidisciplinary Necessity

For the best chance of long-term relief, you need a multidisciplinary team where specialists coordinate their efforts rather than working in “silos” [1][4]. Research shows that institutional experience matters: patients treated at centers where allergists and surgeons work closely together see faster improvement in both their sinus and lung symptoms [5].

Your Core Team Members

A highly effective AERD team is usually built around two key specialists:

  • The Rhinologist (ENT Subspecialist): Unlike a general ENT, a rhinologist is fellowship-trained specifically in the nose and sinuses [6].
    • Their Role: They perform the complex Endoscopic Sinus Surgery (ESS) needed to clear out aggressive polyps and, most importantly, “open the plumbing” so that medicated rinses can actually reach your sinus cavities [6][7].
  • The Allergist/Immunologist: This specialist focuses on the “metabolic fire” driving the inflammation [6].
    • Their Role: They manage the system-wide treatments, such as biologics (like dupilumab) and the “gold standard” aspirin challenge and desensitization [6][8]. Because desensitization requires a safely equipped clinic and hours of monitoring, many general allergists do not offer it [8][9].

The Benefit of Specialized Centers

In a general practice, you might see an ENT for surgery, but then your asthma is managed by a different doctor who doesn’t realize how the two are linked. At a Center of Excellence or a specialized AERD clinic:

  • Coordinated Timing: Your doctors will plan the exact timing of your surgery so that it can be followed immediately by aspirin desensitization or biologics, which is the most effective way to prevent polyps from growing back [6][10].
  • Advanced Experience: These teams are familiar with the specific “Type 2” inflammation markers of AERD and can pivot quickly to newer treatments if a standard approach fails [11][12].

How to Build Your Team

If you suspect you have AERD but are currently seeing generalists, you may need to be your own advocate. Look for doctors who specifically mention Samter’s Triad or NSAID-Exacerbated Respiratory Disease (N-ERD) on their professional profiles [1]. A clear indicator of a qualified team is a practice that has an established protocol for in-office aspirin desensitization—a procedure that requires high-level expertise and specific emergency equipment [8][9].

Common questions in this guide

What type of doctor treats AERD?
AERD is best managed by a multidisciplinary team led by a rhinologist (a specialized ENT) and an allergist or immunologist. The rhinologist handles sinus surgery, while the allergist manages systemic treatments like aspirin desensitization and biologics.
Why do I need a rhinologist instead of a general ENT for AERD?
AERD causes aggressive, recurring nasal polyps that require complex endoscopic sinus surgery. A rhinologist is fellowship-trained specifically in the nose and sinuses, giving them specialized experience to safely clear polyps and open sinus pathways so medicated rinses can work.
Where can I get aspirin desensitization for AERD?
Aspirin desensitization should be performed by an allergist in a clinic equipped with specific emergency monitoring equipment. Many general allergy practices do not offer this procedure because it requires hours of careful observation and specialized protocols.
Why is treatment timing so important for AERD?
Proper treatment timing is critical to prevent nasal polyps from growing back rapidly. The most effective approach involves doctors coordinating care so that sinus surgery is followed immediately by aspirin desensitization or targeted biologic medications.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How frequently do you coordinate with the other specialist on my team—if you are my allergist, how often do you speak with my rhinologist?
  2. 2.Are you fellowship-trained in rhinology or a board-certified allergist with a specific interest in Samter's Triad?
  3. 3.Do you perform aspirin challenges and desensitization in your office, and what safety protocols are in place for emergencies?
  4. 4.Do you have a preferred sequence for my treatment, such as surgery followed immediately by a biologic or aspirin desensitization?
  5. 5.What experience do you have in managing the high rate of polyp recurrence specifically in AERD patients?

Questions For You

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References

References (12)
  1. 1

    What's New in the Diagnosis and Treatment of Aspirin-Exacerbated Respiratory Disease: A Brief Review.

    Douglas JE, Bosso JV

    American journal of rhinology & allergy 2023; (37(2)):198-206 doi:10.1177/19458924221145254.

    PMID: 40071630
  2. 2

    Management of Aspirin-Exacerbated Respiratory Disease: What Does the Future Hold?

    O'Brien EK, Jerschow E, Divekar RD

    Otolaryngologic clinics of North America 2024; (57(2)):265-278 doi:10.1016/j.otc.2023.09.006.

    PMID: 37833102
  3. 3

    Clinical evaluation and diagnosis of aspirin-exacerbated respiratory disease.

    Haque R, White AA, Jackson DJ, Hopkins C

    The Journal of allergy and clinical immunology 2021; (148(2)):283-291 doi:10.1016/j.jaci.2021.06.018.

    PMID: 34364538
  4. 4

    Treatment practices for aspirin-exacerbated respiratory disease: analysis of a national insurance claims database.

    Roland LT, Nagy C, Wang H, et al.

    International forum of allergy & rhinology 2020; (10(2)):190-193 doi:10.1002/alr.22471.

    PMID: 31693796
  5. 5

    Institutional Experience in Aspirin-Exacerbated Respiratory Disease Yields Favorable Pulmonary and Sinonasal Outcomes.

    Douglas JE, Tang SH, Mani A, et al.

    Ear, nose, & throat journal 2025; 1455613251356359 doi:10.1177/01455613251356359.

    PMID: 40613262
  6. 6

    Update on aspirin exacerbated respiratory disease with chronic rhinosinusitis.

    Gandre JR, Ledford DK

    Current opinion in allergy and clinical immunology 2025; (25(1)):10-18 doi:10.1097/ACI.0000000000001054.

    PMID: 39641754
  7. 7

    Quantifying surgical completeness in patients with aspirin exacerbated respiratory disease.

    Levin M, Chan Y, Sommer DD, et al.

    Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2023; (52(1)):83 doi:10.1186/s40463-023-00682-1.

    PMID: 38105254
  8. 8

    Performing Aspirin Desensitization in Aspirin-Exacerbated Respiratory Disease.

    Waldram JD, Simon RA

    Immunology and allergy clinics of North America 2016; (36(4)):693-703 doi:10.1016/j.iac.2016.06.006.

    PMID: 27712764
  9. 9

    A survey of aspirin desensitization practices among allergists and fellows in training in the United States.

    Waldram JD, White AA

    The journal of allergy and clinical immunology. In practice 2016; (4(6)):1253-1255 doi:10.1016/j.jaip.2016.06.016.

    PMID: 27452889
  10. 10

    Biomarkers for predicting response to aspirin therapy in aspirin-exacerbated respiratory disease.

    Tyrak KE, Pajdzik K, Jakieła B, et al.

    Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 2021; (51(8)):1046-1056 doi:10.1111/cea.13886.

    PMID: 33905579
  11. 11

    Aspirin-exacerbated respiratory disease in the era of biologics.

    Laidlaw TM

    Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2025; (135(4)):366-373 doi:10.1016/j.anai.2025.06.001.

    PMID: 40490219
  12. 12

    IL-4Rα signaling promotes barrier-altering oncostatin M and IL-6 production in aspirin-exacerbated respiratory disease.

    Chen CC, Buchheit KM, Lee PY, et al.

    The Journal of allergy and clinical immunology 2024; (154(2)):458-467.e3 doi:10.1016/j.jaci.2024.04.020.

    PMID: 38704098

This page provides educational information on building a care team for AERD and does not replace professional medical advice. Always consult with a qualified allergist or rhinologist to determine the best treatment plan for your specific condition.

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