Review Article

Pathogenic Mechanisms and In Vitro Diagnosis of AERD

Table 1

Terms used for reactions of NSAID-triggered hypersensitivity. NSAID: nonsteroidal anti-inflammatory drugs; COX: cyclooxygenase.

Terms usedPredominant manifestation/location of symptomsSupposed underlying pathomechanism

Syndrome de WidalAirwaysPathomechanism unknown, hyperreactivity/-sensitivity to aspirin and aspirin-like drugs
Samter’s triadAirwaysPathomechanism suspected to altered sensitivity of chemoreceptor, hyperreactivity of airway mucosa to aspirin and aspirin-like drugs
Aspirin idiosyncrasyAnywhere, ubiquitous“Peculiarity” of hypersensitive reaction to aspirin and aspirin-like drugs which is not elicit by immunoglobulin-mediated/immunologic reactions, but by dysfunction or loss of function of enzymes
Aspirin allergyAnywhere, UbiquitousInvolvement of immunoglobulin-mediated/immunological reactions directed to aspirin and aspirin-like drugs
Pseudoallergic reaction to aspirinAnywhere, ubiquitousReaction to aspirin and aspirin-like drugs, causing symptoms as seen by allergic, reactions (i.e., immunoglobulin-mediated/immunologic), but without involvement of immunological reactions
Aspirin intoleranceAnywhere, ubiquitousPathomechanism unknown/not defined, but aspirin and aspirin-like drugs are not tolerated by an individual
Aspirin sensitivityAnywhere, ubiquitousPathomechanism unknown, but hyperreactivity/-sensitivity to aspirin and aspirin-like drugs, symptomatic description
Aspirin-sensitive asthmaLower airwaysHyper-reactivity to aspirin and aspirin-like drugs causing airway obstruction
Aspirin-induced asthmaLower airwaysPathomechanism unknown, but initiated/induced by aspirin and aspirin-like drugs
Aspirin-exacerbated respiratory disease (AERD)Airways, systemicExacerbated by NSAIDs blocking COX-1 pathway
NSAID-induced rhinitis and asthma (NIRA)AirwaysExacerbated by NSAIDs blocking COX-1 pathway
NSAID-induced urticaria/angioedema (NIUA)Skin, systemicExacerbated by NSAIDs blocking COX-1 pathway
Single drug-induced urticaria/angioedema (SDUA)SkinExacerbated by a single NSAID blocking COX-1 pathway
Multi-drug-induced urticaria/angioedema (MDUA)SkinExacerbated by multiple NSAIDs blocking COX-1 pathway
Single drug-induced anaphylaxis (SDA)SystemicSensitisation to a single NSAID blocking COX pathway, suggested immunoglobulin-mediated/immunologic pathomechanism
NSAID-blended reaction (NBR)Airways, skinPathomechanism unknown; not AERD, not NIRA, presumably not immunoglobulin-mediated/immunologic