It’s a trifecta of chronic diseases, with three conditions rolled into one — asthma, sinus infections and recurring nasal polyps, and a negative reaction to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs).
Known as aspirin-exacerbated respiratory disease (AERD), or Samter’s Triad, this condition also has a fourth component that further affects a person’s quality of life — an allergy-like response to drinking alcohol.
When many people with AERD drink alcohol, they develop nasal congestion, a runny nose, wheezing, or shortness of breath. These usually start within an hour of having a drink.
But there’s good news. A new study found that a common treatment for AERD can reduce many of these symptoms, and may allow people to have the occasional drink again.
Loss of smell and alcohol intolerance
Dr. John Bosso, a co-author on the new study, said that about 75 to 80 percent of patients who have AERD are intolerant to alcohol.
On top of this, the condition may also impair their sense of smell and taste due to nasal symptoms. This can severely impact their quality of life.
“Sense of smell is probably number one for these patients, in terms of the thing they want back the most. I think it sometimes even causes them to be somewhat depressed and upset about the disease,” said Bosso, director of Penn Medicine’s Otorhinolaryngology Allergy Clinic and medical director of the Penn AERD Center in Philadelphia.
Lack of smell can rob people of many of life’s pleasures, such as enjoying their food. Alcohol intolerance is not far behind.
“Next to sense of smell, the inability to drink alcohol is definitely one of the things people get bummed about — that they can’t have a glass of wine or beer once in a while,” said Bosso.
According to the American Academy of Allergy, Asthma & Immunology (AAAAI), most people with AERD need to take daily medications to control their symptoms. These include inhaled corticosteroids for asthma, intranasal steroids for nasal symptoms, and steroids injected directly into the polyps.
People may also need endoscopic sinus surgery to remove nasal polyps. These benign growths in the sinus cavities often return after surgery, though.
The reason that AERD also has symptoms after drinking is due to chemicals in the alcohol that block an enzyme called cyclooxygenase, which makes people with AERD develop sinus and asthma symptoms.
“In addition to aspirin, a group of naturally occurring substances found in plants known as polyphenols can also block cyclo-oxygenase,” the AAAAI writes. “Polyphenols are frequently found in red wine, where they come from the grape skin, and in beer, where they come from the barley and hops added to the brew.”
A common treatment for AERD — known as aspirin desensitization — can reduce many of the symptoms of AERD, including the regrowth of polyps.
In this treatment, a doctor gives a patient gradually increasing doses of aspirin to help the person become less sensitive to NSAIDs. Patients need to continue taking aspirin daily in order to maintain their desensitization.
The reaction to NSAIDs in people with AERD isn’t a true allergy because it doesn’t involve the production of antibodies.
The Penn AERD Center uses a multidisciplinary approach to this condition — aspirin desensitization to reduce the growth of future polyps, and surgery to remove existing polyps.
Treatment reduces alcohol symptoms
Aspirin desensitization has other benefits. One of these is the return of peoples’ sense of smell and taste. And, it turns out, the ability to drink alcohol without unpleasant symptoms.
Doctors, including Bosso, had heard stories before from people with AERD that they could drink alcohol again after aspirin desensitization.
In this published case study, a 56-year-old man reported significant runny nose and facial flushing while drinking, but after undergoing aspirin desensitization he was able to drink without issue.
“Significantly, he self-challenged to wine, grain liquor, and beer without any symptoms and continues to tolerate these beverages without issue,” the authors wrote.
But that was a single case study and until now, no one had done a thorough study of this additional benefit.
But in this recent study published July 10th in the International Forum of Allergy and Rhinology, Bosso and his colleagues asked 37 people undergoing aspirin desensitization a series of questions about their intolerance to alcohol after surgery.
They asked questions before and after treatment, including what kind of reaction people had, and how long after they drank alcohol the reaction occurred.
“About 86 percent of patients showed significant improvement in their ability to tolerate alcohol — for about 70 percent it was pretty dramatic,” said Bosso. “I think it’s made their lives a little bit more ‘normal.’”
These improvements also fit with improvements seen in other symptoms.
“People who really say that they’re able to drink alcohol seem to have very good control of their disease now,” said Bosso, including regaining their sense of smell, less congestion, and having fewer sinus infections and asthma flare-ups.
There are, of course, both benefits and drawbacks to surgery and aspirin desensitization, and not everyone’s symptoms improve.
But given the new study results, Bosso said he now feels more confident about including “being able to enjoy a drink of alcohol again” as one of the potential benefits when he talks to patients about treatment for AERD.
“I don’t think [alcohol tolerance] is the selling point for why people should undergo treatment exclusively,” said Bosso. “But it’s one extra thing to add to the ‘pro’ column.”