title: Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease: an evidence-based review with recommendations.
abstract: Chronic rhinosinusitis (CRS) in aspirin-exacerbated respiratory disease (AERD) represents a recalcitrant form of sinonasal inflammation for which a multidisciplinary consensus on patient management has not been reached. Several medical interventions have been investigated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the multidisciplinary management of CRS in AERD.
  
  
  
  A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria included: adult population >18 years old; CRS based on published diagnostic criteria, and a presumptive diagnosis of AERD. We focused on reporting higher-quality studies (level 2 or higher) when available, but reported lower-quality studies if the topic contained insufficient evidence. Treatment recommendations were based on American Academy of Otolaryngology (AAO) guidelines, with defined grades of evidence and evaluation of research quality and risk/benefits associated with each treatment.
  
  
  
  This review identified and evaluated the literature on 3 treatment strategies for CRS in AERD: dietary salicylate avoidance, leukotriene modification, and desensitization with daily aspirin therapy.
  
  
  
  Based on the available evidence, dietary salicylate avoidance and leukotriene-modifying drugs are options following appropriate treatment with nasal corticosteroids and saline irrigation. Desensitization with daily aspirin therapy is recommended following revision endoscopic sinus surgery (ESS).
authors.affiliation: Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Levy
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
authors.affiliation: Allergy Division, Department of Internal Medicine, Northwestern University, Chicago, IL.
authors.forename: Anju T
authors.initials: AT
authors.lastname: Peters
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Wise
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
authors.affiliation: Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D055963:Asthma, Aspirin-Induced / Q000517:prevention & control / Q000628:therapy*; D002908:Chronic Disease; D006801:Humans; D009298:Nasal Polyps / Q000628:therapy*; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*
keywords: aspirin; asthma; evidence-based practice; respiratory track diseases; review; sinusitis