Treatment of Aspirin Exacerbated Respiratory Disease with a Low Salicylate Diet: A Pilot Crossover Study

Abstract

Objective Aspirin exacerbated respiratory disease (AERD) is comprised of aspirin/acetylsalicylic acid (ASA) sensitivity, bronchial asthma, and nasal polyposis. Treatment of this condition is challenging and may include topical/systemic steroids, endoscopic sinus surgery, and/or aspirin desensitization. Study Design A prospective crossover pilot study (n = 10) was conducted in which patients were randomized into either of 2 groups with 6 weeks of regular diet (R) or 6 weeks of a low salicylate diet (LS). Setting The study was conducted in a tertiary otolaryngology clinic. Subjects Patients with AERD were enrolled in the study. Methods Subjective (Sino‐nasal Outcome Test‐22 [SNOT‐22], Nasal Sinus Symptom Scale [NSSS], and the Asthma Control Questionnaire‐7 [ACQ‐7]) and objective outcome instruments (Peri‐Operative Sinus Evaluation [POSE] and Lund‐Kennedy Endoscopic Score [LKES]) were used to evaluate patients at baseline, 6 weeks (at crossover), and 12 weeks. Results Wilcoxon rank sum tests demonstrated that patients on the low salicylate diet had improved scores compared to their regular diet when evaluated by 4 of the 5 outcome measures (SNOT‐22 p LS = 0.0059, NSSS p LS = 0.0195, LKES p LS = 0.0039, POSE p LS = 0.005). Conclusion Results of the pilot study indicate that implementation of a low salicylate diet improves the nasal symptoms and nasal endoscopy findings of individuals with AERD. Further research is required to support these findings.