Is aspirin desensitization indicated for the treatment recalcitrant chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease?

BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) in aspirin-exacerbated respiratory disease (AERD) represents a severe chronic rhinosinusitis (CRS) phenotype with increased sinonasal inflammation and worse health-related quality-of-life (HRQoL) compared to CRSwNP without aspirin sensitivity. Conventional treatment strategies frequently fail to control this recalcitrant form of airway inflammation, with 37% of patients requiring revision endoscopic sinus surgery (ESS) within 5 years of their first procedure. Aspirin desensitization represents a treatment option for patients with AERD, with associated benefits extending beyond those seen with strict acetylsalicylic acid avoidance. However, broad utilization remains limited due to heterogeneous outcome studies, availability, and concerns of adverse reactions associated with long-term therapeutic daily aspirin therapy.