Understanding AERD and Its Dietary Link
Aspirin-Exacerbated Respiratory Disease (AERD) is a chronic inflammatory condition characterized by a unique set of symptoms: asthma, recurrent nasal polyps, and an allergic-type reaction to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Patients with AERD experience an overproduction of inflammatory lipids called leukotrienes and prostaglandins, which trigger respiratory symptoms like wheezing, congestion, and shortness of breath.
While NSAIDs are a primary trigger, many AERD patients also find that certain foods can worsen their symptoms. The most significant dietary triggers are naturally occurring compounds called salicylates, found in many plant-based foods, and alcohol. By understanding and managing dietary intake, many individuals can achieve better symptom control in conjunction with medical treatment.
High-Salicylate Foods to Avoid
Salicylates are natural compounds derived from salicylic acid that plants produce as a defense mechanism. They are chemically similar to aspirin, which is why they can cause similar inflammatory reactions in sensitive AERD patients. Strict adherence to a low-salicylate diet is challenging and should be done under medical supervision, but reducing high-salicylate foods can make a notable difference for many.
Fruits with High Salicylate Content
- Berries (blueberries, blackberries, raspberries, cranberries, strawberries)
- Dried fruits (raisins, prunes, dates)
- Cherries, grapes, oranges, pineapple, plums, and prunes
Vegetables with High Salicylate Content
- Broccoli, spinach, and zucchini
- Tomatoes and tomato-based products
- Peppers (capsicum), radishes, and cucumbers
- Olives and pickles
Herbs, Spices, and Condiments
- Curry powder, paprika, cumin, turmeric, oregano, and thyme
- Mint, cinnamon, and cloves
- Vinegars (red, white, and cider)
- Worcestershire sauce and most salad dressings
Other Sources
- Honey
- Almonds and peanuts
- Coffee and tea
The Impact of Alcohol on AERD
One of the most common dietary triggers for AERD is alcohol, with studies showing that a significant majority of patients experience respiratory symptoms after ingestion. These reactions can occur even after consuming small amounts and may include nasal congestion, wheezing, and shortness of breath.
- Polyphenols: Compounds found in red wine and beer, derived from grape skins, barley, and hops, are believed to be a contributing factor.
- Sulfites: These preservatives are common in wine, beer, and many other foods, and are known to worsen asthma symptoms in sensitive individuals.
- Acetaldehyde: A recent study suggests that an enzyme deficiency in the respiratory tract of AERD patients, driven by inflammation, may lead to an inability to properly metabolize alcohol-derived acetaldehyde, resulting in mast cell activation and respiratory reactions.
Clear liquors like vodka or gin generally contain fewer polyphenols and may be tolerated better by some, but complete avoidance is often the safest approach.
Food Additives and Processed Foods
Beyond salicylates and alcohol, certain food additives can also trigger adverse reactions in sensitive AERD individuals. Processed and junk foods should generally be minimized or avoided due to their high content of inflammatory ingredients.
- Sulfites: Used as preservatives in dried fruits, bottled juices, and certain condiments.
- Artificial Colorings: Dyes like tartrazine have been suspected of causing reactions, although conclusive evidence is mixed.
- MSG: This flavor enhancer has been linked to asthma exacerbations in some patients.
- Highly Processed Foods: High in saturated fats, sugar, and refined carbohydrates, these foods contribute to overall inflammation, which can worsen AERD symptoms.
Omega-3 vs. Omega-6 Fatty Acids
Research has explored the effect of fatty acids on AERD inflammation. Omega-6 fatty acids, abundant in common vegetable oils and processed foods, are precursors to inflammatory leukotrienes. In contrast, omega-3 fatty acids possess anti-inflammatory properties.
A 2018 study found that a high omega-3/low omega-6 diet significantly decreased inflammatory markers and improved patient-reported symptoms in AERD patients. This suggests that modifying the balance of fatty acids in your diet may be a valuable non-pharmaceutical adjunct treatment.
High omega-6 foods to limit:
- Corn oil, soybean oil, safflower oil, sunflower oil
- Processed meats and fried foods
High omega-3 foods to include:
- Fatty fish (salmon, sardines)
- Seeds (flaxseed, chia seeds)
- Nuts (walnuts)
Low-Salicylate Diet Comparison Table
| Food Category | High-Salicylate Example (Avoid/Limit) | Low-Salicylate Alternative (Safe for Many) |
|---|---|---|
| Fruits | Berries, oranges, grapes, dried fruits | Peeled pears, bananas, golden delicious apples |
| Vegetables | Tomatoes, peppers, broccoli, spinach | Cabbage, celery, iceberg lettuce, white potatoes (peeled) |
| Spices/Herbs | Curry, paprika, thyme, mint, cinnamon | Parsley, salt, carob |
| Beverages | Wine, beer, coffee, black/green tea | Water, milk, whiskey, gin |
| Nuts/Seeds | Almonds, peanuts, pine nuts | Cashews, poppy seeds |
Conclusion
Adopting a tailored nutrition diet is a practical and effective way for many individuals to help manage Aspirin-Exacerbated Respiratory Disease symptoms alongside their prescribed medical treatments. By understanding what foods should be avoided with AERD, particularly high-salicylate items, alcohol, and certain additives, patients can significantly reduce inflammatory triggers and potentially improve their quality of life. Shifting toward an anti-inflammatory diet rich in omega-3 fatty acids and fresh, whole foods can provide further benefits. It is important to note that a low-salicylate diet is not a cure and is best implemented with the guidance of a healthcare provider or a registered dietitian to ensure proper nutrition.
For more information and resources on managing AERD, you can visit the Samter's Society website.
