In aspirin-exacerbated respiratory disease, which statement is true?

• A. Other non-aspirin NSAIDs can precipitate reactions
• B. Only aspirin triggers the reaction
• C. Acetaminophen triggers reactions
• D. NSAIDs never trigger reactions

Answer: (A)

In aspirin-exacerbated respiratory disease, the issue is cross-reactivity to NSAIDs that inhibit COX-1, which shifts arachidonic acid metabolism toward leukotrienes and triggers bronchospasm and nasal symptoms in sensitive individuals. Because many non-aspirin NSAIDs also block COX-1, they can precipitate reactions, not just aspirin itself. Acetaminophen generally does not inhibit COX-1 in the airways, so it is usually tolerated. NSAIDs never trigger reactions and the idea that only aspirin triggers the response are not accurate.