Published online: November 10, 2017
Aspirin-exacerbated respiratory disease (AERD) is characterized by asthma, nasal polyps, and sensitivity to aspirin and other nonsteroidal anti-inflammatory (NSAID) medications. Dysregulated metabolism of arachidonic acid, an omega-6 fatty acid (FA), drives the overproduction of leukotrienes and other inflammatory lipids in AERD and is therefore a primary contributor to its classic nasal and respiratory symptoms. Since FAs consumed in the diet are precursors to arachidonic acid, dietary alterations may offer therapeutic benefit to individuals with AERD. Over the past century in the United States, dietary omega-6 FA intake has dramatically increased with respect to its anti-inflammatory counterparts, omega-3 FAs. Whereas humans consumed relatively equivalent quantities of omega-6 and omega-3 in the early 20th century, the ratio in the modern Western diet is estimated to be 30:1.
In an article published in The Journal of Allergy and Clinical Immunology: In Practice, Schneider and colleagues hypothesized that adoption of a diet low in omega-6 FAs and high in omega-3 FAs would decrease production of inflammatory lipid mediators, thereby improving nasal and respiratory symptoms of AERD. After a two-week period of maintaining their typical diet, ten subjects with AERD were instructed to increase omega-3 FA intake to more than three grams per day and decrease omega-6 intake to less than four grams per day. At baseline and after the two-week treatment period, participants completed questionnaires evaluating sinonasal symptoms and asthma control, and various markers of inflammation in the blood and the urine were assessed.
In the ten participants who completed the dietary intervention, levels of urinary leukotrienes and other lipid metabolites significantly decreased. Sinonasal symptom scores and asthma control scores improved, though the change in reported asthma control did not meet criteria for clinical significance. All patients lost some weight over the two-week intervention period, and the diet was safe and well tolerated.
As asthma and nasal polyps tend to have greater severity and recurrence, respectively, in AERD, a diet high in omega-3 FAs and low in omega-6 FAs may provide a useful non-pharmaceutical adjunct for this patient population.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.