allergies, common asthma, and/or nonallergic rhinitis. AERD is generally diagnosed based on a patient's medical history, however an oral aspirin challenge at a specialized facility is considered the most definitive method of diagnosis. Patients are considered candidates for an AERD diagnosis if they meet the following three points: History of adverse reactions to aspirin or other NSAIDs Reduced ability to smell (hyposmia or anosmia) History of rhinosinusitis and nasal polyps Further, if a patient meets two or more of the following criteria, then an AERD diagnosis is strongly considered: Moderate or severe asthma Asthma with an intractable cough Onset of asthma after adolescence A weakly atopic disposition 10% or greater increase in peripheral eosinophilia High urinary leukotriene E (uLTE) concentration is also a sign of AERD, especially when noted in conjunction with the criteria listed above due. High uLTE concentration alone cannot be used to diagnose AERD, however it may be possible to rule out AERD in patients without high uLTE due to its strong negative predictive value. Urinary LTE concentration is generally around 3 to 5 times higher in patients with AERD that it is in those with aspirin-tolerant asthma, and increases 2 to 30 fold during an aspirin challenge test. Management Medication Since nasal polyps have been identified as an important source of inflammatory compounds in AERD, much effort goes into the prevention of polyp growth and control of sinus symptoms in general. There is evidence supporting four different long-term pharmacological treatments to this end: intra-nasal corticosteroids, aspirin desensitization and therapy, a range of biologic medicines, and antileukotrienes. Each treatment has benefits and drawbacks, so no one option can be recommended for all patients. Asthma symptoms, if not controlled via biologics or other means, are managed with standard asthma treatments such as inhaled corticosteroids and long-acting beta-agonists. Despite optimal medical management, many patients continue to require oral steroid medications to alleviate asthma and chronic nasal congestion. Intra-nasal corticosteroids Common corticosteroids such as fluticasone or budesonide are often used as a first line treatment for AERD. They can be delivered topically to the nasal and sinus mucosa via a variety of methods, such as nasal spray, rinse, drops, stents and exhalation delivery systems. Overall effectiveness is low-to-moderate, but wide availability and low cost make this a widely used treatment option. Stent, spray and exhalation delivery systems are generally among the most beneficial depending on outcome measured, while no major