differences in adverse effects have been measured between delivery methods. Aspirin desensitization and therapy Avoidance of NSAID medications will not stop the progression of the disease. However one treatment option is desensitization to aspirin, undertaken at a clinic or hospital specializing in such treatment. Patients who are desensitized then take a maintenance dose of aspirin daily to maintain their desensitization. The recommended maintenance dose for symptom control is 650 mg to 1300 mg aspirin daily. While on daily aspirin, patients experience improved quality of life and reduced nasal symptoms, however there is no improvement in smell compared to placebo and there is no reduction in the need for oral corticosteroids or rescue surgery. Once desensitized to aspirin, most patients can safely take other NSAID medications again as long the daily maintenance dose is continued. Risk of adverse advents such as bleeding or gastrointestinal side effects is relatively high with daily aspirin therapy. Even an 81 mg daily aspirin regimen for cardiovascular benefits has been shown to increase risk of long-term bleeding, so the significantly higher aspirin doses used for maintenance therapy are of some concern. This is borne out in studies on AERD patients—compared against standard of care and biologic medicines, aspirin therapy has a significantly higher rate of adverse outcomes. Biologics Various novel biologic monoclonal antibody medications that have come to market in recent years have been used to treat AERD including dupilumab, mepolizumab, omalizumab, and benralizumab. Among treatment options, biologics have the highest certainty and magnitude of improvement effect. However, due to the high cost and systemic nature of biologics, some patients whose symptoms are sufficiently controlled with other treatments may prefer to avoid them or not qualify under stricter prescription guidelines. Among biologics and aspirin desensitization and therapy, dupilumab (Dupixent) was show to be the most effective across six different patient-important outcomes. Dupilumab and omalizumab have been shown to increase aspirin tolerance in AERD patients, however mepolizumab does not appear to have this effect. The mechanism through which dupilumab treats AERD and restores aspirin tolerance is not fully understood, but it is theorized that by blocking IL-4, dupilumab increases EP2 expression back to normal levels, normalizing COX function and PGE2 production. Antileukotrienes Leukotrienes are a family of inflammatory mediators derived from arachidonic acid that include CysLTs implicated in AERD pathophysiology. Drugs that prevent leukotriene production, such as zileuton, and that block leukotriene receptors, such as montelukast and