Background A large percentage of patients with aspirin exacerbated respiratory disease (AERD) statement the development of alcohol-induced respiratory reactions but Letaxaban (TAK-442) the true prevalence of respiratory reactions caused by alcoholic beverages in these patients was not known. AERD 2 aspirin-tolerant asthmatics (ATA) 3 aspirin-tolerant patients with chronic rhinosinusitis (CRS) and 4) healthy controls. Two-tailed Fisher’s exact test with Bonferroni corrections were used to compare the prevalence of respiratory symptoms between AERD and other groups with Letaxaban (TAK-442) P≤0.017 considered significant. Results The prevalence of alcohol-induced upper (rhinorrhea/nasal congestion) respiratory reactions in patients with AERD was 75% compared to 33% in ATA 30 in CRS and 14% in healthy controls (P<0.001 for all those comparisons). The prevalence of alcohol-induced lower (wheezing/dyspnea) respiratory reactions in AERD was 51% compared to 20% in ATA and 0% in both CRS and healthy controls (P<0.001 for all those comparisons). These reactions were generally not specific to one type of alcohol and often occurred after ingestion of only a few sips of alcohol. Conclusion Alcohol ingestion causes respiratory reactions in the majority of patients with AERD and clinicians should be aware that these alcohol-induced reactions are significantly more common in AERD than in aspirin-tolerant controls. Keywords: Samter’s Triad Aspirin Exacerbated Respiratory Disease AERD Aspirin Intolerant Asthma Aspirin triad Non-steroidal anti-inflammatory drugs Asthma Alcohol Wine Leukotriene Introduction Aspirin Exacerbated Respiratory Disease (AERD) is usually characterized clinically by the triad of asthma recurrent nasal polyposis and hypersensitivity to cyclooxygenase (COX)-1 inhibitors.1 This asthma subtype accounts for 5%-10% of adult asthmatics 2 yet represents a disproportionately high proportion of severe asthma cases3 and can be hard to diagnose and treat. Formal aspirin difficulties are required for definitive diagnosis of AERD 10 in part because self-reported aspirin sensitivity is not reliably predictive 11 and because many asthmatics do not use nonsteroidal anti-inflammatory drugs regularly and may be unaware of their hypersensitivity.15 Alcohol-induced respiratory reactions have been reported with rates varying from 20-40% in asthmatics4-6 and occasionally in patients Letaxaban (TAK-442) with rhinitis7 and in the general population.8 However the majority of our patients with AERD explained going through respiratory reactions following alcohol ingestion with a seemingly greater prevalence than that known for other patient groups and several patients with AERD reported that alcohol experienced induced frightening lower respiratory symptoms and acute asthma exacerbations. Though an association between aspirin sensitivity and alcohol-induced reactions in asthmatics has been suggested 4 5 9 these reactions have never been characterized in a well-phenotyped group of patients with aspirin challenge-confirmed AERD. Additionally we found no published data regarding the characteristics of alcohol-induced respiratory reactions in patients MAPTL with AERD. To address these issues and explore the potential mechanisms underlying alcohol-induced reactions we designed a questionnaire to investigate the incidence and frequency of reactions and to Letaxaban (TAK-442) examine details including time to onset of reactions amount of alcohol required to induce reactions and type of alcohol most likely to cause reactions. Letaxaban (TAK-442) We offered participation in this multi-centered questionnaire-based study to aspirin challenge-confirmed Letaxaban (TAK-442) patients with AERD and to three clinically-defined control groups: patients with aspirin-tolerant asthma (ATA) chronic rhinosinusitis (CRS) and healthy controls. Our findings show that patients with AERD statement a strikingly high prevalence of both upper and lower respiratory reactions induced by alcohol; this observation furthers the clinical characterization of AERD and may suggest its diagnosis. Methods Patients and human subject characterization Study participants between the ages of 21 and 75 were recruited from your Brigham and Women’s Hospital Allergy and Asthma and Otolaryngology clinics and from your Scripps Clinic’s Allergy and Asthma medical center..