"One type of adverse reaction to ASA and NSAIDs occurs in people that have asthma, nasal polyps and chronic sinusitis. They may experience significant shortness of breath, wheezing and nasal congestion. This condition is known as aspirin-exacerbated respiratory disease (AERD)." archived here: http://archive.li/dPlWn

"Another type of reaction occurs in some people who already have chronic urticaria. Approximately 20% to 40% of patients with underlying chronic idiopathic urticaria will have worsening of their hives or swelling (angioedema) when they take either ASA or NSAIDs."

"Still other reactions consistent with an allergy to ASA or NSAIDs occur in people with none of these pre-existing conditions and may occur after years of successfully taking the medicine in question. Some people may only react to one specific medication and not all NSAIDs."

Diagnosis

"The diagnosis of a hypersensitivity to both ASA and NSAIDs is a clinical one, since the symptoms are usually clear. However, there are no skin tests or blood tests that can easily determine if someone is allergic or hypersensitive to ASA or NSAIDs. Allergists may occasionally recommend an oral challenge, particularly if it is suspected that a patient may not be allergic to all NSAIDs. This procedure is performed under observation in a hospital or clinic setting because of the risk of a reaction."

Treatment and Management

"For those that do have reactions to ASA or NSAIDs, the treatment is complete avoidance. It is very important for patients to read all labels of both prescription and over-the-counter medications since many contain variations of either ASA or NSAIDs and to check with their physician or pharmacist if they have any doubts. For example, some topical preparations (gels) and oral preparations for upset stomachs may contain ASA or related medications."

https://www.allergy.org.au/patients/drug-allergy/allergic-reactions-to-aspirin-and-other-pain-killers

2009 Harvard Medical School Health Publishing - In the red: In the digestive tract, COX-1 makes hormone-like compounds called prostaglandins. Prostaglandins help protect cells in the lining of the stomach and intestines from the corrosive action of acids and digestive enzymes. By blocking COX-1, aspirin turns down the production of prostaglandins. This can lead to anything from a mild feeling of heartburn to bleeding ulcers. Since aspirin also makes it more difficult for blood to clot, a bleeding ulcer can lead to serious blood loss."

"The other downside of aspirin use is an increased risk of bleeding (hemorrhagic) stroke. This type of stroke occurs when a blood vessel in the brain bursts. By interfering with blood clotting, aspirin can promote hemorrhagic strokes or make them worse. Hemorrhagic strokes are less common than ischemic strokes, accounting for about 20% of all strokes, but they tend to be more damaging than ischemic strokes."

Some of the 50 million Americans who take aspirin for their hearts' sake shouldn't be taking it; others who need aspirin aren't taking it.

Updated recommendations from the U.S. Preventive Services Task Force fill in two big gaps — about aspirin for women and about the safest dose to take (Annals of Internal Medicine, March 17, 2009). But the recommendations don't provide a cookie-cutter approach. Instead, they emphasize weighing the benefits of aspirin therapy against the risks. This isn't differential calculus, but it does require a few numbers, some thought, and input from a trusted physician to make a good decision.

Aspirin-exacerbated respiratory disease (AERD)

The article regarding AERD states:

In general, AERD develops quite suddenly in adulthood, usually between the ages of 20 and 50, and there is no clearly understood trigger that causes the disease.

The characteristic feature of AERD is that patients develop reactions to aspirin and other NSAIDs. These reactions classically involve both upper respiratory symptoms (increasednasal congestion, frontal headache or sinus pain, and sneezing) as well as lower respiratory symptoms (cough, wheezing, chest tightness), but they can also induce skin flushing, rash, abdominal pain and occasionally vomiting.

The diagnosis of AERD is a clinical one, meaning that there is no one specific test or blood result that alone can be used to diagnose the disease. The symptom triad of asthma plus nasal polyps plus respiratory reactions to NSAIDs is all that is needed for the diagnosis.

However, for patients in whom their history of possible reaction to an NSAID is not clear,it is often helpful to do a formal aspirin challenge to confirm the diagnosis. This can be done either as an oral challenge, or as a combination of an intranasal and oral challenge, andthe procedure is done in a hospital or clinic with an experienced doctor and medical team.

Additionally, people with AERD have large numbers of eosinophils in their nasal polyps and often have elevated levels of eosinophils in their blood. Eosinophils are a type of immune cell that is involved in inflammation. Though the presence of an elevated eosinophil level is not required as part of the diagnosis, it can be a helpful additional insight for these patients. Eosinophils is related to white blood counts and Joans WBC was frequently elevated.

http://archive.li/dPlWn

Merck Manuals - Elevated Eosinophil / White Blood Cells (WBC)

Additionally, people with AERD have large numbers of eosinophils in their nasal polyps and often have elevated levels of eosinophils in their blood. Eosinophils are a type of immune cell that is involved in inflammation. Though the presence of an elevated eosinophil level is not required as part of the diagnosis, it can be a helpful additional insight for these patients. Eosinophils is related to white blood counts and Joans WBC was frequently elevated.

https://www.merckmanuals.com/home/blood-disorders/white-blood-cell-disorders/eosinophilic-disorders