CRSwNP & N-ERD (AERD) pathway

Diagnoses CRSwNP, identifies N-ERD, and sequences medical therapy, biologics, and aspirin desensitization per the 2023 JTFPP GRADE guideline. Links the SNOT-22 calculator.

Evidence tier: Guideline-derived.

Decision points

  • Aspirin/NSAID respiratory reactions?
  • Uncontrolled after optimized therapy/surgery?
  • Escalation route: is this N-ERD?

Do-not-miss pitfalls

  • Do not confuse isolated allergic rhinitis with CRSwNP, CRSwNP needs objective polyp confirmation.
  • Do not miss immunodeficiency, cystic fibrosis, primary ciliary dyskinesia, or fungal disease in recurrent/refractory sinusitis.
  • Do not perform aspirin challenge in uncontrolled asthma or with FEV1 <70% predicted.
  • Do not ignore NSAID history in nasal-polyp patients, and remember COX-2 inhibitors are generally tolerated in N-ERD.
  • Do not assume all anti-IL-5 agents carry a CRSwNP indication, benralizumab is not FDA-approved for it.

Evidence & citations

  1. Rank MA, Chu DK, Bognanni A, et al. The Joint Task Force on Practice Parameters GRADE guidelines for the medical management of chronic rhinosinusitis with nasal polyposis. J Allergy Clin Immunol. 2023;151(2):386-398. PMID 36370881
  2. Kim S, Marcus B, Monteiro R, et al. The chronic rhinosinusitis practice parameter. Ann Allergy Asthma Immunol. 2023;131(3):307-323. PMID 37667905
  3. Kowalski ML, Agache I, Bavbek S, et al. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD), an EAACI position paper. Allergy. 2019;74(1):28-39. PMID 30216468
  4. Tezepelumab (anti-TSLP) FDA approval for CRSwNP, Oct 2025 (WAYPOINT trial). FDA approval

Clinician decision support. Verify against the cited source. Not a substitute for clinical judgment. 100% on-device; no patient data is stored or transmitted.