Medication Avoidance of NSAID medications will not stop the progression of the<unk> . The preferred treatment for many patients is desensitization to<unk> , undertaken at a clinic or hospital specializing in such treatment. Patients who are desensitized then take a maintenance dose of<unk>  daily to maintain their desensitization. The recommended maintenance dose for symptom control is 650 mg to 1300 mg<unk>  daily. While on daily<unk> , most patients have reduced need for supporting medications, fewer asthma and sinusitis symptoms than previously, and an improved sense of smell. Desensitization to<unk>  reduces the chance of nasal polyp recurrence and may slow the regrowth of nasal polyps. Once desensitized to<unk> , most patients can safely take other NSAID medications again. Even patients desensitized to<unk>  may continue to need other medications including nasal steroids, inhaled steroids, and leukotriene antagonists. Leukotriene antagonists and inhibitors (montelukast, zafirlukast, and zileuton) often are helpful in treating the symptoms of<unk> . In a large survey of<unk>  patients, it was reported that Zyflo (zileuton) was significantly more effective at controlling the symptoms of the<unk>  than Singulair (montelukast). Biologic medications such as dupilumab, mepolizumab, and omalizumab may also be of benefit. In a 2021 survey of biologics, dupilumab was found to be most effective in treating symptoms of<unk> . Despite optimal medical management, many patients continue to require oral steroid medications to alleviate asthma and chronic nasal congestion. Surgery Often surgery is required to remove nasal polyps, although they typically recur, particularly if<unk>  desensitization is not undertaken. 90% of patients have been shown to have recurrence of nasal polyps within five years after surgery, with 47% requiring revision surgery in the same time period. A complete endoscopic sinus surgery followed by<unk>  desensitization has been shown to reduce the need for revision surgeries. Exact cause of nasal polyp formation is unknown. However, Differential gene expression analysis of<unk>  nasal polyp epithelial cells versus<unk>  non polyp nasal mucosa revealed DMRT3 could be potentially involved in nasal polyp development in<unk>  patients. Furthermore, several genes are downregulated, hinting at the dedifferentiation phenomenon in<unk>  polyps. Diet The majority of those with<unk>  experience<unk>  reactions to alcohol. One study found that 83% reported such reactions. Of those who had reactions, 75% had a sinus reaction (runny nose, nasal congestion) and 51% had a lower<unk>  reaction (wheezing, shortness of breath). The current theory on the cause of these reactions is that they may be related to polyphenols found in alcoholic beverages. A 2017 study found that alcohol sensitive patients reacted to catechins in red wine, but not to resveratrol. It has been suggested that steel fermented white wines and clear liquors may cause less of a reaction than other alcoholic beverages. Desensitization to<unk>  has been found to reduce reactions to alcohol. Some people have reported relief of symptoms by following a low-salicylate diet such as the Feingold diet.<unk>  is quickly converted in the body to salicylic acid, also known as 2-Hydroxybenzoic acid. A prospective randomized trial with 30 patients following a low-salicylate diet for six weeks demonstrated a clinically significant decrease in both subjective and objective scoring of severity of<unk> , but made note of the challenge for patients in following what is a fairly stringent diet. Despite these findings, experts on the<unk>  do not believe that dietary salicylates contribute to<unk>  symptoms. Dietary salicylates do not significantly inhibit the COX-1 enzyme, which is the cause of<unk>  reactions. One confounding factor in the study that showed a benefit from avoidance of dietary salicylates is that a low salicylate diet involves eliminating wine and beer. The majority of<unk>  patients react to wine and beer for reasons that do not involve their salicylate content. There is also a strong placebo effect involved with any dietary intervention. In contrast to<unk> , dietary salicylates are not acetylated and therefore do not block cyclooxygenases and hence, there is no rationale why a low salicylate diet would be beneficial for<unk>  patients. A diet low in omega-6 oils (precursors of arachidonic acid), and high in omega-3 oils may also be of benefit. In a small study,<unk> -sensitive asthma patients taking 10 grams of fish oil daily reported relief of most symptoms after six weeks, however, symptoms returned if the supplement was stopped. In another study, a diet low in omega 6 fatty acids and high in omega 3 fatty acids significantly reduced sinus symptoms in<unk>  patients.
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