Acute wheeze after aspirin in a woman with asthma and nasal polyps

A 38-year-old woman with a history of asthma and nasal polyps presents to the emergency department with sudden-onset wheeze and nasal congestion. She had taken a single 300 mg aspirin tablet for a headache approximately one hour before the onset of symptoms. She has been taking regular beclomethasone inhaler (two puffs twice daily) and montelukast 10 mg once daily for the past two years without dose changes. On examination, she is in respiratory distress, with an oxygen saturation of 92% on room air, diffuse expiratory wheeze, and bilateral nasal congestion. She is afebrile and has no other signs of infection. The nasal congestion was not present before the aspirin ingestion. She was managed with oxygen and nebulised salbutamol; her symptoms improved significantly over two hours. The aspirin was discontinued after the reaction, and she has not taken it since. She has no history of prior exposure to aspirin or other nonsteroidal anti-inflammatory drugs. The alternative possibility of a viral respiratory infection was considered, but there is no supporting evidence such as fever or coryzal symptoms. No rechallenge with aspirin was performed. She was admitted for observation and monitoring.