Drugs, including aspirin and other NSAIDs, such as nonsteroidal anti-inflammatory drugs, including ibuprofen, can cause an increase in eosinophils for reasons that are not well understood. 19659006] "I would have days when I felt really bad, and days when I felt better," he recalled about apathy and fatigue. The night sweats were particularly annoying. "I woke up from a deep sleep, completely soaking the sheets"
He returned with his internist in March. "This is the flu, you can take it for a while, do not worry," recalls the doctor, referring to her prolonged discomfort.
Bates, who at that time was an independent contractor who worked from home, said she spent her work day taking naps.
The previous months had been difficult. In early December, Bates had twisted his ankle. She decided that the injury was not serious enough to warrant a visit to the doctor and started taking ibuprofen to reduce swelling and pain. It seemed to work.
But her collapse in April made her realize how accustomed she was to feeling sick.
"I remember that I was loaded into the ambulance and I thought maybe this was the last thing I was going to do," said Bates, who spent five days in the hospital.
He was surprised to learn that his pneumonia was not caused by the usual viruses or bacteria, but was classified as eosinophilic pneumonia, a form of lung infection caused by an increase in eosinophils, a type of white blood cell.
Drugs, including aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs, including ibuprofen) can cause an increase in eosinophils for reasons that are not well understood.
A pulmonologist who saw Bates in the hospital warning him that he was essentially allergic to NSAIDs and should never take them again.
"That was difficult," Bates said, because he left acetaminophen as the only over-the-counter pain reliever he could take. Unlike NSAIDs, paracetamol does not reduce inflammation and is generally not considered effective in the treatment of sinus infections.
His asthma, which was sometimes difficult to control, remained a major concern. Bates estimates that three or four times a year, she would end up in the emergency room without being able to breathe.
Two years after his pneumonia, Bates moved to northern California in the United States. I hoped the new climate would be better for your health.
Instead, their problems worsened.
In December 2015, Bates was referred to Feng. His ear, nose and throat specialist had recommended endoscopic surgery to relieve his repeated sinus infections and eliminate nasal polyps.
But first he wanted to make sure that Bates did not have underlying allergies, such as tree pollen or herbs, which could compromise the effectiveness of the operation.
The allergist performed a workup. To Bates's surprise, she was not allergic to anything except dust mites. When he mentioned his allergy to NSAIDs for Feng, his interest was aroused.
His story had a familiar sound. Feng had recently completed his residency at the Scripps Clinic in San Diego, USA. UU., During which I had participated in the care of several dozen patients with a similar profile: recurrent sinus infections, asthma and high counts of eosinophils.
After he learned that Bates had developed asthma and sinus problems in his 40s and became congested after drinking alcohol, he realized that "he had all the symptoms."
Feng strongly suspected that Bates had a little-known condition called Samter's triad, also known as aspirin-aggravated respiratory disease, or AERD.
AERD, which is believed to affect approximately nine percent of adults with asthma, is a chronic condition marked by a life-threatening sensitivity to NSAIDs. Some people lose their sense of smell. Most do not respond to traditional treatments for sinusitis, which typically develop in middle age.
"The immune system becomes hyperactive," said Feng, "but nobody really knows what causes it."
Some people undergo sinus surgery to remove nasal polyps, which then regrow because the underlying problem remains unresolved.
One treatment, initiated in recent years, involves the administration of aspirin in progressively higher doses under medical supervision.
Called desensitization of aspirin, the ambulatory procedure usually two or three days and can alleviate the symptoms of AERD, reducing the frequency of sinus infections and improving the control of asthma and the quality of life of the patient.
The Scripps Research Institute, of Brigham and Women's Hospital in Boston, is known for its treatment with AERD programs. (Desensitization is also often used to treat environmental allergies.)
But this treatment also requires patients to take a daily dose of aspirin. Some can not tolerate it because aspirin causes gastrointestinal bleeding.
Bates said he was initially surprised when Feng proposed the treatment, fearing it was potentially dangerous.
But after undergoing breast surgery in April 2016, he changed his mind.  "I felt much better," he said, and worried that the improvement could be temporary if it did not address the root cause.
Bates said he also spoke with a friend who had been desensitized successfully for another condition. , which dissipated their fears.
After his insurer approved the treatment, Bates scheduled it for December 2016.
Initially he was given aspirin for infants, which did not cause any reaction. That was followed an hour later by two baby aspirins, which triggered an asthma attack that Feng quickly controlled.
Over the next two days, Feng proceeded to increase the dose until Bates could tolerate two 325-milligram aspirin tablets without adverse reaction. She keeps taking that dose every day.
Bates said the desensitization treatment marked a turning point in his health.
In the past 15 months, she said, she has not made any emergency room visits for asthma and has suffered from a single sinus infection, from which she recovered more quickly than before.
"I definitely have a better quality of life now," he said. "I feel very good".
It seems ironic that he did not end up in the hospital with a case of life-threatening pneumonia, that he may never have known about the disorder that caused it, and that for a decade he had done it is so miserable.
Although the experience was "terrifying, I'm glad I got it and they diagnosed me," he said.
– The Washington Post