Samter's triad

Samter's Triad is a medical condition consisting of asthma, aspirin sensitivity, and nasal polyposis. It occurs in mid-life (twenties and thirties are the most common onset times) and may not include any allergies. It is also known as Aspirin-sensitive asthma, aspirin triad, widal's triad, and aspirin induced asthma and rhinitis (AIAR).

Symptoms

Most commonly, the first symptom is rhinitis (inflammation of the nose), which might be described as sneezing, a runny nose, or congestion. The disorder typically progresses to asthma, then polyposis, with aspirin sensitivity coming last. The aspirin reaction can be severe, including an asthma attack, anaphlaxis, and urticaria in some cases. Patients typically react to other NSAIDS such as ibuprofen, although Tylenol (acetaminophen) is generally considered safe.

Anosmia (lack of smell) is also typical, as the inflammation reaches the olfactory receptors in the nose.

Treatment

Treatment typically focuses on each of the symptoms, and includes nasal steroids, inhaled steroids, and leukotriene antagonists. Occasionally surgery may be required to remove polyps, although they typically recur. Some patients require oral steroids to alleviate asthma and congestion, and most patients will have recurring or chronic sinusitis due to the nasal inflammation.

The cause of Samter's triad is unknown, but it is widely believed that the disorder is caused by an anomaly in the arachidonic acid cascade, which causes undue production of leukotrienes, a series of chemicals involved in the body's inflammatory response. When prostaglandin production is blocked by NSAIDS like aspirin, the cascade shunts entirely to leukotrienes, producing the severe allergy-like effects.

Leukotriene antagonists and inhibitors such as Singulair, Accolate, and Zyflo show great promise in treating Samter's. A diet low in omega-6 oils (precursors of arachidonic acid), and high in omega-3 oils, may also help. Ongoing study at the Scripps clinic suggests that aspirin desensitization may be beneficial, but the procedure is dangerous due to the risk of anaphlaxis or urticaria, and must be done under medical supervision.

Alternate Names

Samter's Triad goes by several other names:

• AERD (Aspirin-Exacerbated Respiratory Disease)
• AIAR (Aspirin-Induced Asthma and Rhinitis)
• Widal's Triad
• Aspirin Triad
• Aspirin Allergy (a misnomer)
• Aspirin Intolerance

A sufferer who has not yet experienced asthma or aspirin sensitivity might be diagnosed as having

• Non-allergic Rhinitis
• Nonallergic rhinitis with eosinophilia syndrome (NARES)

Links

• Aspirin Intolerance and Nasal Polyposis
• Samters Group at yahoo.com
• links at the Samter's Group

more to come.