Samter’s Triad

What’s Samter’s Triad?

Samter’s Triad is a chronic condition that is found in patients that have asthma. Samter’s Triad is also known as Aspirin Exacerbated Respiratory Disease (AERD) or ASA Triad. Some of the symptoms include sinus inflammation with recurring nasal polyps, as well as a sensitivity to Aspirin.

Patients with Samter’s Triad that have taken Aspirin or related anti-inflammatory drugs, will have a reaction that would affect both the upper and lower respiratory systems. Other symptoms could include a rash as well as abdominal pain.

 

What are the symptoms of Samter’s Triad?

When a patient that is diagnosed with Samter’s Triad take NSAID medication like Aspirin, will develop symptoms that can affect both the upper and lower respiratory system.

Samter’s Triad is usually diagnosed in patients that have asthma, sinus inflammation or congestion, and usually have recurring nasal polyps. Some patients have to avoid all NSAIDs like Aspirin, if they have both nasal polyps and asthma, even if they have never experienced any of the symptoms when taking Aspirin.

The symptoms that occur in a patient with Samter’s Triad, can occur 30 to 120 minutes after they have take Aspirin or Aspirin related drugs. Some of the symptoms they could show include the following:

  • coughing
  • wheezing
  • tightness in the chest
  • nasal congestion
  • headache
  • sinus pain
  • Sneezing

 

Other possible symptoms include:

  • rash
  • flushing of the skin
  • abdominal pain
  • diarrhea or vomiting

Some patients with Samter’s Triad can lose their sense of smell due to recurring sinus infections. Patients are advised to avoid red wine and all alcoholic beverages, as 70% of patients can have a sensitivity to alcohol.

 

What causes Samter’s Triad?

There is no research that shows what causes Samter’s Triad. But, according to the American Academy of Allergy Asthma and Immunology around 9% of adults with asthma and 30% of adults that have both asthma and nasal polyps show signs of Samter’s Triad.

Adults that are between the ages of 20 and 50 can develop or be diagnosed with Samter’s Triad. The average age of patients the show symptoms is 34 years old.

 

How’s Samter’s Triad diagnosed?

There is no test that can diagnose a patient with Samter’s Triad. The only way to diagnose someone with this disease is by knowing that the patient is someone with the following conditions; Asthma, Nasal Polyps and a sensitivity to Aspirin.

To confirm that the patient has a sensitivity to Aspirin your doctor may do an “Aspirin Challenge Test”, which can confirm that the patient has the three conditions. This test will be performed in the hospital under the supervision of your doctor and nurses. The Aspirin test to done by giving the patient a dose of Aspirin to see if there is a reaction. When a doctor suspects that a patient may have Samter’s Triad, this test is used as a diagnostic tool to see if the patient has a sensitivity to Aspirin.

Patients with Samter’s Triad sometimes have a large number of eosinophils in their nasal polyps or blood. Eosinophils are a type of immune cell.

 

How’s Samter’s Triad treated?

Patients that have been diagnosed with Samter’s Triad need to treat each condition with different medications. For asthma, an inhaler or sinus rinses can be used to control respiratory symptoms and sinus inflammation. A steroid injection can be used to treat nasal polyps.

To help Samter’s Triad even further depending on the patient and how severe the conditions are, surgery can be performed to remove nasal polyps. This will not cure the condition, due to the possibility of the polyps reappearing.

There are other options that can help treat Samter’s Triad that include the following:

 

Aspirin Desensitization

This treatment involves creating a tolerance to aspirin. The doctor performs this treatment by giving the patient doses of aspirin, slowly until the patient can tolerate the recommended dose for this treatment. After this treatment (most stays are just one day unless reactions to the doses are more severe. In this case, the treatment may need to involve the patient staying in the hospital until the recommended dose doesn’t cause a reaction.), the patient will then continue to take the recommended dose of aspirin daily.

This treatment is especially important if the patient needs to take Aspirin or any other NSAID medication for cardiovascular disease or chronic pain.

After completing the Aspirin Desensitization treatment, it can improve the patient’s asthma and sinus inflammation, which then can decrease the chances of nasal polyps.

 

Avoidance of Aspirin and Other NSAID Medications

Patients that can’t undergo Aspirin Desensitization then should avoid all NSAIDs. It is hard for any patient to avoid all NSAIDs due to these medications being used to treat or manage other conditions, like cardiovascular diseases or other conditions.

Patients that weren’t able to proceed in aspirin desensitization treatments, will continue to have the symptoms of asthma, nasal inflammation, and recurring polyps. These patients may still need to have repeated sinus surgeries due to nasal polyps and continue with their medications to manage symptoms.

 

Other Interventions

There is one other method that your doctor could try, and that is giving the patients a drug called a leukotriene-modifying agent. This drug can be used to reduce inflammation in the patient’s airways.

Other studies show that these drugs can also improve a patient’s lung functions, asthma flare-ups, and reduce eosinophils that are found in nasal polyps.

Some foods can contain an ingredient called Salicylic Acid. If a patient avoids these foods, it can also help their conditions. Salicylic Acid is an ingredient that is used in Aspirin. Some types of foods that could have Salicylic Acid include certain fruits, vegetables, herbs, and spices. Ask your doctor what types of foods you should avoid helping your symptoms.

 

Contact your local Samter’s Triad Specialist

Atlanta Asthma and Allergy specialist Dr. Thomas Chacko specializes in asthma conditions and can help diagnose if a patient has Samter’s Triad. Dr. Chacko can help control a patient’s conditions and symptoms. Give our office a call today to schedule an appointment.
Contact your local Atlanta, GA allergist and asthma professional, Dr. Thomas Chacko at 770-475-3361 or e-mail us using our online form. We have five locations for your convenience, including Atlanta, Cummings, Duluth, Johns Creek and Roswell.