Allergy

Allergic Triad

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Allergic Triad, Aspirin Induced Asthma, Aspirin Allergy, Aspirin Exacerbated Respiratory Disease, Samter's Triad, Samter's Syndrome

  • See Also
  1. Eosinophilic Asthma
  • Definitions
  1. Allergic Triad (Samter's Triad)
    1. Allergic Constellation centered around Aspirin (or NSAID) allergy or sensitivity
    2. Associated with Nasal Polyps and Eosinophilic Asthma (T2 Asthma)
  • Pathophysiology
  1. Associated with disordered Arachidonic Acid metabolism (cyclooxygenase mediated to inflammatory agents)
  • Associated Conditions
  1. Aspirin-induced Asthma
  2. Rhinorrhea
  3. Nasal Polyps
  4. Chronic Sinusitis
  5. Conjunctival edema
  • Course
  1. Onset as perennial Vasomotor Rhinitis
  2. Develops into hyperplastic Rhinosinusitis, Nasal Polyps
  3. Asthma is typically severe from onset with frequent exacerbations
  • Causes
  1. Aspirin
  2. Cross-reactivity with NSAIDs
    1. Indomethacin
    2. Naproxen
    3. Ibuprofen
    4. Fenoprofen
    5. Mefenamic acid
    6. Phenylbutazone
  • Labs
  • Markers
  1. See Extrinsic Asthma
    1. Associated with increased urinary LTE4 > 166 pg/mgCr
      1. Divekar (2016) J Allergy Clin Immunol Pract 4(4): 665-70 [PubMed]
  • Management
  1. Avoid Aspirin and causative NSAIDs above
  2. Use safe alternative Analgesics instead
    1. Salsalate
    2. Acetaminophen
  3. Treat Aspirin-induced Asthma
    1. Leukotriene Modifiers (e.g. Sinulair)
  • References
  1. Kuruvilla (2019) Clin Rev Allergy Immunol 56(2):219-33 +PMID: 30206782 [PubMed]