Samter’s Triad

Samter’s triad is a respiratory intolerance to aspirin or salicylate containing medication (such as non-steroidal antiinflammatories NSAI’s), that results in maturity onset asthma and polyps obstructing the nasal passages with exacerbations induced by the intake of salicylate (aspirin) containing medications. This group of medications reduce production of prostaglandins and pain, but may increase production of pro-inflammatory leucotriences in the airways of susceptoible individuals. They may then present with nasal blockage and loss of smell (anosmia), with acute asthma attacks and even urticaria (hives) in middle age. About 5% of asthma sufferers are sensitive to aspirin and salicylate which may trigger asthma attacks when these medications are taken.

Treatment includes withdrawal of all salicylate containing medications (such as aspirin, ibuprofen, diclofenac, indomethacin) and related preservatives such as sodium benzoate and artificial colourings (tartrazine). Paracetamol is usually safe to be taken. Surgical removal of nasal polyps helps but very often the polyps grow back.  Steroidal nasal sprays and Montelukast (a leukotiriene receptor antagonist) with slow the regrowth of the polyps and prevent asthma. Desensitisation starting with traces of aspirin to induce tolerance is possible but requires hospitalisation in a specialist unit.  An enormous number of foods contain traces of salicylate, thus making a salicylate-free diet impractical except perhaps to avoid excess spicy foods, berriy fruits and strong tea all of which contain high levels of natural salicylate. 

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