Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Samter’s Triad, also know as aspirin-exacerbated respiratory disease, is a condition of asthma, nasal polyps, and sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs). It is named after the allergist Max Samter, who published research on the topic in the 1950s and suggested that the symptoms were due to a disease of the entire respiratory tract.
Read on to learn more about this condition, its symptoms, and management.
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Samter’s Triad Symptoms
Aspirin-exacerbated respiratory disease is known as Samter’s “Triad” because of the classic three findings ofNSAIDsensitivity,nasal polyps, and asthma.
Signs and symptoms include the following:
Samter’s triad is more common in women and is estimated to affect less than 1% of people but up to 10% of people with adult-onset asthma.
What are NSAIDs?
The cause of aspirin-exacerbated respiratory disease still remains somewhat unclear. Scientists have discovered that people with AERD have differing levels of various inflammatory proteins, includingcysteinyl leukotriene(CysLT) andprostaglandinD2.
Only 1-2% of people with AERD appear to have a number of family members affected, suggesting the possibility of an inherited genetic cause.Another explanation that can explain the lack of inheritance in most people and the later onset of symptoms may beepigeneticchanges. Epigenetics refers to changes in the expression of genes that can be thought of as an on/off switch for making or not making specific proteins.
Unlike many allergic syndromes diagnosed with skin testing, AERD does not typically show abnormalities on skin testing. It instead requires a medical history, physical examination, and an “NSAID challenge test.”
When taking a medical history, a healthcare provider will ask about symptoms, reactions to medications, like aspirin and other NSAIDs, and family history. The physical examination will include an examination of the nasal cavity to look for polyps.
In an NSAID challenge test, Aspirin or another NSAID is given in a monitored setting. Symptoms usually are evident in 30min to 3 hours. Pulmonary function testing, which requires measuring lung volumes and force of exhalation, is done as part of challenge testing.
Treatment of AERD involves avoiding triggers, taking medications to relieve symptoms, and possible surgery.
Avoiding Triggers
NSAID sensitivity is a hallmark of AERD, so these medications must be avoided. If you have AERD, make sure to pay close attention to the ingredients in medications. Look for NSAIDs that are often found in cough and cold medications and headache medication. Tylenol (acetaminophen) can be a good alternative to NSAIDs when needed for pain or fever. However, some people with AERD can also have sensitivity to Tylenol.
Avoiding medications isn’t always enough. Certain spices, foods, and beverages can also trigger unwelcome symptoms in those with AERD. Keeping a log of your diet and symptoms can help uncover aggravating foods.
The following foods and drinks may contain salicylates and cause symptoms in some people with AERD:
Medications
Symptoms of AERD can be drastically improved with certain medications. Your allergist may prescribe the following medications to help:
Nasal Surgery
Nasal polyps can not only be uncomfortable, but can cause problems with breathing and sleep. For those with significant symptoms from nasal polyps, surgery to remove them can be done. Nasal polyps can grow back, so repeat surgery may be needed.
Desensitization Therapy
Desensitization has also been shown to delay nasal polyp growth and improve other AERD symptoms.
Summary
The causes of AERD are unclear, but epigenetic factors seem to play a role in abnormal levels of specific proteins with roles in the immune response. Treatment can involve medications, surgery to remove nasal polyps, and avoidance or desensitization to NSAIDs.
A Word from Verywell
Drug sensitivities can be extremely scary, particularly when they cause symptoms like shortness of breath with airway obstruction, which can be life-threatening. If you have concern about NSAID sensitivity or have been diagnosed with AERD, know what medications and foods to avoid. Since asthma in Samter’s triad can be severe, it is essential to have an asthma action plan and carry prescribed rescue inhalers at all times.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Samter’s Society.The history of AERD (Samter’s Triad).Taniguchi M, Mitsui C, Hayashi H, et al.Aspirin-exacerbated respiratory disease (AERD): Current understanding of AERD.Allergol Int. 2019 Jul;68(3):289-295. doi:10.1016/j.alit.2019.05.001American Academy of Allergy, Asthma & Immunology.Nasal polyps.Kim SD, Cho KS.Samter’s triad: tate of the art.Clin Exp Otorhinolaryngol. 2018;11(2):71-80. doi:10.21053/ceo.2017.01606American College of Rheumatology.NSAIDs (Nonsteroidal anti-inflammatory drugs).Badrani JH, Doherty TA.Cellular interactions in aspirin-exacerbated respiratory disease.Curr Opin Allergy Clin Immunol. 2021;21(1):65-70. doi:10.1097/ACI.0000000000000712Centers for Disease Control and Prevention.What is epigenetics?The Samter’s Society.Avoiding NSAIDs.Workman AD, Bleier BS.Biologic therapies versus surgical management for aspirin-exacerbated respiratory disease: A review of preliminary data, efficacy, and cost.World J Otorhinolaryngol Head Neck Surg. 2020;6(4):230-234. doi:10.1016/j.wjorl.2020.06.002American Academy of Allergy, Asthma & Immunology.Aspirin-exacerbated respiratory disease.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Samter’s Society.The history of AERD (Samter’s Triad).Taniguchi M, Mitsui C, Hayashi H, et al.Aspirin-exacerbated respiratory disease (AERD): Current understanding of AERD.Allergol Int. 2019 Jul;68(3):289-295. doi:10.1016/j.alit.2019.05.001American Academy of Allergy, Asthma & Immunology.Nasal polyps.Kim SD, Cho KS.Samter’s triad: tate of the art.Clin Exp Otorhinolaryngol. 2018;11(2):71-80. doi:10.21053/ceo.2017.01606American College of Rheumatology.NSAIDs (Nonsteroidal anti-inflammatory drugs).Badrani JH, Doherty TA.Cellular interactions in aspirin-exacerbated respiratory disease.Curr Opin Allergy Clin Immunol. 2021;21(1):65-70. doi:10.1097/ACI.0000000000000712Centers for Disease Control and Prevention.What is epigenetics?The Samter’s Society.Avoiding NSAIDs.Workman AD, Bleier BS.Biologic therapies versus surgical management for aspirin-exacerbated respiratory disease: A review of preliminary data, efficacy, and cost.World J Otorhinolaryngol Head Neck Surg. 2020;6(4):230-234. doi:10.1016/j.wjorl.2020.06.002American Academy of Allergy, Asthma & Immunology.Aspirin-exacerbated respiratory disease.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
The Samter’s Society.The history of AERD (Samter’s Triad).Taniguchi M, Mitsui C, Hayashi H, et al.Aspirin-exacerbated respiratory disease (AERD): Current understanding of AERD.Allergol Int. 2019 Jul;68(3):289-295. doi:10.1016/j.alit.2019.05.001American Academy of Allergy, Asthma & Immunology.Nasal polyps.Kim SD, Cho KS.Samter’s triad: tate of the art.Clin Exp Otorhinolaryngol. 2018;11(2):71-80. doi:10.21053/ceo.2017.01606American College of Rheumatology.NSAIDs (Nonsteroidal anti-inflammatory drugs).Badrani JH, Doherty TA.Cellular interactions in aspirin-exacerbated respiratory disease.Curr Opin Allergy Clin Immunol. 2021;21(1):65-70. doi:10.1097/ACI.0000000000000712Centers for Disease Control and Prevention.What is epigenetics?The Samter’s Society.Avoiding NSAIDs.Workman AD, Bleier BS.Biologic therapies versus surgical management for aspirin-exacerbated respiratory disease: A review of preliminary data, efficacy, and cost.World J Otorhinolaryngol Head Neck Surg. 2020;6(4):230-234. doi:10.1016/j.wjorl.2020.06.002American Academy of Allergy, Asthma & Immunology.Aspirin-exacerbated respiratory disease.
The Samter’s Society.The history of AERD (Samter’s Triad).
Taniguchi M, Mitsui C, Hayashi H, et al.Aspirin-exacerbated respiratory disease (AERD): Current understanding of AERD.Allergol Int. 2019 Jul;68(3):289-295. doi:10.1016/j.alit.2019.05.001
American Academy of Allergy, Asthma & Immunology.Nasal polyps.
Kim SD, Cho KS.Samter’s triad: tate of the art.Clin Exp Otorhinolaryngol. 2018;11(2):71-80. doi:10.21053/ceo.2017.01606
American College of Rheumatology.NSAIDs (Nonsteroidal anti-inflammatory drugs).
Badrani JH, Doherty TA.Cellular interactions in aspirin-exacerbated respiratory disease.Curr Opin Allergy Clin Immunol. 2021;21(1):65-70. doi:10.1097/ACI.0000000000000712
Centers for Disease Control and Prevention.What is epigenetics?
The Samter’s Society.Avoiding NSAIDs.
Workman AD, Bleier BS.Biologic therapies versus surgical management for aspirin-exacerbated respiratory disease: A review of preliminary data, efficacy, and cost.World J Otorhinolaryngol Head Neck Surg. 2020;6(4):230-234. doi:10.1016/j.wjorl.2020.06.002
American Academy of Allergy, Asthma & Immunology.Aspirin-exacerbated respiratory disease.
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