SAMTER'S TRIAD

. Posted in SPECIAL PATIENTS

Although Samter’s triad is rare, when it is present it can be insidious. This syndrome includes chronic sinusitis with nasal polyposis, asthma, and aspirin allergy. This syndrome can look different in each case, because it presents with a disparate set of symptoms. These sufferers usually complain of nasal congestion, lack of sense of smell and taste, yellow - green discharge, postnasal drip, mouth breathing, a drowned or hoarse voice, chapped lips, and mild headaches and/or pressure. They are prone to nasal polyps and their asthma is usually aggressive. Upon further inquiry or testing, allergy to aspirin or other nonsteroidal anti-inflammatory agents, such as ibuprofen, will be discovered.

Samter’s triad often occurs in midlife (20s and 30s are the most common onset times) and may or may not include any environmental allergies. Sampter’s triad is also known as aspirin-sensitive asthma, aspirin-induced asthma, aspirin triad, or Widal’s triad - and to the fully uninformed, as rhinitis. Sampter’s patients typically seek medical attention for wheezing or chest tightness (asthma), then polyp formation is discovered, and aspirin sensitivity is revealed. The aspirin reaction can be mild, including a rash or hives and swelling, or it can be severe, including an asthma attack and/or anaphylaxis The exact cause of Samter’s triad is unknown, but it is widely believed that the disorder is caused by a genetic abnormality that effects the body’s inflammatory response. Treatment typically focuses on each of the symptoms, and includes nasal steroids, inhaled steroids, and leukotriene antagonists. The chronic sinusitis is treated with various medicines such as antibiotics and antifungal medicines as well as irrigation. Surgery may be required to open up obstructed areas of the sinuses and to remove polyps. Typically, the polyps will recur and so it is important for these patients to be under close supervision by a surgeon. The surgeon periodically checks if the polyps have returned. When polyp disease recurs the polyps should be removed immediately to prevent obstruction of the sinus pathways. The infection should be removed as well. Furthermore, these sufferers
need to abstain from taking any aspirin or nonsteroidal anti-inflammatory agents. Some people require oral steroids to alleviate asthma and congestion, and most patients will have recurring or chronic sinusitis caused by the nasal inflammation. Leukotriene antagonists and inhibitors such as Singulair, Accolate, and Zyflo show great promise in treating these patients. Frequent irrigation and cleaning with emollients is also recommended to keep the nasal membranes from becoming inflamed, thereby thwarting the growth of polyps before they begin.

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