Samter's triad

• Samter’s triad is a condition characterised by:
  • Asthma
  • Nasal polyps
  • Aspirin intolerance

Clinical course

• Starts as nasal symptoms of sneezing, running nose and congestion
• Progresses to asthma and nasal polyposis (especially ethmoidal polyps)
• Aspirin intolerance comes last
• Allergic reaction to aspirin in these patients may cause
  • Exacerbation of asthma
  • Uriticaria
  • Angioedema – It is a life threatening condition and hence a medical emergency

Pathophysiology:

• Aspirin being a cyclooxygenase inhibitor, causes increased activity of the leukotriene synthesis pathway
• The excess production of leukotrienes cause allergic reactions like asthma

Treatment:

• Each component of Samter’s triad is treated separately
  • Aspirin intolerance
    • Stop aspirin intake
    • Leukotriene antagonsits (montelukast, zafirlukast)
    • Aspirin desentisation therapy
    • Steroids
  • Asthma – treat according to severity
  • Nasal polyps – treat if they are symptomatic
    • Steroids – medical polypectomy
    • Surgical removal

Samter’s triad is also known as:

• Samter’s syndrome
• Aspirin triad
• Asthma triad
• Acetyl salicylic acid triad
• Widal-Abrami-Lermoyez triad
• Widal-Lermoyez syndrome
• Widal’s syndrome
• Francis’ triad