Samter's Triad

Legend By Legend, 26th Dec 2014 | Follow this author | RSS Feed | Short URL http://nut.bz/1pq4_bn0/
Posted in Wikinut>Health>General Health>Allergies

Some people develop a unique form of airway with classic characteristics known as Samter's triad. I start with a recent - true medical case and then elaborate

Disclaimer

These medical articles are intended to generate information for laymen as well as aspiring professionals. Effort is placed into assuring the information is accurate and up to date at the time of writing. Although all the information written here is presumed to be correct at the time of writing, it should not come in place of professional medical advice and attention. In addition, medicine is a science in a developing world and what has been considered true for the past century may not be true in the immediate future.

A case in point

A thirty year old male enters the emergency room with severe shortness of breath. The nurse says that this is his seventh time in the past few months. "He always gets better very quickly" she says.
His shortness of breath is so severe that he is immediately given advanced noninvasive airway support. He says that he had fever at home although now he has none.
I asked him if his previous episodes of shortness of breath also began with fever at home and he replied that they had. I then asked him what he had taken for his fever at home and he said Ibuprofen. Finally, I asked him if he had undergone any nasal surgery as a youth and he said that he had had small nasal polyps excised.
I told him:

You probably have Samter's triad - your shortness of breath is probably due to the Ibuprofen, you should avoid all similar medications as well as aspirin

The shortness of breath indeed resolved spontaneously within an hour. The patient was discharged for further follow up and counselled to avoid aspirin, ibuprofen and all related anti inflammatory medications.

First described 100 years ago

Airway sensitivity to aspirin was apparently described already in 1922. The description was formally determined to be a triad of findings only in 1968 by Samter and hence the eponym. The triad included:
1) Asthma
2) Nasal polyps
3) Airway sensitivity to aspirin
While the mechanism of Samter's triad is not entirely clear we now know that not all patients with asthma and aspirin sensitivity will have nasal polyps. Genetics has been used to describe particular mutations which are considered associated with the triad of Samter. Typically, the patients diagnosed with this triad will have a more severe asthma with more frequent and more severe exacerbations. In addition, it has been demonstrated that there is a broad spectrum of patients with asthma who will suffer a minor decrease in their breathing performance following use of aspirin but this decrease will not be significant enough to be noticed clinically by the person and only with carefully conducted pulmonary function tests can this be identified.

Possible solutions

While avoiding the use of painkillers like ibuprofen may be possible and only a minor inconvenience, aspirin is a far more essential medication. Aspirin is still the front line medication for people with heart disease, both for prevention of recurrent myocardial infarction as well as for treatment during an acute myocardial infarct. Aspirin is also the front line treatment for prevention of recurrent ischemic stroke. Thus avoiding aspirin is more of a medical problem. Fortunately there are two solutions which are available:
1) When aspirin is indicated for "blood thinning" as in heart attacks or stroke, it is possible to give an alternative blood thinner which does not provoke such side effects. The classic example being clopidogrel, another medication that inhibits platelets much like aspirin but through a different mechanism.
2) In many cases it is possible to use a special desensitization protocol where small doses of aspirin are given daily and the dose is gradually increased. For most people this lets the body adapt to the aspirin and prevents the severe air way flare up that is classic of Samter's triad.

Tags

Aerd, Airway Hypereactivity, Aspirin, Aspirin Sensitivity, Asthma, Ibuprofen, Nasal Polyp, Nsaid, Nsaids, Samter, Samter Triad, Samters Triad, Sensitivity

Meet the author

author avatar Legend
I am a practicing physician. I have spent 5 years in Yeshiva studying religion. I published a card game on wikinut and I am in a process of getting divorced

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Comments

author avatar Kingwell
17th Feb 2015 (#)

Interesting. Thanks for sharing this.

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