Samter's syndrome

What is Samter's Syndrome?

Samter's syndrome (or Samter's triad) is a condition that consists of the following three symptoms: asthma, nasal polyps (small growths), and a reaction against aspirin.

Usually, the first symptom is rhinitis (nasal inflammation), with sneezing, a runny nose, congestion, and often a reduced sense of smell. This is usually followed by the development of asthma, and then the growth of polyps inside the nose. Polyps can cause sinusitis, post-nasal drip and obstruction of the airways.

Finally, aspirin sensitivity develops. This can be quite serious, prompting asthma attacks and anaphylaxis (acute allergic reaction throughout the body), sometimes with hives and swelling of body-parts such as lips, tongue and neck. In some cases this swelling can be so severe that there is a risk of fatal suffocation. Patients often also react to other aspirin-type anti-inflammatory drugs, although acetaminophen or paracetamol is considered safe.

The condition may be accompanied by an increase in certain white blood cells.

Samter's syndrome may be acquired at any time of life, although it often affects people in their twenties and thirties.

Other names

The syndrome is known by several other names, including:

• AERD (aspirin-exacerbated respiratory disease)
• AIAR (aspirin-induced asthma and rhinitis)
• Widal's triad (or syndrome)
• Widal-Abrami-Lermoyez triad
• Widal-Lermoyez triad
• Francis' triad
• Aspirin triad
• Aspirin intolerance
• Aspirin-sensitive asthma

What causes it?

The cause of this condition is unknown, although in some cases it may have a genetic base. Current research indicates that the problem may be caused by excessive production of leukotrienes, which are chemicals involved in the body's inflammatory response.

Treatment

The separate parts of the triad are treated separately.

• Asthma treatment depends on severity: some patients require medication only during an attack, while others need to be on daily doses. Generally, asthma patients learn how to avoid the things that trigger their asthma. Oral steroids may alleviate asthma and congestion.
• Hives and angioedema (swelling) are treated with antihistamines or corticosteroids.
• It is important to avoid aspirin and aspirin-containing medications. However, aspirin intolerance may be alleviated by a course of desensitisation to aspirin, followed by daily maintenance doses.
• Polyps can be removed by surgery, although they often recur. Medications (corticosteroids) can also shrink the polyps. If they are not causing problems or discomfort, they may not need treatment.
• Leukotriene antagonists and inhibitors are helpful in treating Samter's.
• A diet low in omega-6 oils and high in omega-3 oils may also help this condition.