Abstract
BackgroundAspirin-exacerbated respiratory disease (AERD), also known as Samter’s triad, is a clinical syndrome which consists of aspirin (ASA) intolerance, chronic rhinosinusitis with nasal polyposis, and intrinsic bronchial asthma (Press Med 119:48-51, 1922). ASA challenge is the gold standard for diagnosing AERD (Curr Allergy Asthma 9:155-163, 2009). The practice of ASA challenge and desensitization in Canada is infrequently utilized, which may explain its omission as a viable therapeutic option in the latest Canadian clinical practice guidelines for acute and chronic rhinosinusitis (AACI 7:1-38, 2011).MethodsThis retrospective study assessed 111 patients who underwent ASA desensitization in the Allergy and Immunology clinic at St. Joseph’s Healthcare (SJHC) in London, Ontario. The mean age was 50.7 years, and 52.5% (n = 58) were male. Sixty-one percent (n = 68) claimed prior, significant reactions to ASA, and all patients had features of AERD.ResultsSeventy-three percent (n = 81) claimed symptom improvement after achieving maintenance dosing on the desensitization protocol. Of this population, 21.6% (n = 24) improved in all 3 areas of interest (sense of taste or smell, upper respiratory symptoms and lower respiratory symptoms). Twenty-six percent (n = 29) had adverse effects, mostly in the way of gastrointestinal upset, but no severe adverse events were seen.ConclusionsASA desensitization helps improve symptoms in patients with AERD. Further, it allows patients to tolerate additional ASA and other non-steroidal anti-inflammatories (NSAIDs) when needed for supplemental analgesia or for cardio-protection. This is of particular benefit in those who require these medications for improved quality of life, and for reduced morbidity and mortality, such as those with cardiovascular disease or chronic pain. There should be further studies conducted in Canada as well as consideration for ASA desensitization to be included in the next clinical practice guidelines.
Highlights
Aspirin-exacerbated respiratory disease (AERD), known as Samter’s triad, is a clinical syndrome which consists of aspirin (ASA) intolerance, chronic rhinosinusitis with nasal polyposis, and intrinsic bronchial asthma (Press Med 119:48-51, 1922)
Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome which consists of aspirin intolerance, chronic rhinosinusitis with nasal polyposis and intrinsic bronchial asthma as first described by Widal in 1922 [1]
AERD affects 0.3-0.9% of the general population, but its prevalence rises to 10-20% in asthmatics, and up to 30-40% in asthmatics with nasal polyposis [3,4]
Summary
Aspirin-exacerbated respiratory disease (AERD), known as Samter’s triad, is a clinical syndrome which consists of aspirin (ASA) intolerance, chronic rhinosinusitis with nasal polyposis, and intrinsic bronchial asthma (Press Med 119:48-51, 1922). The practice of ASA challenge and desensitization in Canada is infrequently utilized, which may explain its omission as a viable therapeutic option in the latest Canadian clinical practice guidelines for acute and chronic rhinosinusitis (AACI 7:1-38, 2011). Aspirin-exacerbated respiratory disease (AERD) is a clinical syndrome which consists of aspirin intolerance, chronic rhinosinusitis with nasal polyposis and intrinsic bronchial asthma as first described by Widal in 1922 [1]. Max Samter, an American immunologist, revisited the association and proposed the possible pathogenesis in the 1960s. His name is often associated with the syndrome—Samter’s triad [2]. Asthma may precede the upper airway disease or develop later
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