The Samter triad is a clinical picture characterized by nasal polyps, bronchial asthma and intolerance to non-steroidal anti-inflammatory drugs (NSAIDs). Hypersensitivity to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs occurs. Treatment of the disease is carried out only symptomatically.
What is a Samter triad?
The Samter triad is characterized by the existence of bronchial asthma and nasal polyps as well as intolerance to non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs). These agents also include acetylsalicylic acid. After taking these drugs, severe respiratory problems and allergy-like symptoms occur, which can also lead to anaphylactic shock. See wholevehicles for What are the Meanings of HVD.
However, it has been found that this disease is not based on allergic reactions. It is a hypersensitivity reaction to nonsteroidal anti-inflammatory drugs (NSAIDs). Since reactions similar to those of an allergy occur, it is referred to as a pseudoallergy. The Samter triad is also known as Samter’s disease or Widal’s disease. The connection between the symptoms and intolerance to acetylsalicylic acid was discovered as early as 1922.
It has also been shown that 8 to 20 percent of all patients with bronchial asthma and six to fifteen percent of all patients with nasal polyps have these intolerances. The disease cannot be cured and will continue to progress even without the use of non-steroidal anti-inflammatory drugs. Only symptomatic treatment with long-term adaptation to ASA is possible.
Causes
A hereditary predisposition is suspected for the development of a Samter triad. However, it is not yet known exactly where the genetic defect is located. However, a disturbed degradation of arachidonic acid could be detected. Arachidonic acid is a semi-essential unsaturated fatty acid from the group of omega-6 fatty acids that is found in the cell membrane and plays an important role in the synthesis of leukotrienes and prostaglandins.
These substances mediate inflammatory processes within the framework of immune reactions. The breakdown of arachidonic acid is slowed down and is additionally inhibited by the influence of acetylsalicylic acid (ASA) and related compounds. After taking ASA or other non-steroidal anti-inflammatory drugs, the breakdown of arachidonic acid is completely restricted. At the same time, the arachidonic acid is stimulated to form prostaglandins and leukotrienes.
These are inflammatory factors that immediately lead to allergy-like symptoms. Under physiological conditions, arachidonic acid is broken down by the enzyme cyclooxygenase. This enzyme, in turn, is inactivated by ASA and its related compounds, stopping the breakdown of arachidonic acid. Arachidonic acid accumulates further in the cell and increases the formation of inflammatory factors.
Symptoms, Ailments & Signs
Multiple inflammations occur in the body, which are caused by the increased formation of prostaglandins and leukotrienes. The already existing breathing difficulties increase drastically. Numerous bronchospasms, swelling of the mucous membranes and sinusitis occur. The acute attack of the disease is very dangerous. Anaphylactic shock can occur.
But there are also constant complaints between the acute phases. The enzymatic activity of the cyclooxygenase is restricted overall, so that chronic respiratory problems occur in the quiet sections. Bronchial asthma and nasal polyps have existed since early childhood. However, the salicylates that can be derived from ASA are also found in low concentrations in many foods. Many preservatives contain salicylates.
Food that has been preserved with preservatives, such as fruit, vegetables, meat, sausages, cheese and much more, contributes a great deal to the chronic clinical picture of the Samter triad. If massive symptoms occur even at very low ASA concentrations, the violent reaction to direct confrontation with high concentrations can lead to potentially fatal anaphylactic shock.
Diagnosis & course of disease
The diagnosis of a Samter triad is often not easy. First of all, a comprehensive anamnesis of the medical history is necessary, in which questions must also be asked about the connection between symptoms and nutrition and drug treatment. The present symptoms also occur in classic allergic reactions. It is therefore also important to carry out an intensive allergological examination.
The suspicion of a Samter triad increases when asthma attacks in particular occur after contact with non-steroidal anti-inflammatory drugs (NSAIDs), a negative allergy test is available, there are many nasal polyps and the most severe asthma attacks occur. Morphological inflammation of the paranasal sinuses (pansinusitis) can be detected on CT.
Complications
In most cases, those affected with the Samter triad suffer from severe breathing difficulties. These are further intensified by taking the medication, so that in the worst case the person concerned can lose consciousness and possibly injure himself. Swelling of the mucous membrane can also occur and have a very negative effect on the quality of life of those affected.
Asthma and other breathing problems can also occur in early childhood. Many of those affected suffer from loud breathing noises and snoring. In the event of shock, the person affected can also die. Furthermore, the disease also leads to intolerance to many foods and thus to severe restrictions in the diet of those affected.
As a rule, the disease cannot be treated causally. Those affected are therefore dependent on a strict diet in order to completely avoid the symptoms and complaints. In this way, all complications can usually be avoided. In the event of an asthma attack, an ambulance should be called immediately. It cannot be universally predicted whether the patient’s life expectancy will be reduced as a result of the disease.
When should you go to the doctor?
Symptoms such as nasal polyps or bronchial asthma indicate a Samter triad. Medical advice is required if repeated asthma attacks occur after contact with nonsteroidal anti-inflammatory drugs, nasal polyps are noticed or a sinus infection occurs. If you have severe breathing difficulties, it is best to consult your doctor immediately. If the above symptoms are noticed in the child, the pediatrician should be consulted. The doctor can determine the Samter triad based on an intensive allergological examination and initiate drug treatment.
If this happens early, any complications such as allergic shock reactions can be avoided. If you suspect Samter’s triad or another allergic disease, you should consult your family doctor or an allergist . A first-time allergic shock requires emergency medical treatment. If necessary, the medical emergency service can be contacted first. The Samter triad must be closely monitored, since the symptoms can occur more frequently and the drug therapy must be regularly adjusted. Ideally, those affected should keep in constant contact with their family doctor and inform him about unusual symptoms and any side effects and interactions of the drugs used.
Treatment & Therapy
The treatment of a Samter triad is very lengthy and can only be started successfully when the cause has been fully clarified. A causal treatment of the disease is not yet possible. The disturbance in the breakdown of arachidonic acid is probably hereditary. The required enzyme is additionally inhibited by contact with NSAIDs.
First of all, care must be taken to avoid contact with ASA and NSAIDs so as not to provoke a life-threatening asthma attack. However, studies in recent years have shown that the body can gradually adapt to higher doses of these substances, especially ASA. This is possible because the metabolic pathway still has room for modulation in the breakdown of non-steroidal anti-inflammatory drugs.
So, in the long term, a slightly modified degradation path for ASA can be developed. It was found that 24 to 72 hours after the first intake of ASA, a further application does not cause an intolerance reaction. Based on this knowledge, slow adjustments can be made to acclimate the body to higher doses.
Prevention
Since the Samter triad is present from birth, there is no recommendation for its prophylaxis. Only the asthmatic attacks can be prevented by consistently avoiding contact with ASA and NSAIDs.
Aftercare
In most cases, those affected with Samter’s triad only have a few follow-up measures available. For this reason, if you have this disease, you should ideally see a doctor as soon as the first symptoms and signs appear, so that there are no complications or other complaints for the person affected as the disease progresses.
Regular checks and examinations by a doctor are essential for this disease. The kidneys and urinary tract in particular should be checked regularly by a doctor. Regular blood tests should also be carried out. In some cases, Samter’s triad can lead to infections or inflammation of the urinary tract or kidneys, so treatment with antibiotics is necessary.
In many cases, the support and help of one’s own family is also necessary to prevent depression or mental disorders. As a rule, this disease does not reduce the life expectancy of the affected person.
You can do that yourself
With Samter’s triad, everyday habits have to be changed. First, avoid foods that contain salicylic acid. If possible, you should also avoid stimulants such as alcohol, cigarettes and caffeine, as these can trigger a flare-up of the disease. Patients should obtain the necessary information regarding nutrition and general measures from the German Samter Trias Association and implement this consistently in everyday life.
Techniques such as progressive muscle relaxation and respiratory gymnastics help with asthmatic symptoms. Some forms of yoga can also be used. Special respiratory therapy devices loosen the mucus from the bronchi and allow you to breathe more freely. An asthma diary provides clues to possible triggers. Everyday life can then be changed accordingly to reduce the asthma attacks.
Sport can also be practiced in consultation with the doctor. Running and cycling are particularly good because the airways are supplied with plenty of fresh air. It is best for Samter triad patients to contact the health insurance company so that the costs for physiotherapy, aids and an optimized diet can be reimbursed. In addition, the ear, nose and throat doctor must be consulted regularly and informed about current symptoms. This ensures that Samter Trias is treated optimally.