1902: aspirin sensitivity was a first described with aspirin exposure in an asthmatic patient
1968: Samter and Beers described the triad of asthma, aspirin sensitivity, and nasal polyps, now known as “Samter’s triad” (Ann Intern Med, 1968) [MEDLINE]
Reaction to Aspirin and Other COX-1 Inhibiting NSAID’s: with clinical symptoms of nasal congestion and bronchoconstriction beginning 20-180 min after exposure
Prevalence
Overall Prevalence from Meta-Analysis of 27 Studies
Aspirin-Exacerbated Respiratory Disease is Present in Approximately 7.15% of Typical Adult Asthma Patients and Approximately 14.89% of Patients with Severe Asthma (J Allergy Clin Immunol, 2015) [MEDLINE]
Prevalence in Patients with Chronic Rhinosinusitis: 8.7%
Prevalence in Patients with Nasal Polyposis: 9.69%
Iranian Study of Prevalence
Aspirin-Exacerbated Respiratory Disease is Common in Patients with Chronic Rhinosinusitis and Nasal Polyposis in Tehran, Iran (Am J Rhinol Allergy, 2014) [MEDLINE]
Serum IgE is Variably Elevated and Does Not Does Not Appear to be Correlated with the Degree of Mucosal Sinus Disease (by CT) (Arch Otolaryngol Head Neck Surg, 2007) [MEDLINE]
Clinical Manifestations
General Comments
Natural History
Aspirin-Exacerbated Respiratory Disease is Usually Diagnosed in Adulthood
Symptoms Relevant to the Three Components of the Triad Usually Develop Sequentially Over a Period of Years (Eur Respir J, 2000) [MEDLINE] and Clin Rev Allergy Immunol, 2003) [MEDLINE]
However, Some Cases Present with Rapid Progression of Sinus/Nasal Symptoms to Asthma
Precipitation of Symptoms by Alcohol Consumption (see Ethanol, [[Ethanol]])
Ethanol Ingestion Precipitating Symptoms Has Been Reported in 77% of Patients with Aspirin-Exacerbated Respiratory Disease (by Survey) (J Allergy Clin Immunol Pract, 2015) [MEDLINE]
Symptoms Typically Occur within 1 hr of Ethanol Ingestion (J Allergy Clin Immunol Pract, 2014) [MEDLINE]
Precipitation of Symptoms by Dietary Elements
Dietary Triggers Have Been Reported in 63% of Patients with Aspirin-Exacerbated Respiratory Disease (by Survey) (J Allergy Clin Immunol Pract, 2015) [MEDLINE]
Allergic/Immunologic Manifestations
Atopy
Epidemiology: approximately 30-70% of patients are atopic
Diagnosis: some patients have elevated specific IgE against inhalant antigens (most commonly dust mite antigens)
Typically Occurs After the Onset of Rhinosinusitis: however, not all cases develop asthma
Clinical: symptoms generally become more severe over time (even with aspirin avoidance)
Other Manifestations
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Treatment
Specific Management of Asthma (see Asthma, [[Asthma]])
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Avoidance of Nonsteroidal Anti-Inflammatory Drugs (NSAID) with COX-1 Inhibitory Properties (see Nonsteroidal Anti-Inflammatory Drug, [[Nonsteroidal Anti-Inflammatory Drug]])
NSAID Agents with COX-1 Inhibitory Properties
Leukotriene Modifier Agents
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References
General
Intolerance to aspirin. Clinical studies and consideration of its pathogenesis. Ann Intern Med. 1968;68(5):975 [MEDLINE]
Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol. 1999;28(4):717 [MEDLINE]
Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. J Allergy Clin Immunol. 2003;111(5):913 [MEDLINE]
Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ. 2004;328(7437):434 [MEDLINE]
Aspirin hypersensitivity in patients with chronic rhinosinusitis and nasal polyposis: frequency and contributing factors. Am J Rhinol Allergy. 2014;28(3):239 [MEDLINE]
Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: A meta-analysis of the literature. J Allergy Clin Immunol. 2015;135(3):676 [MEDLINE]
Clinical
Chronic sinusitis. Relationship of computed tomographic findings to allergy, asthma, and eosinophilia. JAMA. 1994;271(5):363 [MEDLINE]
Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma. Eur Respir J. 2000;16(3):432 [MEDLINE]
Local and systemic eosinophilia in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis with and without polyposis. Clin Otolaryngol Allied Sci. 2003 Feb;28(1):55-8 [MEDLINE]
Natural history and clinical features of aspirin-exacerbated respiratory disease. Clin Rev Allergy Immunol. 2003;24(2):113 [MEDLINE]
Total IgE levels and peripheral eosinophilia: correlation with mucosal disease based on computed tomographic imaging of the paranasal sinus. Arch Otolaryngol Head Neck Surg. 2007 Jul;133(7):701-4 [MEDLINE]
Characterization and treatment of patients with chronic rhinosinusitis and nasal polyps. Ann Allergy Asthma Immunol. 2013 Nov;111(5):337-41. Epub 2013 Aug 20 [MEDLINE]
Alcohol-induced respiratory symptoms are common in patients with aspirin exacerbated respiratory disease. J Allergy Clin Immunol Pract. 2014;2(2):208 [MEDLINE]
