Gramercy Allergy & Asthma

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Jennifer Collins, MD
Board certified in Internal Medicine and Allergy and Immunology

Aspirin Exacerbated Respiratory Disease (AERD)/Samter’s Triad

What is Aspirin Exacerbated Respiratory Disease (AERD) or Samter’s Triad?

  • Patients with asthma and sinus disease can have reactions to these drugs and are diagnosed with Aspirin Exacerbated Respiratory Disease (AERD). This is also known as Samter’s Triad.
  • Typically patients will have asthma, nasal polyps and allergy to aspirin. You don’t have to have all three diseases to have Samter’s Triad.
  • A majority of patients also experience respiratory reactions to alcohol and an impaired sense of smell.
  • As many as 7-10% of persons with asthma may have Aspirin Exacerbated Respiratory Disease (AERD). In patients with severe asthma as many as 15% of patients have AERD. If you have both asthma and nasal polyps the disease may be as high as 40% according to studies.
  • The diagnosis of AERD is difficult and many patients are undiagnosed. The first ever AERD Awareness Day was September 26, 2018
  • They undergo recurrent surgery for nasal polyps or chronic oral steroid use for their asthma.
  • Many think that avoidance of aspirin or NSAIDS will prevent the disease, but THIS IS NOT TRUE.
  • AERD can start at any age and is an acquired condition. It may be slightly more common in women then men.

What Are Symptoms Associated with Aspirin Exacerbated Respiratory Disease/Samter’s Triad?

  • Nasal congestion
  • Wheezing, chest congestion
  • Severe poorly controlled asthma
  • Recurrent nasal polyps.
  • Facial pain and pressure
  • Flushing and/or a rash
  • Nausea and/or abdominal cramping
  • Loss of sense of smell/taste
  • Adverse reactions to alcohol
  • General feeling of malaise

How Do you Diagnose Aspirin Exacerbated Respiratory Disease/Samter’s Triad?

  • Your doctor may suspect you have AERD based off of your history.
  • The gold standard for diagnosis is an aspirin challenge. THIS SHOULD ONLY BE DONE UNDER THE SUPERVISION OF A HIGHLY TRAINED ALLERGIST.
  • An aspirin challenge is performed to evaluate if you have an allergy to aspirin non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen.
  • Patients with AERD may benefit from aspirin desensitization followed by twice daily aspirin therapy.

What to Expect During An Aspirin Challenge?

  • Both the aspirin challenge and aspirin desensitization are performed at Gramercy Allergy and Asthma. Jennifer Collins, MD and Dr. Meng Chen, MD are highly trained in the diagnosis and treatment of this disease.
  • They will coordinate with your other physicians (ENT’s) to make sure this is done at the right time.
  • Please plan for the aspirin challenge to take approximately 5 hours (but possibly longer if you have a reaction and need to be monitored for longer). The desensitization takes at least one full day and the morning of the following day.
  • Prior to the aspirin challenge, please stop antihistamines (Benadryl, Claritin, Allegra, Zyrtec, etc) at least 5 days in advance
  • The day of the aspirin challenge we will first check your vital signs and spirometry, which is a breathing test
  • During the aspirin challenge, you will first be given escalating doses of aspirin followed by careful monitoring.
  • You will be monitored closely throughout the day. We will frequently check on your symptoms, vitals signs and spirometry
  • If you have a reaction, we will treat your symptoms. An aspirin challenge is concluded once you have symptoms as a reaction confirms your diagnosis.

What are the Benefits?

Patients who are diagnosed with AERD/Samter’s Triad may be started on high dose aspirin therapy.

If you respond to treatment you may experience:

  • Improved sense of smell
  • Decreased growth of nasal polyps
  • Fewer polyp surgeries
  • Improvement in asthma symptoms and reduced number/ severity of asthma attacks
  • Need for less medication for asthma

What are the Risks?

During an aspirin challenge and/or desensitization, patients can have reactions that range from mild to severe and life-threatening, which is why the procedures are performed in our office in a closely monitored setting.

You will likely experience the following symptoms:

  • Eye symptoms: watering, itchiness, redness
  • Nasal symptoms: sneezing, stuffiness
  • Respiratory symptoms: coughing, wheezing, chest tightness
  • Headache and/or sinus pressure

You may also experience hives/ rash, flushing, nausea/ vomiting/ abdominal pain

Aspirin can prevent your blood from clotting efficiently. The risks of taking aspirin everyday includes easy bruising and bleeding. You should stop aspirin immediately if you develop any bleeding problems. Patients who are pregnant should not undergo aspirin desensitization.

Do You Want More information on Aspirin Exacerbated Respiratory Disease/Samter’s or Suspect you have this Disorder?

  • Please call the office for an appointment and evaluation. We will work with you to help you determine the right medication and if an aspirin challenge is appropriate for you.

Want more information on Aspirin Exacerbated Respiratory Disease/Samter’s Triad?