ASA Triad

September 7, 2012

Aspirin Exacerbated Respiratory Disease (AERD) (also known as Sampter’s Triad or ASA triad) is characterized by nasal polyps, asthma and aspirin intolerance. This aspirin intolerance is not a simple allergic reaction to aspirin. It is due to increased production of molecules that cause inflammation in the upper and lower airway called leukotrienes. Patients with this condition have a baseline level of inflammation giving rise to sinus and nasal symptoms as well as asthma. In addition, patients with AERD may develop life threatening symptoms including an asthmatic attack and/or a special rash when they take aspirin, nonsteroidal anti-inflammatory medications (ibuprofen, others) or even acetaminophen at high doses. Because of this type of reaction, some patients with nasal polyps and asthma are often advised to avoid aspirin, even if they have never had a reaction to aspirin.

Patients with AERD have severe asthma and rhinosinusitis. Even after appropriate sinus surgery, the polyps can return. Optimal treatment includes sinus surgery and medical management. Most patients with AERD require systemic and topical corticosteroids. Good asthma treatment is critical as well. Some centers employ aspirin desensitization, a specific technique to create aspirin tolerance, which seems to improve both the asthma and the rhinosinusitis.

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