Samter’s Triad: Asthma, Nasal Polyps, and Aspirin Sensitivity

Medically reviewed by Adithya Cattamanchi, M.D. — Written by Jill Seladi-Schulman, Ph.D.

What’s Samter’s Triad?

Samter’s Triad is a chronic condition defined by asthma, sinus inflammation with recurring nasal polyps, and aspirin sensitivity. It’s also called aspirin-exacerbated respiratory disease (AERD), or ASA triad.

When people with Samter’s Triad are exposed to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), they have an adverse reaction. The reaction includes both upper and lower respiratory symptoms. They can also develop a rash and abdominal pains.

What are the symptoms of Samter’s Triad?

People with Samter’s Triad have asthma, sinus inflammation or congestion, and recurring nasal polyps. Often these symptoms don’t respond to standard treatment. People that have both nasal polyps and asthma are often told to avoid taking aspirin even if they’ve never had an adverse reaction.

Individuals with Samter’s Triad develop a severe reaction with both upper and lower respiratory symptoms when they take aspirin or other NSAIDs. These symptoms usually occur between 30 and 120 minutes after taking aspirin. Symptoms of this reaction include:

  • coughing
  • wheezing
  • tightness in the chest
  • nasal congestion
  • headache
  • sinus pain
  • sneezing

Other possible symptoms include:

  • rash
  • flushing of the skin
  • abdominal pain
  • diarrhea or vomiting

Some people with Samter’s Triad can lose their sense of smell and have recurring sinus infections. In some reports, up to 70 percent of people with Samter’s Triad report a sensitivity to red wine or other alcoholic beverages.

What causes Samter’s Triad?

There’s no clear cause of Samter’s Triad. According to the American Academy of Allergy, Asthma & Immunology, about 9 percent of adults with asthma and 30 percent of adults with both asthma and nasal polyps also have Samter’s Triad.

The condition develops in adulthood, typically in people between 20 and 50 years old. The average age of onset is 34 years of age.

How’s Samter’s Triad diagnosed?

There’s no specific test to diagnose Samter’s Triad. Typically, a diagnosis is made when someone has asthma, nasal polyps, and a sensitivity to aspirin.

The aspirin challenge test is used to confirm the diagnosis. This test is done in a hospital under the supervision of a doctor. The person suspected of having Samter’s Triad is given a dose of aspirin to see if there’s an adverse reaction. The aspirin challenge is also used as a diagnostic tool when doctors suspect Samter’s Triad as the person has asthma and nasal polyps, but no history of aspirin sensitivity.

Also, people with Samter’s Triad often have a large number of eosinophils in their nasal polyps or blood. Eosinophils are a specific type of immune cell.

How’s Samter’s Triad treated?

People with Samter’s Triad will need to take medications daily to control their symptoms. An inhaler is used to control asthma symptoms. Intranasal steroid sprays or steroid sinus rinses can be used to treat sinus inflammation. Nasal polyps can be treated with steroid injections.

Treatment for Samter’s Triad can also involve sinus surgery to remove the nasal polyps. But there’s a high likelihood that the nasal polyps will reappear after surgery.

There are several other treatment approaches for Samter’s Triad:

Aspirin Desensitization

The goal of aspirin desensitization is to create a tolerance to aspirin. Your doctor will slowly give you increasing doses of aspirin over time until you can tolerate it in high doses. Afterward, you’ll continue to take a high dose of aspirin daily. This is especially important for people that need to use aspirin or other NSAIDs for conditions such as cardiovascular disease or chronic pain.

Aspirin desensitization can improve your asthma and sinus inflammation as well as lead to a decrease in the formation of nasal polyps. As such, it also reduces both the need for sinus surgery and the amount of corticosteroids that people with Samter’s Triad have to take.

Many people with Samter’s Triad respond to aspirin desensitization. However, in some people symptoms don’t improve. A long-term study from 2003 of 172 patients, found that 22 percent reported either seeing no improvement in their symptoms following aspirin desensitization or had to stop taking aspirin due to side effects.

Aspirin desensitization isn’t appropriate for people who shouldn’t take aspirin. This includes those who are pregnant or have a history of gastric ulcers.

Avoidance of aspirin and other NSAIDs

People that haven’t undergone aspirin desensitization should avoid aspirin and other NSAIDs to prevent a reaction from occurring. Yet in many cases it’s not possible to completely avoid aspirin and other NSAIDs. These drugs are often used to treat or manage cardiovascular disease and other conditions.

People that haven’t had aspirin desensitization will still experience the symptoms of asthma, nasal inflammation, and recurring polyps. They’ll likely need to have repeated sinus surgeries to remove nasal polyps and also continue to take corticosteroids to manage their symptoms.

Other interventions

In addition to the methods mentioned above, a type of drug called a leukotriene-modifying agent can be used to reduce inflammation in the airway. Initial studies suggest that these drugs may improve lung function, reduce asthma flare-ups, and reduce the amount of eosinophils found in nasal polyps.

Also, cutting back on eating foods containing salicylic acid could help with symptoms. Salicylic acid is one of the ingredients in aspirin. A small, recent study showed that eliminating foods with salicylic acid, such as certain fruits, vegetables, herbs, and spices, led to an improvement in symptoms.

The takeaway

Samter’s Triad is a condition in which an individual has asthma, sinus inflammation with recurring nasal polyps, and sensitivity to aspirin and some other NSAIDs. When aspirin or a similar drug is taken, people with Samter’s Triad have a severe reaction with both upper and lower respiratory symptoms.

Samter’s Triad is usually treated by managing asthma symptoms, taking corticosteroids, and having nasal surgery to remove polyps. People can also be desensitized to aspirin, which may result in a decrease in most of the symptoms of Samter’s Triad.

If you believe you may have Samter’s Triad or are having trouble managing it, you should speak to your doctor about a treatment that’ll address your specific concerns.