The History of AERD (Samter's Triad)

A Brief History

Aspirin is derived from willow bark, which ancient Egyptians used to relieve aches and pains. The active ingredient is salicylic acid. In 1897, Felix Hoffmann, a chemist employed by Friedrich Bayer and Company, acetylated salicyclic acid to produce acetylsalicyclic acid. In 1899, Bayer patented the drug and named it "aspirin" and began selling it as a pain relief formula around the world.

The first case of a patient with asthma developing aspirin sensitivity was reported in 1902. The disease now known as AERD was first described in 1922 by Fernand Widal and his associates. After an oral challenge with aspirin, their female volunteer had an asthma attack, sinus symptoms, and urticaria. They found that the same reactions occurred after a challenge with antipyrine, which was the only other available NSAID medication at the time. This research was published in French and went largely ignored until 1968, when a German-American immunologist named Max Samter published research on patients with the three symptoms of asthma, aspirin sensitivity, and nasal polyps, The disease began to gain recognition in the medical community and came to be known as Samter’s Triad.

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History of AERD

Symptoms

Diagnosis

Subtypes

Cause

Living With AERD

Sense of Smell

Do I Have AERD?

Avoiding NSAIDs

AERD has also been called:

Samter's Triad

Samter's Syndrome

Aspirin Induced Asthma

Aspirin Intolerant Asthma

Aspirin Sensitive Respiratory Disease

NSAID Exacerbated Respiratory Disease

Acetylsalicylic Acid Triad

Aspirin Triad

Francis' Triad

Widal's Triad

Originally from Berlin, Max Samter immigrated to the United States before World War II and soon became a leader of American allergology. He was president of the American Academy of Allergy, Asthma, and Immunology 1958-59 and was honored in 1982 as Allergist of the Year by the Asthma and Allergy Foundation of America. He helped establish the International Association of Allergology in the 1950s.

Name Confusion

Samter's Triad is what AERD originally became well known as, and old habits die hard. "Aspirin Exacerbated Respiratory Disease" doesn't exactly roll off the tongue and AERD is not a catchy acronym. To further complicate matters, the disease has also been referred to as Samter's Syndrome, NSAID Exacerbated Respiratory Disease (NERD), Widal’s Syndrome, Aspirin Induced Asthma, Aspirin Triad, Aspirin Sensitive Respiratory Disease (ASRD), Aspirin Sensitive Asthma (ASA), Aspirin Intolerant Asthma (AIA), and just plain Aspirin Intolerance - to name a few!

Disagreement over the name of the disease has probably contributed to a misunderstanding of it, as well as a lack of awareness. Including the words "aspirin" or "NSAID" in the name may suggest to a casual observer that the disease is caused by or dependent on these medications, which is incorrect. The disease progresses independently of exposure to NSAIDs - reactions to them are just a symptom. 

Today, most allergists in the United States prefer the name Aspirin Exacerbated Respiratory Disease (AERD). In many parts of Europe and the Middle East, NERD (NSAID Exacerbated Respiratory Disease) is more commonly used. The disease isn't actually a "triad." It is now known that there is more to the disease then the original three symptoms described by Samter. Hyperplastic eosinophilic sinusitis (sinus enlargement caused by excessive multiplication of cells) is a fourth hallmark of AERD. Research has also shown that it is possible to have AERD without having asthma at all. 

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