Symptoms of AERD (Samter's Triad)
Aspirin Exacerbated Respiratory Disease (AERD, Samter's Triad) consists of three different medical problems: nasal polyps, asthma, and a sensitivity to aspirin and NSAIDs. "Triad" means "three," in case you were wondering. The disease first became known as "Samter's Triad" because Max Samter was one of the first researchers to report on patients with this trio of medical problems.
It's important to recognize that aspirin and NSAIDs do not cause this disease - our sensitivity to them is just a sign of it. Asthma and nasal polyps have their own symptoms, which you are probably already far too familiar with. Wheezing, tightness in the chest, a stuffed or blocked nose, thick nasal mucus, loss of smell and taste, and facial pain are only a few of the problems that AERD causes. These problems will be chronic and progressive even if you avoid aspirin and other NSAIDs. Ingestion of NSAIDS results in an acute reaction, but the underlying disease is not dependent on them or caused by them.
Symptoms of AERD:
Increased nasal congestion
Eye watering or redness
Cough, wheezing, or chest tightness
Frontal headache or sinus pain
Flushing and/or a rash
Nausea and/or abdominal cramping
General feeling of malaise, sometimes accompanied by dizziness.
AERD Reactions Can Be Deadly
Acute reactions to aspirin and other NSAIDs are typically severe and can be life threatening. Research has found that about 25% of patients who required emergency mechanical ventilation due to an asthma exacerbation were found to be aspirin intolerant. The severity of past reactions is not a reliable predictor of future reactions. Studies have found that patients who had a history or mild reactions were just as likely to have a severe reaction during oral aspirin challenge.
AERD/Samter's Triad is usually diagnosed in adulthood, but it can also occur in adolescents, and even children. In most cases, the symptoms develop over a period of 1 to 5 years, which adds to the difficulty of diagnosis. Often, it is not until the disease has reached its full progression that AERD is considered as a cause.
Most patients first develop sinusitis in their thirties. This progresses into a more severe form of sinus disease (hypertrophic eosinophilic rhinosinusitis), which causes nasal polyp growth and often results in loss of sense of smell. As the sinusitis continues to worsen, the lower airway becomes inflamed and asthma develops. At some point during this process, aspirin and NSAID sensitivity appears. In rare cases, the aspirin/NSAID sensitivity develops first.
There are many AERD patients who don't fit this mold. Some of us had asthma or sinusitis since childhood and went on to develop AERD as adults. No two AERD patients are exactly alike!
If you think you might have AERD (Samter's Triad), but you're not sure, read more about signs and symptoms on this page.
Less Common Symptoms
In addition to asthma, nasal polyps, and NSAID sensitivity, many patients experience an array of other symptoms. These can include flushing, a rash (urticaria), red or watery eyes, general malaise, and gastrointestinal symptoms, such as nausea or abdominal cramping.
Urticaria (hives) is not one of the hallmarks of AERD, but it is more common than was previously believed. Urticaria may occur after ingestion of alcohol or NSAIDs, or seemingly at random. One study found that 33% of patients had experienced cutaneous symptoms. Of those who had skin symptoms, 16.7% had chronic urticaria and 75% had experienced acute urticaria. For some patients, antihistamines provide some relief of chronic urticaria symptoms. Systemic treatments for AERD, such as aspirin desensitization, anti-leukotriene medications, oral steroids, and biologic drugs may also be helfpul.
Otologic (Ear) Symptoms and AERD
Hearing loss and other ear problems can develop as a result of the chronic sinus inflammation caused by AERD. Otologic manifestations of AERD can include a feeling of ear fullness, vertigo, eardrum perforation, and even hearing loss. In one study, researchers found that 26% of patients studied developed otological manifestations with ear pressure and conductive hearing loss at an advanced stage of the disease. These symptoms began 4-11 years after the development of sinus symptoms. Other research has found that the odds of AERD patients developing hearing loss increase with each additional year of having nasal polyps.
Otologic complications are believed to be caused by eustachian tube dysfunction, which has been associated with chronic sinus inflammation. It is recommended that patients have their hearing screened regularly.
In rare cases, patients with AERD can develop eosinophilia-associated coronary artery vasospasm. This can occur in patients whether or not they have been desensitized to aspirin, but it can occasionally be worsened by high-dose aspirin therapy. Patients with symptoms of ischemic chest pain should be screened for eosinophilia. Early treatment with corticosteroids can be life-saving. If you are a patient who has unexplained chest pain, print this study and discuss it with your doctors.
Eosinophilic esophagitis can also be associated with AERD. Symptoms of eosinophilic esophagitis include difficulty swallowing, chest pain that does not respond to antacids, and persistent heartburn. Patients who experience such symptoms should be screened for eosinophilic esophagitis.