Aspirin triad comprises of asthma, aspirin sensitivity and nasal/ethmoidal polyposis. It is a disorder experienced by subpopulation of asthmatic people who are sensitive to aspirin. The allergic reaction develops into rhino-sinusitis and other complications due to aspirin intolerance.
Aspirin-Exacerbated Respiratory Disease (AERD), Samter’s Triad, Aspirin Sensitive Asthma and Sampter’s Syndrome are other terms to describe this condition. In aspirin triad, combined symptoms of all the three conditions are seen. Sneezing, runny nose and congestion are followed by asthma attack and nasal polyps.
Diagnosis of Aspirin Triad:
Aspirin intolerance is diagnosed first by taking history of adverse reactions into account. Majority of aspirin intolerant people have convincing history of NSAID-induced adverse reactions. Oral aspirin challenge is the standard to confirm the diagnosis, i.e, to confirm aspirin intolerance.
Those who are aspirin tolerant are distinguished from aspirin intolerant by conducting in vitro tests. The Aspirin Sensitive Patient Identification Test and basophil activation test are other tests done to confirm aspirin intolerance.
Treatment of Aspirin Triad:
Management of aspirin triad is similar to treatment of other forms of asthma and rhino-sinusitis. First step is patient education to avoid NSAIDs and recommend using alternative analgesics. Those who can be desensitized are given a special doses of aspirin under the supervision of a doctor.
Asthma is managed by asthmatic medications such as inhaled glucocorticosteroids that are combined with beta-2 agonists. Leukotriene modifiers are given to improve asthma and rhinosinusitis in aspirin intolerant patients. Leukotriene antagonists and inhibitors that are helpful in treating aspirin triad are montelukast, zileuton and zafirlukast.
Surgery may be required to relieve the symptoms of nasal obstruction caused by polyps. Chronic sinusitis and obstructions cease once the polyps are removed surgically. It may consist of a polypectomy and functional endoscopic sinus surgery either with or without ethmoidectomy.
