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Granulomatous Disease of the Nose

Question
26 out of 35
 

Samter's triad includes: [AIIMS Nov 2011]



A Nasal polyps
B Aspirin sensitivity

C Bronchiectasis
D Bronchial asthma

E Immunodeficiency

Ans. A B and D. Nasal polyps; Aspirin sensitivity; and Bronchial asthma

Ref. Scott Brown 7th/ed Vol 2 p 1472; 307

Samter's triad is a medical condition consisting of asthma, aspirin sensitivity, and nasal/ethmoidal polyposis. It occurs in middle age (twenties and thirties are the most common onset times) and may not include any allergies ..

a. Most commonly, the first symptom is rhinitis.

b. The disorder typically progresses to asthma, then polyposis, with aspirin sensitivity coming last.

c. The aspirin reaction can be severe, including an asthma attack, anaphy1axis, and urticaria in some cases. Patients typically react to other NSAIDs such as ibuprofen, although paracetamol is generally considered safe.

d. Anosmia (lack of smell) is also typical, as the inflammation reaches the olfactory receptors in the nose.

Cause

The cause of Samter's triad is unknown, but it is widely believed that the disorder is caused by an anomaly in the arachidonic acid cascade, which causes undue production ofleukotrienes, a series of chemicals involved in the body's inflammatory response. When prostaglandin production is blocked by NSAIDs like aspirin, the cascade shunts entirely to leukotrienes, producing the severe allergy-like effects.

Treatment

a. Medical: The preferred treatment now is desensitization to aspirin, undertaken at a clinic specializing in such treatment.

b. Leukotriene antagonists and inhibitors (montelukast, zafirlukast, and zileuton) are helpful in treating Samter's.

c. Surgical: Occasionally, surgery may be required to remove polyps, although they typically recur, particularly if desensitization is not undertaken.

d. Diet: A diet low in omega-6 oils (precursors of arachidonic acid), and high in omega-3 oils, may also help.

Granulomatous Disease of the Nose Flashcard List

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