Asthma, nasal polyps, and aspirin intolerance

MedGen UID:: 347198
•Concept ID:: C1859648
•: Disease or Syndrome

Synonym:	ASA TRIAD

Genes (locations): Gene(s) directly associated with this condition or phenotype.	PTGER2 (14q22.1); TBX21 (17q21.32)

Monarch Initiative:	MONDO:0008834
OMIM®:	208550

Definition

Patients with asthma, nasal polyps, and aspirin intolerance may have severe asthma with rhinosinusitis and nasal polyposis, accompanied by hives, flushing, or abdominal pain following the administration of aspirin or nonsteroidal antiinflammatory drugs (NSAIDs). Severe episodes are life-threatening (summary by Arm and Austen, 2002). [from OMIM]

Clinical features

From HPO

Bronchoconstriction

MedGen UID:: 36266
•Concept ID:: C0079043
•: Organ or Tissue Function

Tightening of smooth muscle surrounding the bronchi and bronchioles with consequent wheezing and shortness of breath.

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Asthma

MedGen UID:: 2109
•Concept ID:: C0004096
•: Disease or Syndrome

Asthma is characterized by increased responsiveness of the tracheobronchial tree to multiple stimuli, leading to narrowing of the air passages with resultant dyspnea, cough, and wheezing.

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Aspirin-induced asthma

MedGen UID:: 230819
•Concept ID:: C1319853
•: Disease or Syndrome

A type of asthma in which aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit cyclooxygen-ase 1 (COX-1) exacerbate bronchoconstriction.

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Nasal polyposis

MedGen UID:: 6524
•Concept ID:: C0027430
•: Anatomical Abnormality

Polypoidal masses arising mainly from the mucous membranes of the nose and paranasal sinuses. They are freely movable and nontender overgrowths of the mucosa that frequently accompany allergic rhinitis.

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Abnormality of head or neck
- Nasal polyposis
Abnormality of the immune system
- Aspirin-induced asthma
- Asthma
Abnormality of the respiratory system
- Bronchoconstriction

Professional guidelines

PubMed

Aspirin-exacerbated respiratory disease: Prevalence, diagnosis, treatment, and considerations for the future.

Kennedy JL, Stoner AN, Borish L
Am J Rhinol Allergy 2016 Nov 1;30(6):407-413. doi: 10.2500/ajra.2016.30.4370. PMID: 28124651 Free PMC Article

The Role of Surgery in Management of Samter's Triad: A Systematic Review.

Adelman J, McLean C, Shaigany K, Krouse JH
Otolaryngol Head Neck Surg 2016 Aug;155(2):220-37. Epub 2016 Apr 12 doi: 10.1177/0194599816640723. PMID: 27071444

Aspirin-exacerbated respiratory disease: characteristics and management strategies.

Simon RA, Dazy KM, Waldram JD
Expert Rev Clin Immunol 2015;11(7):805-17. Epub 2015 May 2 doi: 10.1586/1744666X.2015.1039940. PMID: 25936612

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Recent clinical studies

Etiology

A proinflammatory marker in chronic rhinosinusitis: serum calprotectin.

Candar T, Baklaci D, Kuzucu I, Kayabasi S
Acta Biochim Pol 2020 Aug 31;67(3):367-371. doi: 10.18388/abp.2020_5204. PMID: 32865947

Dipeptidyl-peptidase 10 as a genetic biomarker for the aspirin-exacerbated respiratory disease phenotype.

Kim SH, Choi H, Yoon MG, Ye YM, Park HS
Ann Allergy Asthma Immunol 2015 Mar;114(3):208-13. Epub 2015 Jan 13 doi: 10.1016/j.anai.2014.12.003. PMID: 25592153

Increased in vitro cysteinyl leukotriene release from blood leukocytes in patients with asthma, nasal polyps, and aspirin intolerance.

Mewes T, Riechelmann H, Klimek L
Allergy 1996 Jul;51(7):506-10. doi: 10.1111/j.1398-9995.1996.tb04657.x. PMID: 8863928

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