When medications such as NSAIDs or aspirin block the COX-1 enzyme, production of thromboxane and some anti-inflammatory prostaglandins is decreased, and in patients with aspirin-induced asthma, this results in the overproduction of pro-inflammatory leukotrienes, which can cause severe exacerbations of asthma and allergy-like symptoms. The underlying cause of the disorder is not fully understood, but there have been several important findings:

Abnormally low levels of prostaglandin E2 (PGE2), which is protective for the lungs, has been found in patients with aspirin-induced asthma and may worsen their lung inflammation. In addition to the overproduction of cystinyl leukotrienes, overproduction of 15-lipoxygenase-derived arachidonic acid metabolites viz., 15-hydroxyicosatetraenoic acid and eoxins by the eosinophils isolated from the blood of individuals with AERD; certain of these products may help promote the inflammatory response. Overexpression of both the cysteinyl leukotriene receptor 1 and the leukotriene C4 synthase enzyme has been shown in respiratory tissue from patients with aspirin-induced asthma, which likely relates to the increased response to leukotrienes and increased production of leukotrienes seen in the disorder. The attachment of platelets to certain leukocytes in the blood of patients with aspirin-sensitive asthma also has been shown to contribute to the overproduction of leukotrienes. There may be a relationship between aspirin-induced asthma and TBX21, PTGER2, and LTC4S.
In contrast to aspirin, dietary salicylates are not acetylated and therefore do not block cyclooxygenases and hence, there is no rationale why a low salicylate diet would be beneficial for AERD patients.A diet low in omega-6 oils (precursors of arachidonic acid), and high in omega-3 oils may also be of benefit. In a small study, aspirin-sensitive asthma patients taking 10 grams of fish oil daily reported relief of most symptoms after six weeks, however, symptoms returned if the supplement was stopped. In another study, a diet low in omega 6 fatty acids and high in omega 3 fatty acids significantly reduced sinus symptoms in AERD patients. Alternate and related names
Aspirin-induced asthma
Leukotriene associated hypersensitivity 
Samters triad
Acetylsalicylic acid triad 
Widals triad
Francis triad
Aspirin triad
Aspirin-exacerbated respiratory disease (AERD). NSAID-exacerbated respiratory disease (NERD)
Aspirin-induced asthma and rhinitis (AIAR) A person who has not yet experienced asthma or aspirin sensitivity might be diagnosed as having:

Non-allergic rhinitis
Non-allergic rhinitis with eosinophilia syndrome (NARES)

History
The syndrome is named for Max Samter.Initial reports on a linkage among asthma, aspirin, and nasal polyposis were made by Widal in 1922. Further studies were conducted by Samter and Beers in reports published in 1968. See also
Salicylate sensitivity
Drug intolerance
Alcohol-induced respiratory reactions

References


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