Samter’s Triad

Samter’s triad is characterized by the triad of

A. Bronchial asthma
B. Nasal polyps
C. Aspirin intolerance

Disease with Samter’s Triad is also called

  • Aspirin-exacerbated respiratory disease (AERD)
  • NSAID-exacerbated respiratory disease (NERD/N-ERD)
  • Aspirin-induced asthma
  • Samter’s Triad

Diagnosis of AERD

Patients are considered candidates for an AERD diagnosis if they meet the following three points:

  1. History of adverse reactions to aspirin or other NSAIDs
  2. Reduced ability to smell (hyposmia or anosmia)
  3. History of rhinosinusitis and nasal polyps

Further, if a patient meets two or more of the following criteria, then an AERD diagnosis is strongly considered:

  1. Moderate or severe asthma
  2. Asthma with an intractable cough
  3. Onset of asthma after adolescence
  4. A weakly atopic disposition
  5. 10% or greater increase in peripheral eosinophilia

High urinary leukotriene E4

High urinary leukotriene E4 (uLTE4) concentration is also a sign of AERD.

High uLTE4 concentration alone cannot be used to diagnose AERD.

Strong negative predictive value

It may be possible to rule out AERD in patients without high uLTE4 due to its strong negative predictive value.


Urinary LTE4 concentration is generally around 3 to 5 times higher in patients with AERD that it is in those with aspirin-tolerant asthma,

Aspirin challenge test

Urinary LTE4 concentration – Increases 2 to 30 fold during an aspirin challenge test

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