Anaphylaxis in a Patient Undergoing FESS for Nasal Polyposis: Revisting Samter’s Triad
Patients with nasal polyposis frequently have associated bronchial asthma and hypersensitivity to NSAIDs. When the three conditions co-exist, it is referred to as the Samter’s triad. Patients with Samter’s triad are an important subset of those with aspirin-exacerbated respiratory disease (AERD). We present a case of a young female patient undergoing endoscopic sinus surgery for nasal polyps, who although did not show any other features of AERD, went on to develop florid anaphylaxis to diclofenac administration intra-operatively. After adequate resuscitation and intensive care stay, the patient made a complete recovery. NSAIDs must be avoided in patients with nasal polyps, despite showing no other features of this syndrome. Other analgesic agents that can be used include IV paracetamol and opioids like tramadol.
 Makowska J, Lewandowska-Polak A, Kowalski ML. Hypersensitivity to aspirin and other NSAIDs: diagnostic approach in patients with chronic rhinosinusitis. Curr Allergy Asthma Rep 2015;15(8):47.
 Widal F, Abrami P, Lermoyez J. Anaphylaxis and idiosyncrasy. Allergy Proceedings 1993; 14(5):373-6.
 Samter M, Beers RF Jr. Concerning the nature of intolerance to aspirin. J Allergy. 1967; 40(5):281-93.
 Pham DL, Kim JH, Trinh TH, Park HS. What we know about nonsteroidal anti-inflammatory drug hypersensitivity. Korean J Intern Med. 2016; 31(3):417-32.
 Kowalski ML, Makowska JS. Seven steps to the diagnosis of NSAIDs hypersensitivity: how to apply a new classification in real practice? Allergy Asthma Immunol Res. 2015; 7(4):312-20.
 Rajan JP, Wineinger NE, Stevenson DD, White AA. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: a meta-analysis of literature. J Allergy Clin Immunol. 2015; 135(3):676-81.
 Rozsasi A, Blidaru N, Rockemann M, Santak B, Polzehl D, Keck T. Intraoperative bronchospasm during paranasal sinus surgery- indicator of aspirin intolerance syndrome? Laryngorhinootologie 2006; 85(6):415-20.
 Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004; 328:434-7.
 Picado C. Aspirin intolerance and nasal polyposis. Curr Allergy Asthma Rep. 2002; 2(6):488-93.
 Fruth K, Pogorzelski B, Schmidtmann I, Springer J, Fennan N, Fraessdorf N, et al. Low-dose aspirin desensitization in individuals with aspirin-exacerbated respiratory disease. Allergy. 2013; 68(5):659-65.
 Stewart RA, Ram B, Hamilton G, Weiner J, Kane KJ. Montelukast as an adjunct to oral and inhaled steroid therapy in chronic nasal polyposis. Otolaryngol Head Neck Surg. 2008; 139(5):682-7.
 Olivier F, George M, Leuba D, Monnier P, Friedrich JP. Long-term outcomes following functional endoscopic sinus surgery in Samter’s triad. J Laryngol Otol. 2015; 129(6):548-52.
 Sommer DD, Rotenberg BW, Sowerby LJ, Lee JM, Janjua A, Witterick IJ, et al. A novel treatment adjunct for aspirin exacerbated respiratory disease: the low-salicylate diet: a multicenter randomized control crossover trial. Int Forum Allergy Rhinol. 2016; 6(4):385-91.
|Issue||Vol 7 No 4 (2021): Autumn|
|Anaphylaxis Nasal polyp Aspirin Samter’s triad Diclofenac Functional endoscopic sinus surgery (FESS) Non-steroidal anti-inflammatory drugs (NSAIDs)|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|