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Now available: No. 21!
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When painkillers do more harm than good: Samter’s syndrome (Part 1/3)
Samter’s syndrome, also known as acetylsalicylic acid (ASA) intolerance syndrome, is a rare reaction to the active ingredients in common over-the-counter painkillers. As early as three years after aspirin was first introduced in 1899, doctors reported noticing “allergy-like” side effects. Allergies, generally triggered by pollen, household dust mites, animal hair or foods such as flour, milk, nuts etc., involve excessive activation of the body’s own immune system. In comparison, ASA intolerance is due to a dysfunctional metabolism which shows itself as a complex of symptoms.
The symptoms of the condition are:
- Sensitivity to painkillers (aspirin, ibuprofen, diclofenac, indometacin etc.)
- Nasal polyps
- Loss of sense of smell
- Chronic rhinitis
- Asthma
- Urticarial skin reactions
Recently experts have favored the term Aspirin-Exacerbated Respiratory Disease (AERD). Here, the emphasis is on the exacerbating effect of aspirin and other analgesics, as in most cases patients already suffer from a severe chronic respiratory condition, irrespective of the painkillers they take.
The patients who are affected
ASA intolerance primarily affects female patients from 30 years of age onwards. The intolerance reaction usually appears within one hour of the patient having taken a painkiller. It takes the form of an asthma attack, often combined with a runny nose, conjunctivitis and flushing of the face and neck. In severe incidences the reaction can lead to a potentially fatal case of anaphylactic shock.
There is very little data on the frequency of illnesses of the upper respiratory tract owing to ASA intolerance, as only a very few studies with very limited numbers of patients have been conducted thus far. According to estimates, around 8 to 20 percent of all asthmatics are affected by the condition and therefore at risk of suffering severe, life-threatening attacks. Roughly 6 to 15 percent of patients with nasal polyps are affected by this intolerance. According to other publications, every tenth patient affected by chronic inflammation of the paranasal sinuses owing to polyps (polyposis nasi) can also expect to suffer from ASA intolerance.
Nasal polyps are known to trigger migraines and inflammation of the paranasal sinuses, leading to throbbing pain and/or headaches, and unfortunately analgesic intolerance strongly limits pain treatment options. In the case of nasal polyps the body may react to the painkiller, resulting in an intensification of the inflammatory process, which further stimulates the formation of polyps and increases the risk of an asthma attack. Owing to these multiple factors ASA intolerance triggers a vicious cycle.
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