Samter's triad in childhood: a warning for those prescribing NSAIDs

Paediatr Anaesth. 2013 Aug;23(8):757-9. doi: 10.1111/pan.12216. Epub 2013 Jun 20.


Aspirin-exacerbated respiratory disease (AERD) has been recognized in adults with chronic asthma. Samter's triad is a subset of AERD where adult patients develop nasal polyps, asthma, and sensitivity to aspirin. This condition is thought not to occur before the third decade of life. We report a 13-year-old boy with nasal polyps who suffered a life-threatening exacerbation of asthma during a graded aspirin challenge. Resuscitation required positive pressure ventilation and inotropic support. Our observations confirm that classical Samter's triad can occur in children. We suggest that graded aspirin challenges in children are undertaken in a facility with equipment and staff trained for resuscitation. Consideration should be given to this rare complication when prescribing nonsteroidal anti-inflammatory drugs in the perioperative period. Suspicion of this condition merits referral to an immunologist for desensitization to aspirin.

Keywords: anaphylaxis; aspirin; asthma; child.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetates / therapeutic use
  • Adolescent
  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Aspirin / adverse effects
  • Asthma / complications
  • Asthma, Aspirin-Induced / diagnostic imaging
  • Asthma, Aspirin-Induced / drug therapy
  • Asthma, Aspirin-Induced / therapy*
  • Bronchodilator Agents / therapeutic use
  • Cranial Sinuses / diagnostic imaging
  • Critical Care
  • Cyclopropanes
  • Epinephrine / therapeutic use
  • Humans
  • Male
  • Nasal Polyps / complications
  • Quinolines / therapeutic use
  • Respiration, Artificial
  • Respiratory Tract Diseases / complications
  • Sulfides
  • Tomography, X-Ray Computed


  • Acetates
  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Bronchodilator Agents
  • Cyclopropanes
  • Quinolines
  • Sulfides
  • montelukast
  • Aspirin
  • Epinephrine