A rare case in an adolescent patient with nasal polypsresistant to polypectomy: Samter’s syndrome

The comorbidity of recurrent nasal polyps, non-steroidal anti-inflammatory drug hypersensitivity and chronic rhinosinusitisis called Samter’s syndrome. It is less common in childhood than in adulthood. Patients first have nasal symptoms and thenasthma and non-steroidal anti-inflammatory drug (NSAID) hypersensitivity begin to accompany. For definitive diagnosis, NSAIDor aspirin hypersensitivity must be shown with provocation test. In this case report, oral provocation test with ibuprofen wasperformed on a 17-year-old female patient who had recurrent nasal polyps and chronic rhinosinusitis accompanied by asthmaand NSAID hypersensitivity and the test was found to be positive. The patient was diagnosed with Samter’s syndrome and aspirindesensitization was applied. Inhaled steroid, intranasal steroid and montelukast therapies were started. As a conclusion, althoughit is more common in adults, Samter’s syndrome should also be considered in pediatric patients with recurrent nasal polyp, chronicrhinosinusitis, asthma, and NSAID hypersensitivity.

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1. Stevenson DD, Simon RA. Selection of patients for aspirin desensitization treatment. J Allergy Clin Immunol 2006;118:801-4.
2. Sakalar EG, Muluk NB, Kar M, Cingi C. Aspirinexacerbated respiratory disease and current treatment modalities. Eur Arch Otorhinolaryngol 2017; 274:1291-300.
3. Kim SD, Cho KS. Samter’s Triad: State of the Art. Clin Exp Otorhinolaryngol 2018;11:71-80.
4. Adelman J, McLean C, Shaigany K, Krouse JH. The Role of Surgery in Management of Samter’s Triad: A Systematic Review. Otolaryngol Head Neck Surg 2016;155:220-37.
5. Ameratunga R, Randall N, Dalziel S, Anderson BJ. Samter’s triad in childhood: a warning for those prescribing NSAIDs. Paediatr Anaesth 2013;23:757-9.
6. Lee RU, Stevenson DD. Aspirin-exacerbated respiratory disease: evaluation and management. Allergy Asthma Immunol Res 2011;3:3-10.
7. Scott DR, White AA. Approach to desensitization in aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2014;112:13-7.
8. White AA, Stevenson DD. Aspirin-exacerbated respiratory disease: update on pathogenesis and desensitization. Semin Respir Crit Care Med 2012;33:588-94.
9. Woessner KM, White AA. Evidence-based approach to aspirin desensitization in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 2014;133:286-7.
10. Samter M, Beers RF Jr. Intolerance to aspirin. Clinical studies and consideration of its pathogenesis. Ann Intern Med 1968;68:975-83.
11. Berges-Gimeno MP, Simon RA, Stevenson DD. The natural history and clinical characteristics of aspirinexacerbated respiratory disease. Ann Allergy Asthma Immunol 2002;89:474-8.
12. Comert S, Celebioglu E, Yucel T, Erdogan T, Karakaya G, Onerci M, et al. Aspirin 300 mg/day is effective for treating aspirin-exacerbated respiratory disease. Allergy 2013;68:1443-51.