Aspirin intolerance triad

Introduction to aspirin intolerance triad Aspirin intolerance triad (aspirinintolerance triad) or Wiolal syndrome (Wielalssyndrome) is an unexplained respiratory hyperresponsive disease. These patients are often accompanied by nasal polyps and bronchial asthma. Aspirin, indomethacin and other non-steroidal anti-inflammatory drugs, can often induce rhinitis (sneezing, salivation), asthma attacks, but also accompanied by urticaria, vascular hematoma and other symptoms. The disease is often characterized by vasomotor activity. Patients may have more watery nasal discharges and eosinophils in nasal secretions. Later, hypertrophic sinusitis and nasal polyps may form, and asthma may occur after middle age. Patients taking antipyretic analgesics such as aspirin often induce rhinitis or asthma attacks, and very few patients may have serious reactions such as chest tightness, laryngeal infarction, and even shock and death. basic knowledge The proportion of sickness: 0.002%-0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: shock

Aspirin intolerance to the cause of triad

After immunological experimental research and clinical examination confirmed that the disease has nothing to do with allergic reaction, it is now generally speculated that the metabolism of arachidonic acid in the cell membrane is shifted, resulting in excessive leukobriene (LTS), which is the main cause of this disease. Linkages, aspirin, indomethacin and other non-steroidal anti-inflammatory drugs can shift the metabolism of arachidonic acid. LTS is both a strong bronchial smooth muscle contraction factor and a highly biologically active inflammatory mediator. Eosinophils have high chemotactic activity. LTS can cause local mucosal edema in the respiratory tract and cause large infiltration of eosinophils. The cytotoxic substances (mainly basic proteins) released by the latter can not only cause mucosal epithelial damage. Increased sensitivity can also disrupt the innervation of the small blood vessel wall of the nasal mucosa, dilate small blood vessels, increase permeability, aggravate tissue edema, and contribute to the formation of polyps.

Aspirin intolerance triad prevention

The disease is more common in adults. Because patients often go to the Department of Internal Medicine and Otolaryngology according to their own symptoms, the reported numbers are not consistent. Poole et al. (1985) provide a set of numbers for otolaryngology patients. About 20% of them are intolerant to aspirin, 30% to 40% of those with nasal polyps and asthma are intolerant to aspirin, and 10% of unselected asthma patients.

Aspirin intolerance to complications of triad Complications

Very few patients can have serious reactions, such as chest tightness, laryngeal infarction, and even shock and death.

Aspirin intolerance triad symptoms common symptoms chest tightness allergic rhinitis shock corticosteroid dependence

The disease is often characterized by vasomotor activity. Patients may have more watery nasal discharges and eosinophils in nasal secretions. Later, hypertrophic sinusitis and nasal polyps may form, and asthma may occur after middle age. Patients taking antipyretic analgesics such as aspirin often induce rhinitis or asthma attacks, and very few patients may have serious reactions such as chest tightness, laryngeal infarction, and even shock and death.

Aspirin intolerance triad examination

Aspirin oral challenge test: This method can cause a heavier respiratory response, so the following principles should be followed: 1 should be carried out in patients with asthma remission; 2 by experienced respiratory physicians in emergency conditions; 3 excitation The dose starts from 3mg, every 3 hours, up to 650mg, 3 times a day, lung function should be measured after each stimulation, no longer stimulated when FEV drops more than 25%; 4 pairs have provided clear aspirin intolerance Those who have a medical history should not perform this test again.

Diagnosis and diagnosis of aspirin intolerance triad

1. All patients with nasal polyps should be asked whether there is a history of asthma and antipyretic analgesic tolerance.

2. Nasal examination of asthma patients should be considered routine. In asthma patients, 25% to 30% of nasal polyps can be found (Molone, 1977). If nasal polyps are found, the disease should be highly suspected.

3. There are many eosinophils in the nasal secretions.

4. Radiological examination shows signs of sinusitis. Xie Yongming (1987) reported that aspirin patients with aspirin had a sinusitis change of 89.8%.

5. Foods such as cakes, sausages, canned foods, candies, etc., which can induce asthma, should be further examined.

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