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27-05-2013 | Immunology | Article

New Samter’s syndrome classification proposed


Free abstract

medwireNews: Turkish researchers have developed a classification system for patients with hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs).

They propose that patients with asthma who develop urticaria/angioedema-type reactions following NSAID intake be classified as having "pseudo-Samter's syndrome," after observing that their characteristics differ from those who develop rhinitis/asthma-type reactions.

Ebru Celebioglu (Hacettepe University, Ankara) and colleagues analyzed data on 1137 patients with NSAID hypersensitivity (NH), defined as a clinical history of at least two such reactions plus a positive oral drug provocation test.

Overall, 36.6% of patients had NH with no underlying disease, 5.6% had NH with asthma alone, 12.5% had NH with chronic urticaria, 11.8% had NH with rhinitis, and 33.5% had NH and any combination of rhinitis, asthma, and chronic urticaria.

The most common reaction to NSAIDs was urticaria/angioedema, experienced by 56% of the cohort. Patients with no underlying disease or chronic urticaria most commonly had urticaria/angioedema reactions (75 and 83%, respectively), while those with a combination of rhinitis, asthma, or chronic urticaria most commonly had rhinitis/asthma reactions (45%).

Asthma was significantly associated with having an NSAID-induced rhinitis/asthma or blended (any combination of urticaria, angioedema, rhinitis, or asthma) reaction, as well as female gender, rhinitis/rhinosinusitis, nasal polyposis, history of polyp surgery, immediate reaction (<1 h after intake), food allergy, and family history of asthma.

Among 413 patients with asthma, 304 (73.6%) had NSAID-induced anaphylaxis, rhinitis/asthma, or blended reactions, and were categorized as true Samter's syndrome.

However, 109 (26.4%) experienced NSAID-induced urticaria/angioedema-type reactions, to which the authors designated a new classification of pseudo-Samter's syndrome.

These patients were more likely than those with true Samter's syndrome to have a positive skin prick test, metal allergy, antibiotic allergy, and chronic urticaria, were more often female, and presented at a younger age, which the authors say indicates they represent a distinct spectrum of Samter's syndrome.

"The clinical course and prognosis in such patients is unknown, and it remains unclear if they go into remission or develop rhinitis/asthma-type reactions later during the course of NH," Celebioglu and colleagues write in Respiratory Medicine.

"Additional research is required to more clearly delineate the behavior and natural course of pseudo Samter's syndrome, as well as incomplete forms of the disease," they conclude.

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