Aspirin Intolerance Triad (Wiolal Syndrome)

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Aspirin Intolerance Triad
Body Parts: Head
Medical Subjects: Respiratory System Ear, Nose And Throat
Overview

What Is Aspirin Intolerance Triad

Aspirin intolerance triad, or Wiolal syndrome, is an unexplained respiratory hyperreactive disease. These patients are often accompanied by nasal polyps and bronchial asthma. Aspirin, anti-inflammatory and analgesic non-steroidal anti-inflammatory drugs can often induce rhinitis, including sneezing and runny nose, asthma attack, and may be accompanied by urticaria, vascular hematoma and other symptoms.

Cause

What Is The Cause Of Aspirin Intolerance Triad

Immunological experimental study and clinical examination proved that Aspirin Intolerance Triad has nothing to do with allergy. Now, it is generally speculated that the metabolism of arachidonic acid in cell membrane shifts and produces excessive leukotrichia (LTS), which is the main link of this disease. Aspirin, antiphlogistic and analgesic nonsteroidal anti-inflammatory drugs can shift arachidonic acid metabolism. LTS is not only a strong bronchosmooth muscle contraction factor, but also an inflammatory mediator with strong biological activity, among which LT4 has high chemotactic activity to eosinophils. LTS can cause local mucosal edema and infiltrate eosinophils in respiratory tract. the cytotoxic substances released by lts are mainly basic proteins, which can not only damage the mucosal epithelium and enhance its sensitivity, but also destroy the innervation on the wall of small vessels in nasal mucosa, dilate small vessels, increase their permeability, aggravate tissue edema and contribute to the formation of polyps.

Symptom

What Are The Symptoms Of Aspirin Intolerance Triad

1. All patients with nasal polyps should ask whether they have asthma history and antipyretic and analgesic tolerance.

2. Nasal examination for asthma patients should be regarded as routine. Nasal polyps can be found in 25%-30% of asthma patients, and should be highly suspected if nasal polyps are found.

3. There are more eosinophils in nasal secretions.

4. Radiological examination showed signs of sinusitis. Xie Yongming from China reported that 89.8% of aspirin asthma patients had sinusitis changes on X-ray plain film.

5. Food such as pastry, sausage, canned food, candy, etc. can induce asthma and should be further examined.

6. Aspirin oral challenge test. Therefore, the method can cause severe respiratory reaction, so the following principles should be followed:

  • Should be performed when the patient's asthma is relieved.
  • By experienced respiratory physicians under emergency conditions.
  • The excitation dose starts from 3mg, every 3 hours, and reaches 650mg, three times a day. The lung function should be measured after each excitation, and the excitation is stopped when FEV drops by more than 25%.
  • For those who have provided a clear history of aspirin intolerance, this examination should not be performed again.

Immunological experimental study and clinical examination proved that aspirin intolerance triad has nothing to do with allergy. Now, it is generally speculated that the metabolism of arachidonic acid in cell membrane shifts and produces excessive leukotrichia, which is the main link of this disease. Aspirin, antiphlogistic and analgesic nonsteroidal anti-inflammatory drugs can shift arachidonic acid metabolism. LTS is not only a strong bronchosmooth muscle contraction factor, but also an inflammatory mediator with strong biological activity, among which LT4 has high chemotactic activity to eosinophils. LTS in respiratory tract can cause local mucosal edema and infiltrate eosinophils, which release cytotoxic substances, which are mainly basic proteins, which can not only damage the mucosal epithelium and enhance its sensitivity, but also destroy the innervation on the small vessel wall of nasal mucosa, dilate the small vessels, increase their permeability, aggravate tissue edema and contribute to the formation of polyps.

Aspirin intolerance triad is often manifested as vasomotor at the beginning. Patients may have more watery snot and eosinophils in nasal secretions. Later, hypertrophic sinusitis and nasal polyps may gradually form, and asthma may occur after middle age. After taking aspirin and other antipyretic analgesics, patients can often induce rhinitis or asthma attacks, and very few patients can have serious reactions, such as chest tightness, throat infarction, and even shock and death.

According to clinical manifestations, aspirin intolerance triad has the following characteristics:

1. Recurrent sinusitis often occurs.

2. Nasal polyps are easy to recur after operation.

3. Asthma is severe and often dependent on adrenocortical hormone.

4. Food pigment additives and preservatives often cause asthma attacks and aggravate nasal polyps.

Detect

How To Check For Aspirin Intolerance Triad

Aspirin oral challenge test. Therefore, the method can cause severe respiratory reaction, so the following principles should be followed:

1. Should be performed when the patient's asthma is relieved.

2. By experienced respiratory physicians under emergency conditions.

3. The excitation dose starts from 3mg, every 3 hours, and reaches 650mg, three times a day. The lung function should be measured after each excitation, and the excitation is stopped when FEV drops by more than 25%.

4. For those who have provided a clear history of aspirin intolerance, this examination should not be performed again.

Prevention

How To Prevent Aspirin Intolerance Triad

Aspirin intolerance triad is more common in adults. Because patients often go to the corresponding departments of hospitals according to their own symptoms, the prevalence figures reported by different families are not consistent. Poole and other medical experts provide a set of figures for otolaryngology. About 20% of patients with nasal polyps are intolerant of aspirin, 30%-40% of patients with nasal polyps and asthma are intolerant of aspirin, and 10% of patients with unselected asthma.

Treatment

How To Treat Aspirin Intolerance Triad

1. For nasal polyps and asthma, avoid using analgesics, and do not eat foods containing pigment additives or preservatives.

2. Patients with severe asthma can be given oral prednisone 30mg/ day, and after asthma is controlled, they can be inhaled with dipropanol chlordimison aerosol, three times a day, one spray at a time, with a total daily amount of 400mg.

3. If there are large polyps in the nose, prednisone can be taken orally 30mg/ day for one week continuously. After the volume is reduced, it can be inhaled intranasally with triamcinolone acetonide nasal drops or dipropanol chlordimison aerosol.

4. Patients with nasal obstruction caused by large volume of nasal polyps may consider surgical resection if they are not improved after the above treatment. However, adrenocortical hormone should still be used systemically for 1-2 weeks before operation, and then be used intranasally after operation. Medical experts such as Janhi Alanko pointed out in the report that 59% of patients had asthma improved and 12% had asthma aggravated after operation.

Identify

How To Identify Aspirin Intolerance Triad

Under normal circumstances, triple aspirin intolerance does not need to be differentiated. According to clinical manifestations, it has the following characteristics:

1. There are often recurrent sinusitis.

2. Nasal polyps are prone to relapse after operation.

3. Asthma is severe and often dependent on adrenocortical hormone.

4. Food pigment additives and preservatives often cause asthma attacks and aggravate nasal polyps.

Complication

What Are The Complications Of Aspirin Intolerance Triad

Very few patients with aspirin intolerance triad may have serious reactions, such as chest tightness, throat infarction, and even shock and death.

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