(Widal syndrome, Widal triad)

Association of asthma, nasal polyposis and allergy to aspirin and COX1 selective NSAIDS.

Incidence: approximately 0.3 % of the population and 5-10 % of the adult asthmatic population.

In pediatrics, the most common cause for a chronic rhinosinusitis with nasal polyposis is cystic fibrosis, but cases of allergy to aspirin are described. This allergy is often unrecognized because of the decreasing use of aspirin nowadays.

It is useful to proceed to desensitization to aspirin by oral route (duration: 3-4 days) before the polypectomy. This desensitization must be maintained by a daily aspirin intake.

Anesthetic implications:

avoid COX1 selective NSAIDs and high doses of paracetamol; management of an asthmatic patient; avoid nasal intubation in case of polyps; check the hemostasis.

References:

•        Chen BS, Virant FS, Parikh SR, Manning SC 
  Aspirin sensitivity syndrome (Samter’s triad): an unrecognized disorder in children with nasal polyposis. 
  Int J Pediatr Otorhinolaryng 2013; 777: 281-3.
•        Ameratunga R, Randall N, Dalziel S, Anderson BJ. 
  Samter’s triad : a warning for those prescribing NSAIDs. 
  Pediatr Anesth 2013 ; 23 : 757-9.

Updated: August 2019