Why does hives itch

Migratory wheals

An intolerance reaction to acetylsalicylic acid (ASA) and other non-steroidal anti-inflammatory drugs (NSAIDs) is known as Samter's triad or Widal's disease. The disease, which is called aspirin-exacerbated respiratory disease in Anglo-American parlance, is a pseudoallergic reaction to NSAIDs with a characteristic complex of symptoms:

• nasal symptoms (obstruction, rhinorrhea, nasal polyps),

• non-allergic asthma with severe asthma attacks and

• Skin symptoms in the form of urticaria and angioedema.

There is also a form in which practically only skin symptoms occur (NSAID exacerbated cutaneous disease). The disease can occur after taking drugs that inhibit cyclocoxigenase-1 (COX-1). According to the current state of knowledge, the cause is a misdirection of the arachidonic acid metabolism, which leads to an accumulation of lipoxygenase products. The leukotrienes (LTC4, LTD4, LTE4) in particular have a strong inflammatory and bronchoconstrictor effect.

NSAID intolerance is common in some families. Presumably there is a polymorphism of the promoter gene in correspondingly sensitive people, which leads to an increased expression of the leukotriene genes. A prevalence of 0.5 to 5.7 percent is given for the normal population. In asthmatics, it is considerably higher at around 15 percent (16, 17).