Widal, morbus J45.1

Clinical syndrome with the following triad (velvet triad):

• ASA intolerance (see intolerance reaction below;see drug intolerance, analgesia-induced)
• nasal polyps
• Bronchial asthma.

However, this clinical entity is not limited to ASA. It is also observed in the use of other non-steroidal anti-inflammatory drugs. Patients with Widal's syndrome have a significantly increased tendency to relapse with standard sinusitis therapy.

AERD (aspirin-exacerbated respiratory disease) can be detected in about 10% of asthmatics.

According to current knowledge, the reaction is not based on an IgE-mediated mechanism. The cause is a dysbalance in the arachidonic acid metabolism (increased leukotriene production), which is increased by the intake of non-steroidal anti-inflammatory drugs or salicylates in the diet.

A mutation in the C444 allele of leukotriene C synthase has been described as a possible cause.

1. May A et al (2000) Family investigation in patients with ASA intolerance and rhinosinusitis. HNO 48: 650-654
2. Widal MF, Abramin P, Lermoyez J (1922) Anaphylaxis and idiosyncrasy. Press Med 30: 189