Familial Occurrence of Asthma, Nasal Polyps, and Aspirin Intolerance

Four members of a Mennonite family, three of whom were first cousins, had asthma, nasal polyps, and aspirin-induced wheezing (ASA triad). One of the cousins, whose husband was also a member of the isolate, had a daughter with the ASA triad and an identical twin sister with allergic rhinitis and extrinsic asthma. The twin with the ASA triad and her husband shared common ancestors in the eighth ancestral generation. Two siblings of a non-Mennonite family also had the ASA triad. A third sibling had intrinsic asthma alone, which improved after the ingestion of aspirin. We are aware of only one previous report of the ASA triad in families. The presence of the ASA triad in these constellations of relatives suggests that it is inherited as an autosomal recessive trait. The discordance in the identical twins suggests that the phenotype is also influenced by environment.