Max Samter

Biographical Timeline

• Born March 3, 1908 in Berlin, Germany
• 1931 – Began medical career as an intern at Charité University Hospital, Berlin.
• 1933 – Received MD (University of Berlin). While still an intern at Charité, published early work in asthma including an inhalational challenge approach using histamine/allergens ‘Asthma bronchiale und Histaminempfindlichkeit‘
• 1933–1937 – After Nazi policies barred Jewish physicians from university posts, worked in general practice in Berlin-Karow making house calls on a BMW motorcycle.
• 1937 – Emigrated to the United States via a formal appointment invitation at Johns Hopkins University.
• 1937–1942 – Worked as a (largely unpaid) research assistant: Johns Hopkins (hematology) then University of Pennsylvania (including lymphocyte studies). Translation work to support himself.
• 1943 – Commissioned First Lieutenant, U.S. Army Medical Corps.
• 1944–1945 – Served in the European theatre with a field hospital unit and later administrative duties as a military governor in occupied Germany. Developed progressive hearing loss/deafness from blast exposure.
• 1946 – Discharged; moved to Chicago and began as Research Associate in Biochemistry, University of Illinois.
• 1961 – Appointed Professor (full professor) at University of Illinois College of Medicine.
• 1958–1959 – President, American Academy of Allergy (later AAAAI).
• 1960–1967 – First Chairman, Committee on Certification (AAA/AAAAI), contributing to pathways toward specialty certification in allergy/immunology.
• 1968 – Published clinical work characterising the syndrome of aspirin intolerance, nasal polyps/sinus disease, and asthma that became widely known as “Samter’s triad”.
• 1970–1973 – President, International Association of Allergology
• Mid-1970s – Created the University of Illinois medical school course “Realities in Medicine” reviewing the ethics/humanism/societal role of physicians.
• 1975 – Established and became founding director of the Institute of Allergy and Clinical Immunology at Grant Hospital of Chicago (later named the Max Samter Institute)
• 1982 – Named “Allergist of the Year” by the Asthma and Allergy Foundation of America (AAFA).
• Died February 9, 1999 in Evanston, Illinois, aged 90

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Medical Eponyms

Samter’s triad (1968)

Aspirin-exacerbated respiratory disease (AERD) is an acquired, typically adult-onset inflammatory airway disorder characterised by the combination of:

• Asthma (often late-onset and may become severe)
• Chronic rhinosinusitis with nasal polyposis (often bilateral, recurrent, frequently requiring repeated polypectomy)
• Respiratory reactions to aspirin/COX-1 inhibiting NSAIDs (classically rhinorrhoea/nasal obstruction and bronchospasm; can be severe)

Samter & Beers emphasised that the condition is predominantly non-atopic, arises after middle age, and that nasal/bronchial symptoms may precede aspirin intolerance by months to years. They also noted that reactions could be triggered by other strong “minor analgesics” (e.g., indomethacin, pyrazolones), supporting a non–IgE cross-reactivity mechanism.

1902 – Hirschberg reported an early aspirin “idiosyncrasy” documenting the adverse effects “Nebenwirkung des Aspirin” of 1 g aspirin, with facial/lip swelling, nasal obstruction, throat mucus, and urticarial/scarlatiniform rash

1922 – Fernand Widal, Pierre Abrami and Jacques Lermoyez publish the first complete description of the syndrome and early desensitisation concept. They described a patient with asthma/coryza, mucous nasal polyps, and reproducible reactions to aspirin (and antipyrine). They include a note on “desensitization” using escalating doses of aspirin, with claimed temporary tolerance.

1968 – Samter and Roland F. Beers Jr define the triad as a disease entity and conlcuded that

…the clinical triad of nasal polyposis, bronchial asthma, and life-threatening reactions to acetylsalicylic acid is a disease entity, not a chance cluster…

Samter, Beers 1968

Based on long-term clinical experience (>1,000 “aspirin-sensitive” patients (1954–1965) ), they conducted prospective ward studies in 182 hospitalised aspirin-sensitive patients.

Samter described a typical sequence:

• Early life: unremarkable.
• 2nd–3rd decade: intermittent “vasomotor rhinitis” with watery rhinorrhoea → becomes persistent nasal blockage.
• Progression to nasal polyps (often bilateral; frequent recurrence even after surgery).
• Asthma tends to develop in middle age; sometimes onset/aggravation follows polypectomy in a “suggestive number.”
• Of note: nasal polyposis and asthma continue whether or not aspirin is ingested, and aspirin reactions may appear years after respiratory disease begins.

Aspirin challenge to confirm sensitivity

Samter and Beers gave aspirin under controlled hospital conditions (explicitly warning of possible severe outcomes and recommending an anaesthesia team for airway management if needed). In one subset, 36 patients who claimed they tolerated aspirin received 0.3 g ASA; 34 reacted.

• Symptoms began within ~20 min (sometimes up to 2 hours).
• Commences with profuse watery rhinorrhoea, scarlet flush of head/neck/upper chest/extremities. May have GI symptoms.
• Followed by bronchoconstriction/wheeze/cyanosis often only minutes after nasal symptoms.

Pretreatment corticosteroids did not prevent attacks and corticosteroids given after onset appeared to shorten recovery (used in refractory cases). Aminophylline (drug of choice) ± epinephrine controlled most reactions

They then rotated aspirin-sensitive patients through multiple non-ASA salicylate/salicylate-related compounds (e.g., sodium salicylate, salicylic acid esters, choline salicylate, thioaspirin, N-acetyl-p-aminophenol) and reported no untoward reactions in those test exposures. They concluded “It is certain that intolerance to acetylsalicylic acid is not an intolerance to salicylates..”

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Controversies

Dates of birth and death

Multiple alternate dates of birth and death in circulation on the internet and obituaries.

• Date of birth: March 3, 1908 as supported by:
  • USC Shoah Foundation Visual History Archive testimony profile
  • U.S. Social Security Death Index (SSDI)
• Date of death: February 9, 1999 as supported by:
  • U.S. Social Security Death Index (SSDI)

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Major Publications

• Samter M. Asthma bronchiale und Histaminempfindlichkeit. Zeitschrift für die gesamte experimentelle Medizin, 1933; 89: 24-35 [Bronchial asthma and histamine sensitivity. Translation: Allergy Proc. 1989 Sep-Oct;10(5):379-85.]
• Samter M. The response of eosinophils in the guinea pig to sensitization, anaphylaxis and various drugs. Blood. 1949 Mar;4(3):217-46.
• Samter M. Should one use ACTH and adrenal corticosteroids in seasonal allergies. J Allergy. 1953 Nov;24(6):556-7.
• Samter M. Use of hormones in treatment of otolaryngologic disease. J Am Med Assoc. 1957 Feb 23;163(8):613-5.
• Samter M, Beers RF Jr. Intolerance to aspirin. Clinical studies and consideration of its pathogenesis. Ann Intern Med. 1968 May;68(5):975-83. [Samter triad]
• Samter M. The acetyl- in aspirin. Ann Intern Med. 1969 Jul;71(1):208-9. 
• Samter’s immunologic diseases. 5e, 1995

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References

Biography

• Max Samter. USC Shoah Foundation, Holocaust – Jewish Survivor Interviews. Feb 4, 1996
• Cohen SG, Settipane GA. Max Samter, M.D. 1908-1999. Allergy Asthma Proc. 1999 Sep-Oct;20(5):329-35.
• Cohen SG. Max Samter, MD. JAMA 1999; 281(23): 2255–6.
• Cohen SG. In Lasting Tribute: Max Samter, MD. Journal of Allergy and Clinical Immunology, 1999; 104(2): 274-275

Eponymous terms

• Hirscliberg. Mitteilung uber einen Fall von Nebenwirkung des Aspirin Deutsche medizinische Wochenschrift. 1902; 28: 416
• Widal F, Abrama P, Lermoyez J. Anaphylaxie et idiosyncrasie. Presse Medicale. 1922; 30: 189–193
• Widal F, Abrami P, Lermoyez J. First complete description of the aspirin idiosyncrasy-asthma-nasal polyposis syndrome (plus urticaria)–1922 (with a note on aspirin desensitization). By F. Widal, P. Abrami, J. Lermoyez. J Asthma. 1987;24(5):297-300.
• Krouse HJ, Krouse JH. Samter’s Triad to Aspirin-Exacerbated Respiratory Disease: Historical Perspective and Current Clinical Practice. ORL Head Neck Nurs. 2015 Autumn;33(4):14-8.