Salicylate Sensitivity – Causes, Signs and symptoms

Salicylate Sensitivity

Also called: Salicylate Allergy

Summary

Salicylate sensitivity is a reaction that causes symptoms similar to those of an allergy. However, salicylate sensitivity is not an allergic condition because it does not involve an immunoglobulin E (IgE)-mediated response. Symptoms can be mild or can be life-threatening, such as in rare cases of anaphylactic shock.

Salicylates occur naturally in many plants and act as a plant hormone. The chemical is also manufactured in the form of salicylic acid to be used as a preservative against spoilage. Salicylates are found in many foods and products. It is probably best-known as an ingredient used in aspirin.

Avoidance is the best technique for preventing symptoms related to salicylate sensitivity. This means not consuming or using foods or products that contain salicylate. However, people with salicylate sensitivity may be able to eat some foods containing salicylates. For instance, some people may be able to consume foods that are peeled or cooked, rather than raw.

Medications such as corticosteroids, antihistamines, decongestants and bronchodilators may also be prescribed to treat salicylate sensitivity.

Salicylate sensitivity is more likely to occur in people who have moderate to severe asthma or chronic rhinosinusitis. The problem becomes more common as people age and as their asthma gets worse.

About salicylate sensitivity

Salicylate sensitivity occurs in people who experience symptoms after exposure to the chemical salicylate. Salicylates occur naturally in many plants and act as a natural preservative, preventing the plant from rotting and guarding it from bacteria and fungi. The chemical is also manufactured in the form of salicylic acid to be used as a preservative against spoilage. Salicylates are found in many foods and products, including fruit, vegetables, health and beauty products and medicine. It is probably best-known as an ingredient used in aspirin and other pain relievers.

Salicylate sensitivity causes symptoms similar to those of an allergy, but it does not involve an immunoglobulin E (IgE)-mediated response. Symptoms can be mild or can be life-threatening, as in the case of anaphylactic shock.

Sensitivity to salicylates is similar to food intolerance. A sensitive person may be able to tolerate a small amount of salicylates. However, an excessive intake of salicylates, the amount of which will vary from one individual to another, creates a cumulative effect in the body that triggers symptoms.

Salicylates can be found in two forms:

  • Natural form, such as in certain fruits, vegetables, herbs and plants
  • Manufactured substances, including medicines, solvents and perfume fixatives

Salicylates are found in certain medications that reduce inflammation and relieve pain, including aspirin and ibuprofen. They work by blocking the release of chemicals responsible for pain and swelling. Salicylates can also reduce fever by changing the body’s thermostat. In addition, several skin-care products and other consumer goods also contain salicylates.

People sensitive to salicylates, including aspirin, may be able to tolerate some salicylate-containing foods but not others. Sensitive people may be able to consume small amounts of some foods without triggering a reaction, or consume them in a cooked instead of raw form.

Salicylate sensitivity is more likely to occur in people who have moderate to severe asthma or chronic rhinosinusitis. The problem becomes more common as people age and as their asthma gets worse.

Potential causes of salicylate sensitivity

Salicylates can be found in many products, including foods, medications, cosmetics and certain ingredients. Any of these sources can trigger symptoms related to salicylate sensitivity. Sources of salicylates include:

  • Foods. Some raw foods, dry foods and juices contain more salicylates than cooked food. Salicylates are most concentrated just under the skin of certain fruits and vegetables, and in the outer leaves of vegetables. Salicylate content decreases as a food ripens. Some foods may be better tolerated than others in people with salicylate sensitivity, or can be consumed in a very ripe, peeled or cooked form.

    Foods that contain salicylates include:
Fruits & NutsVegetablesBeverages
& Other
AlmondsAlfalfaAlcohol (except
gin and whiskey)
ApplesBroad beansApple cider
AvocadosBroccoliBeer
Berries (blueberries,
raspberries,
strawberries)
CauliflowerCandy (peppermints, licorice,
mint-flavored gum
and breath mints)
CherriesCucumbersDry spices
DatesEggplantHerbal teas
FigsMushroomsInstant coffee
GrapefruitPeppersJams and jellies
GrapesRadishesOrange juice
KiwiSpinachProcessed cheeses
PeachesZucchiniSoy sauce
Peanuts Teas
Pine nuts Tomato paste
and sauces
Pistachios Vinegars
Plums and prunes Wines
  • Salicylate-containing products include:
    • Aspirin and medications containing aspirin (e.g., antacids, cold and flu medications)
    • Acne products
    • Fragrances and perfumes
    • Shampoos and conditioners
    • Herbal remedies
    • Cosmetics
    • Bubble baths
    • Lozenges
    • Topical creams
    • Lotions
    • Skin cleansers
    • Wart or callus removers
    • Mouthwash and mint-flavored toothpaste
    • Shaving cream
    • Sunscreens and tanning lotions
    • Muscle pain creams

  • Salicylate-containing ingredients include:
    • Aspirin
    • Acetylsalicylic acid
    • Artificial food coloring and flavoring
    • Benzoates
    • Beta-hydroxy acid
    • Magnesium salicylate
    • Menthol
    • Mint
    • Salicylic acid
    • Peppermint
    • Spearmint
    • Phenylethyl salicylate
    • Sodium salicylate
    • FD&C Yellow No. 5 food dye (tartrazine)

Signs and symptoms of salicylate sensitivity

Those who are sensitive to salicylates find that an excessive amount first stimulates, then depresses the central nervous system. This can lead to a variety of symptoms, including some that might seem incompatible. For example, both hyperactivity and lethargy are associated with salicylate sensitivity.

Symptoms of the condition may include:

  • Breathing difficulties
  • Wheezing
  • Headaches
  • Ear infections
  • Changes in skin color
  • Nasal congestion
  • Itching, skin rash or hives
  • Swelling of the hands, feet, eyes, lips and face (angioedema)
  • Stomach pain
  • Hyperactivity
  • Lethargy
  • Inability to concentrate
  • Mouth ulcers, or red rash around the mouth
  • Nasal polyps
  • Coughing
  • Rhinitis
  • Sinusitis
  • Cognitive and perceptual disorders

In rare cases, sensitivity to salicylate can cause symptoms of anaphylactic shock.

Diagnosis methods for salicylate sensitivity

In evaluating a potential reaction to a salicylate, a physician will take a medical history and perform a physical exam.

Participation in an elimination diet is another method of uncovering salicylate sensitivity. In this test, the patient will spend a period of time eating foods with no salicylates, or very low levels of the chemical. The patient must also refrain from using any other products that contain salicylates. If symptoms disappear, salicylate sensitivity can be considered likely.

It is critical that patients work closely with a physician when altering their salicylate intake. A sudden spike in salicylate levels could produce life-threatening anaphylactic shock.

Treatment and prevention

Treatment of salicylate sensitivity will depend on the nature of the symptoms. Corticosteroids are often used to treat skin reactions, and antihistamines and decongestants may be used for nasal symptoms. Bronchodilators are often prescribed to open closed airways.

Avoidance is the best technique for preventing symptoms related to salicylate sensitivity. This means not consuming or using foods or products that contain salicylate. Those with salicylate sensitivity should watch out for the following terms when selecting products:

  • Aspirin
  • Acetylsalicylic acid
  • Artificial food colorings or flavorings
  • Azo dyes
  • Benzoates (preservatives)
  • Benzyl salicylate
  • Beta-hydroxy acid
  • Choline salicylate
  • Disalcid
  • Ethyl salicylate
  • Isoamyl salicylate
  • Magnesium salicylate
  • Menthol
  • Methyl salicylate
  • Mint
  • Octylsalicylate
  • Peppermint
  • Phenylethyl salicylate
  • Salicylic acid
  • Salicylaldehyde
  • Salicylamide
  • Salsalate
  • Sodium salicylate
  • Spearmint

Although numerous foods contain salicylate, there are also many foods that have few if any salicylates in them. They include:

Fruits, Nuts
& Seasonings
Vegetables
& Grains
Dairy, Meat
& Beverages
BananasBamboo shootsButter
LimesBarleyCheese
(except blue)
Maple syrupBuckwheatChicken
Pears (peeled)CabbageDecaffeinated coffee
Poppy seedsCeleryEggs
SaffronDried beans
and split peas
Fish and shellfish
(except prawns)
Sea saltLentilsMeat
(except liver)
Sunflower oilLettuceMilk
Soybean oilMilletRice milk
White sugarOatsSoya Milk
 RiceYogurt
 Rye 
 Wheat 
 White potatoes
(peeled)
 

In addition to the sensitivity of some individuals to salicylates, aspirin and other salicylate-containing medications have been linked to incidences of Reye syndrome (a rare, life-threatening disease that causes damage to the brain and liver) in children. To reduce the risk of developing Reye syndrome, parents and other caregivers should avoid giving aspirin and any other medication derived from salicylic acid to a child or teenager, unless advised to do so by a physician.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to salicylate sensitivity:

  1. Do my symptoms suggest salicylate sensitivity?
  2. What methods will you use to determine if I am sensitive to salicylate?
  3. Does salicylate sensitivity pose a danger to my overall health?
  4. Does having salicylate sensitivity mean that I am allergic to the chemical?
  5. What are my treatment options? How effective are they?
  6. Can you provide me with a list of foods and products that contain salicylate?
  7. Is it safe for me to consume salicylate in small amounts, or must I avoid it completely?
  8. Is it safe for me to use aspirin?
  9. What should I do if I accidentally ingest a large amount of food containing salicylate?
  10. Are my children likely to have salicylate sensitivity as well?
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