Salicylate sensitivity

The most common symptoms of salicylate sensitivity are:{{cite journal |last1=Hanns-Wolf Baenkler |title=Salicylate Intolerance: Pathophysiology, Clinical Spectrum, Diagnosis and Treatment |journal=Deutsches Ärzteblatt International |year=2008 |volume=105 |issue=8 |pages=137–142 |doi=10.3238/arztebl.2008.0137 |pmid=19633779 |pmc=2696737 }}

• Intestinal inflammation or diarrhea
• Itchy skin, hives or rashes
• Asthma and other breathing difficulties
• Polyps with asthma
• Angioedema
• Rhinitis, sinusitis, nasal polyps

Asthma and nasal polyps are also symptoms of aspirin-exacerbated respiratory disease (AERD, Samter's Triad), which is not believed to be caused by dietary salicylates.

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There is no laboratory test for salicylate sensitivity. Typically testing is done by an "elimination challenge," to see if symptoms improve, or "provocative challenge," which intends to induce a controlled reaction as a means of confirming diagnosis. During provocative challenge, the person is given incrementally higher doses of salicylates, usually aspirin, under medical supervision, until either symptoms appear or the likelihood of symptoms appearing is ruled out. This only pertains to short-term symptoms such as digestive, respiratory, and skin itching, rather than slower-developing symptoms such as nasal polyps.

Salicylate sensitivity can be treated with the use of low-salicylate diets, such as the Feingold Diet. The Feingold Diet removes artificial colors and preservatives and salicylates, whereas the Failsafe Diet removes salicylates, as well as amines and glutamates.{{cite web | first = Julie | last = Matthews | url=http://nourishinghope.com/special-healing-diets/feingold-diet-failsafe-diet/ | title= Feingold Diet / Failsafe Diet | work = Nourishing Hope }} The range of foods that have no salicylate content is very limited, and consequently salicylate-free diets are very restricted.

Montelukast is one form of treatment used in aspirin-intolerant asthma.

{{cite journal | vauthors = Kim SH, Ye YM, Hur GY, Lee SK, Sampson AP, Lee HY, Park HS | title = CysLTR1 promoter polymorphism and requirement for leukotriene receptor antagonist in aspirin-intolerant asthma patients | journal = Pharmacogenomics | volume = 8 | issue = 9 | pages = 1143–50 | date = September 2007 | pmid = 17924829 | doi = 10.2217/14622416.8.9.1143 }}

Salicylate sensitivity is noted to be more common in those who also have asthma, 2-22% of people with asthma have a likelihood of also having the intolerance.{{cite journal | last1=Skypala | first1=Isabel J. | last2=Williams | first2=M. | last3=Reeves | first3=L. | last4=Meyer | first4=R. | last5=Venter | first5=C. | title=Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence | journal=Clinical and Translational Allergy | publisher=Wiley | volume=5 | issue=1 | year=2015 | issn=2045-7022 | doi=10.1186/s13601-015-0078-3 | page=34| pmid=26468368 | pmc=4604636 | doi-access=free }}

An important salicylate drug is aspirin, which has a long history. Aspirin intolerance was widely known by 1975, when the understanding began to emerge that it is an adverse drug reaction, not an allergy.{{cite journal | vauthors = Casterline CL | title = Intolerance to aspirin | journal = American Family Physician | volume = 12 | issue = 5 | pages = 119–22 | date = November 1975 | pmid = 1199905 }}

{{cite journal | vauthors = Patriarca G, Venuti A, Schiavino D, Fais G | title = Intolerance to aspirin: clinical and immunological studies | journal = Zeitschrift für Immunitatsforschung. Immunobiology | volume = 151 | issue = 4 | pages = 295–304 | year = 1976 | pmid = 936715 | doi = 10.1016/s0300-872x(76)80024-8}}

Salicylate intolerance is a form of food intolerance or of drug intolerance.

Salicylate sensitivity is a pharmacological reaction, not a true IgE-mediated allergy. However, it is possible for aspirin to trigger non-allergic hypersensitivity reactions.

{{cite journal | vauthors = Palikhe NS, Kim SH, Park HS | title = What do we know about the genetics of aspirin intolerance? | journal = Journal of Clinical Pharmacy and Therapeutics | volume = 33 | issue = 5 | pages = 465–72 | date = October 2008 | pmid = 18834360 | doi = 10.1111/j.1365-2710.2008.00961.x | s2cid = 22584486 | doi-access = free }}{{cite journal | vauthors = Narayanankutty A, Reséndiz-Hernández JM, Falfán-Valencia R, Teran LM | title = Biochemical pathogenesis of aspirin exacerbated respiratory disease (AERD) | journal = Clinical Biochemistry | volume = 46 | issue = 7–8 | pages = 566–78 | date = May 2013 | pmid = 23246457 | doi = 10.1016/j.clinbiochem.2012.12.005 | department = Review }} About 5–10% of asthmatics have aspirin hypersensitivity, but dietary salicylates have been shown not to contribute to this. The reactions in AERD (Samter's triad) are due to inhibition of the COX-1 enzyme by aspirin, as well as other NSAIDs that are not salicylates. Dietary salicylates have not been shown to significantly affect COX-1.

{{cite journal | vauthors = Jang AS, Park JS, Park SW, Kim DJ, Uh ST, Seo KH, Kim YH, Park HS, Park CS | title = Obesity in aspirin-tolerant and aspirin-intolerant asthmatics | journal = Respirology | volume = 13 | issue = 7 | pages = 1034–8 | date = November 2008 | pmid = 18699807 | doi = 10.1111/j.1440-1843.2008.01358.x | s2cid = 26399839 }}

AERD refers to NSAID sensitivity in conjunction with nasal polyps and asthma.

{{cite journal | vauthors = Kim JE, Kountakis SE | title = The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery | journal = Ear, Nose, & Throat Journal | volume = 86 | issue = 7 | pages = 396–9 | date = July 2007 | pmid = 17702319 | doi = 10.1177/014556130708600715| doi-access = free }}

• Aspirin-exacerbated respiratory disease
• NSAID hypersensitivity reactions

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• {{cite journal | vauthors = Parmet S, Lynm C, Glass RM | title = JAMA patient page. Aspirin sensitivity | journal = JAMA | volume = 292 | issue = 24 | pages = 3098 | date = December 2004 | pmid = 15613676 | doi = 10.1001/jama.292.24.3098 | doi-access = free }}

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• {{cite web | url = http://www.salicylatesensitivity.com/ | title = Salicylate Sensitivity Forums and Food/Product Guides | work = SalicylateSensitivity.com }}

{{Poisoning and toxicity}}

Category:Metabolic disorders

Category:Sensitivities

Category:Aspirin