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Salicylate sensitivity, also known as salicylate intolerance, is any adverse effect that occurs when a normal amount of salicylate (salicylic acid) is introduced into a person's body. People with salicylate intolerance are unable to consume a normal amount of salicylate without adverse effects.

Salicylate sensitivity differs from salicylism, which is an overdose of salicylates.^[1] Sufficiently high intake of salicylates can cause poisoning even in non-susceptible people, because, as with all chemicals, the dose makes the poison.

Salicylates are derivatives of salicylic acid that occur naturally in plants and serve as a natural immune hormone and preservative, protecting the plants against diseases, insects, fungi, and harmful bacteria. Salicylates can also be found in many medications, perfumes and preservatives. Both natural and synthetic salicylates can cause health problems in anyone when consumed in large doses. But for those who are salicylate intolerant, even small doses of salicylate can cause adverse reactions.

Terminology

Depending on whether the salicylate is a component of food or medicine, salicylate intolerance is a form of food intolerance or of drug intolerance.

Salicylate sensitivity is a pharmacological reaction, not a true allergy. However, it is possible for aspirin to trigger non-allergic hypersensitivity reactions.^[2] About 5-10% of asthmatics have aspirin hypersensitivity.^[3]

Samter's triad refers to aspirin sensitivity in conjunction with nasal polyps and asthma.^[4]

History

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 a pharmacological reaction, not an allergy.^[5]^[6]

Symptoms

The most common symptoms of salicylate sensitivity are:^{[citation needed]}

Itchy skin, hives or rashes
Stomach pain/upset stomach
Asthma and other breathing difficulties
Angioedema
Headaches
Swelling of hands, feet, eyelids, face and/or lips
Bed wetting or urgency to pass water
Persistent cough
Changes in skin color/skin discoloration
Fatigue
Sore, itchy, puffy or burning eyes
Sinusitis/Nasal polyps
Diarrhea
Nausea
Hyperactivity
Memory loss and poor concentration
Depression
Pseudo-anaphylaxis

Diagnosis

There are no laboratory or skin testing methods for testing salicylate sensitivity. Provocative challenge is one method of obtaining reliable diagnosis. Provocative challenge is intended 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.

Treatment

Completely eliminating salicylate from one’s diet and environment is virtually impossible and is not a recommended course of action by many immunologists.^{[citation needed]} The range of foods that have no salicylate content is very limited, and consequently salicylate-free diets are very restricted. The Feingold Association reports success with salicylate-reduced diets (the Feingold Diet) for treating hyperactivity, bed-wetting, and other symptoms associated with Salicylate sensitivity.

Desensitization involves daily consumption of small doses of salicylate without symptoms re-occurring and slowly increasing the dosage.

Montelukast is one form of treatment used in aspirin-intolerant asthma.^[7]

References

^ "salicylism" at Dorland's Medical Dictionary
^ Palikhe NS, Kim SH, Park HS (2008). "What do we know about the genetics of aspirin intolerance?". Journal of clinical pharmacy and therapeutics. 33 (5): 465–72. doi:10.1111/j.1365-2710.2008.00961.x. PMID 18834360. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Jang AS, Park JS, Park SW; et al. (2008). "Obesity in aspirin-tolerant and aspirin-intolerant asthmatics". Respirology. 13 (7): 1034–8. doi:10.1111/j.1440-1843.2008.01358.x. PMID 18699807. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Kim JE, Kountakis SE (2007). "The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery". Ear, nose, & throat journal. 86 (7): 396–9. PMID 17702319. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Casterline CL (1975). "Intolerance to aspirin". Am Fam Physician. 12 (5): 119–22. PMID 1199905. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Patriarca G, Venuti A, Schiavino D, Fais G (1976). "Intolerance to aspirin: clinical and immunological studies". Z Immunitatsforsch Immunobiol. 151 (4): 295–304. PMID 936715.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Kim SH, Ye YM, Hur GY; et al. (2007). "CysLTR1 promoter polymorphism and requirement for leukotriene receptor antagonist in aspirin-intolerant asthma patients". Pharmacogenomics. 8 (9): 1143–50. doi:10.2217/14622416.8.9.1143. PMID 17924829. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

External links

[1] "salicylism" at Dorland's Medical Dictionary

[pmid18834360-2] Palikhe NS, Kim SH, Park HS (2008). "What do we know about the genetics of aspirin intolerance?". Journal of clinical pharmacy and therapeutics. 33 (5): 465–72. doi:10.1111/j.1365-2710.2008.00961.x. PMID 18834360. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[pmid18699807-3] Jang AS, Park JS, Park SW; et al. (2008). "Obesity in aspirin-tolerant and aspirin-intolerant asthmatics". Respirology. 13 (7): 1034–8. doi:10.1111/j.1440-1843.2008.01358.x. PMID 18699807. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

[pmid17702319-4] Kim JE, Kountakis SE (2007). "The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery". Ear, nose, & throat journal. 86 (7): 396–9. PMID 17702319. {{cite journal}}: Unknown parameter |month= ignored (help)

[pmid1199905-5] Casterline CL (1975). "Intolerance to aspirin". Am Fam Physician. 12 (5): 119–22. PMID 1199905. {{cite journal}}: Unknown parameter |month= ignored (help)

[pmid936715-6] Patriarca G, Venuti A, Schiavino D, Fais G (1976). "Intolerance to aspirin: clinical and immunological studies". Z Immunitatsforsch Immunobiol. 151 (4): 295–304. PMID 936715.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[pmid17924829-7] Kim SH, Ye YM, Hur GY; et al. (2007). "CysLTR1 promoter polymorphism and requirement for leukotriene receptor antagonist in aspirin-intolerant asthma patients". Pharmacogenomics. 8 (9): 1143–50. doi:10.2217/14622416.8.9.1143. PMID 17924829. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

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 == Treatment ==
-Completely eliminating salicylate from one’s diet and environment is virtually impossible and is not a recommended course of action by many immunologists.{{fact|date=October 2009}}  The range of foods that have no salicylate content is very limited, and conseuqently salicylate-free diets are very restricted.
+Completely eliminating salicylate from one’s diet and environment is virtually impossible and is not a recommended course of action by many immunologists.{{fact|date=October 2009}}  The range of foods that have no salicylate content is very limited, and consequently salicylate-free diets are very restricted. The [http://www.feingold.org Feingold Association] reports success with salicylate-reduced diets (the Feingold Diet) for treating hyperactivity, bed-wetting, and other symptoms associated with Salicylate sensitivity.
 [[Desensitization (medicine)|Desensitization]] involves daily consumption of small doses of salicylate without symptoms re-occurring and slowly increasing the dosage.