Salicylate Sensitivity
by Mila McManus, MD
A common challenge in our practice is identifying the source of sensitivities or intolerances. While dairy, gluten, and eggs are more common sensitivities, salicylate sensitivity is a real issue for some people and can cause adverse reactions in those who cannot tolerate it.
Salicylates (sặ∙lis∙y∙late) are a group of chemicals derived from salicylic acid. They are found naturally in some fruits, vegetables, spices, tea, wine, vinegar, honey, olives, and pickles, to name a few. Synthetic forms are used in manufacturing products such as toothpaste, perfumes, shampoos and conditioners, mouthwash, lotion, and medications such as aspirin and Pepto Bismol. Compared to foods, more potent amounts of salicylates are found in medications, which is why salicylate intolerance is most commonly linked to medications.
People with salicylate sensitivity cannot properly metabolize and excrete salicylates. One possible cause is the overproduction of leukotrienes, inflammatory mediators linked to a variety of conditions, including asthma, allergic rhinitis, anaphylaxis, rheumatoid arthritis, and interstitial lung disease. The build-up of leukotrienes in the body leads to the related symptoms of salicylate intolerance. Another likely cause is a sulfur deficiency. Often, a patient will avoid sulfur (e.g., garlic, onions, and sulfa drugs) to avoid reactions that will only create another deficiency. One deficiency can lead to another deficiency and reactions.
Diagnosis of salicylate intolerance is difficult. The most common symptoms can parade as an environmental allergy, with a stuffy nose and asthma. Or it could look like a sinus infection and inflammation, with nasal and sinus polyps. Yet others experience digestive issues, including diarrhea, gas, abdominal pain, and colitis. Some patients have all of these symptoms constantly coming and going. Many of the symptoms overlap with mast cell activation syndrome (MCAS). There are no laboratory tests to diagnose it; however, healthcare professionals will use provocation as one standard test, which involves administering a small amount of salicylic acid and monitoring for symptoms. A trial elimination diet is another method.
The amount of salicylates that trigger a reaction can vary by individual. Some people experience symptoms after exposure to a small amount of these chemicals, while others can tolerate larger amounts before reacting. Extremely salicylate-sensitive people must avoid as many products, medications, and high-salicylate foods as possible. Unfortunately, a low salicylate diet can be restrictive and cause nutrient deficiencies. It is important to use a food and symptom diary and be monitored by a healthcare professional.
The bottom line is that salicylate sensitivity is worth exploring with a trial elimination diet when a patient doesn’t improve within two to three months in our program.
Be Well.
References
Htps://www.healthline.com/nutrition/salicylate-sensitivity