Salicylate Intolerance: The Complete Guide

Salicylate Intolerance- The Complete Guide

Salicylate intolerance is not fully understood by scientists.

The condition is often misdiagnosed, and there is a variety of possible treatments.

Some salicylates are relatively easy to stay away from, but others are nearly impossible to avoid.

This article looks at the evidence-based ways to treat salicylate intolerance. 

What Are Salicylates?

What Are SalicylatesSalicylates is the general term for chemicals that have salicylic acid as their base.

Salicylic acid is a naturally-occurring organic acid found in a variety of plants. These plants produce it as part of their defense system against diseases, insects, bacteria and environmental stress.

Salicylic acid is used as an ingredient in synthetic salicylates and a variety of other products. Aspirin, for example, is made by combining salicylic acid with a chemical called acetic anhydride.




Summary: Salicylates are a group of chemicals that form part of a plant’s natural defense system. They are also used as ingredients in a variety of products.

What Is Salicylate Intolerance?

What Is Salicylate IntoleranceMost tolerate regular amounts of salicylates without any issues.

However, in some people even a small dose can cause problems. This is called salicylate intolerance or salicylate sensitivity.

The percentage of people suffering from salicylate intolerance is unknown but it appears to occur more often in adults than children (1).

The only type of salicylate that has clearly been shown to cause negative reactions in those with salicylate intolerance is acetyl salicylate (in aspirin) (2).

The amount of salicylates in regular aspirin is typically 325 mg. Extra-strength aspirin or arthritis pain relievers can contain 600–650 mg.

In comparison, daily intake of salicylates from food is estimated to be 10–200 mg on average (3).

While foods containing salicylates may be able to cause similar reactions to aspirin, there is no current research to confirm this. And since pain relievers are often taken multiple times a day, the potential amount of salicylates from medication can vastly outweigh those from from foods.

As with other intolerances, such as histamine intolerance, the amount of salicylates consumed probably determines whether symptoms occur. Most people with sensitivities can tolerate at least a small amount.

Summary: Salicylates do not cause problems for most people, however those who are sensitive will react to small amounts. Aspirin is by far the largest source for humans.

Signs and Symptoms of Salicylate Intolerance

Signs and Symptoms of Salicylate IntoleranceTypical signs and symptoms of salicylate intolerance include (1):

  • Sinus inflammation and infection
  • Polyps (small, non-cancerous growths) in the nasal and sinus passages
  • Asthma
  • Hives
  • Fever
  • Tissue swelling
  • Inflammation of large intestine, which can cause abdominal pain and discomfort
  • Diarrhea.

As symptoms of salicylate intolerance can appear very similar to an allergy (hives and sinus problems, for example), it is often misdiagnosed. In fact, for some people salicylates only cause symptoms when they are experiencing allergies, making it even harder to separate the two (5).

However, unlike an allergy, salicylate intolerance doesn’t involve the immune system.

Salicylate intolerance is also more common among adults with asthma. It’s been estimated that 2–23% of asthmatics are sensitive to aspirin (4).

The mechanism by which aspirin and other pain relievers containing salicylates affect asthma is not clear but it can have devastating consequences. In severe cases, a single dose of aspirin can cause a person to lose consciousness and stop breathing (4).

Summary: Symptoms of salicylate intolerance often include asthma, hives, sinus problems and nasal polyps. These symptoms are sometimes mistaken for allergies.

Food Sources of Salicylates

Food Sources of SalicylatesMany foods naturally contain salicylic acid.

Reported levels of salicylates in foods differ somewhat, likely due to differing methods of analysis and the growing conditions and varieties of plants tested.

In general, the highest amounts of salicylates are found in fruits, vegetables and spices. Cereals, meat, fish and dairy products contain very little or none (3).

Based on weight, herbs and spices have the highest concentrations of salicylic acid. Curry powder, for example, has been reported to have 218 mg per 100 grams of powder (3).

For comparison, raspberries are reported to have 4.4 mg per 100 grams and they are considered a high salicylate food.

Here is a list of food sources of salicylates (2, 3):

Foods Containing High Levels of Salicylic Acid

Click to enlarge.

Other Sources of Salicylates

Many health and beauty products and household cleaners also contain salicylates.

They serve a variety of functions in these products including as fragrances, preservatives, exfoliants, conditioners, and anti-dandruff and anti-acne agents.

NON-FOOD SOURCES OF SALICYLATES

Click to enlarge. Source




Summary: Salicylates are found in many foods, medicines, cosmetics and household cleaners. Foods with the highest amounts include spices, fruits and vegetables.

Does Salicylate Intolerance Cause Other Digestive Diseases?

Does Salicylate Intolerance Cause Other Digestive DiseasesSome data suggests that salicylate intolerance may cause other diseases of the digestive tract, including inflammatory bowel disease and food allergies.

One group of researchers suggested that 2–7% of patients with these conditions may also have salicylate intolerance (1).

In that study, patients with ulcerative colitis or food allergies were 3–5% more likely than those with Crohn’s disease to be salicylate intolerant.

The authors suggested that the possibility of salicylate intolerance should be considered among all patients with ulcerative colitis or food allergies.

Summary: Salicylate intolerance may be more common in those with food allergies or Ulcerative Colitis. However, scientists are unsure exactly how the conditions are related.

Treatments For Salicylate Intolerance

Treatments For Salicylate IntoleranceAvoiding aspirin and other salicylate-containing medications is the first line of defense for those with salicylate intolerance.

Switching to cosmetics and cleaners without salicylates may also be helpful.

In some cases, treatment with steroids, other medications or even surgery to remove respiratory growths may be necessary (5).

Desensitization is another treatment sometimes used. The patient is given daily doses of acetyl salicylate, and the dose is slowly increased over time. In about 80% of cases, improvements in ease of breathing, sense of smell and freedom from recurring polyps are observed (6).

Desensitization should only be undertaken with a physician’s care. The first phase is often done in a hospital, since adverse reactions, including asthma, can occur (5).

Summary: Avoidance of aspirin and other salicylate-containing products may be necessary for those with a salicylate intolerance. In some cases, medications, surgery or desensitization treatment may be suggested by a physician.

Is a Low-Salicylate Diet Necessary?

Is a Low-Salicylate Diet NecessaryFor adults who have found no other treatments helpful, a low-salicylate diet is worth consideration (9).

However, there is currently no scientific proof this form of elimination diet is of any benefit (10, 11). In fact, anecdotal reports indicate a low-FODMAP diet may be the better alternative, which is scientifically shown to help treat food intolerance.

Unfortunately, elimination diets are not really appropriate for children.

One study of 74 children put on an elimination diet for salicylates found that almost half experienced harmful side effects. This included nutrient deficiencies, food aversions and eating disorders (7).

Nutrient deficiencies during childhood can have long-lasting impacts on health and development (8). For these reasons a low-salicylate diet (or other elimination diet) should be the last line of treatment for children.

Summary: In severe cases, adults may trial a salicylate-restricted diet (followed by reintroduction) or a low-FODMAP diet. Elimination diets are not usually recommended for children.

A Low-Salicylate Diet Plan

A low salicylate diet planAdults with a high sensitivity to aspirin who have found no relief from other treatments may wish to try a low-salicylate diet.

Important tips to keep in mind:

  • Only foods with the highest levels of salicylates should be avoided (see list above).
  • Restrict high-salicylate foods for a maximum of 4 weeks.
  • Slowly reintroduce high-salicylate foods, noting any symptoms that occurs in a food and symptom diary.
  • Be sure to include plenty of fruits and vegetables that are not on the high-salicylate list.

Here is an example of a realistic 3-day low-salicylate diet plan:

Day 1

Breakfast: Cereal with milk; banana.

Lunch: Salad with mixed lettuce, chicken breast, shredded carrots, shredded cheese and dressing; apple.

Dinner: Baked fish with brown rice and roasted cauliflower.

Snacks: Yogurt; pear.

Drinks: Water; milk.

Day 2

Breakfast: Yogurt with granola and sliced pears.

Lunch: Sandwich with wholegrain bread, sliced turkey breast, lettuce, tomato and cheese.

Dinner: Burritos with wholegrain tortillas, black beans, cheese, lettuce and avocado.

Snacks: Carrot sticks with hummus; string cheese; apple.

Drinks: Water; milk.

Day 3

Breakfast: Oatmeal with walnuts and chopped apples.

Lunch: Tuna sandwich on wholegrain bread with lettuce and tomato; carrot sticks; pear.

Dinner: Baked chicken with mashed potatoes and green beans.

Snacks: Pecans; banana; wholegrain crackers with sliced cheese.

Drinks: Water; milk.

If you feel a low-salicylate diet plan may help you, see a registered dietitian to help you plan an appropriate balanced diet.

Fish Oil For Salicylate Intolerance

Fish Oil For Salicylate IntoleranceLooking at supplements, only fish oil may has been examined for salicylate intolerance.

One small study reported on three patients with extreme intolerance to salicylates, including severe hives and asthma.

After taking fish oil for 6–8 weeks, all three experienced complete or nearly complete improvement of their symptoms. The authors suggested that daily supplementation with 10 grams of fish oil rich in omega-3 fatty acids appears to be a safe and effective treatment for salicylate intolerance (12).

Unfortunately, due to the study size and quality we can’t make any recommendations until more research is complete. Additionally, 10 grams of fish oil per day is incredibly high and should be done under medical supervision.




Summary: Very early evidence suggests 10 grams per day fish oil supplementation may help treat salicylate intolerance. However, this is based on a weak study.

We Have Much More To Learn

Salicylate intolerance is a poorly understood condition.

Treatment can be difficult as it shares symptoms with many allergies and other food intolerances.

Salicylates are also present in a wide variety of foods, medicines, cosmetics and other products, making them difficult to minimize.

The most important step is to eliminate exposure to aspirin and non-food sources of salicylates. If there is no improvement, consider reducing food sources too with either a low salicylate diet or a low FODMAP diet.

Always talk with your doctor before making any changes.



Salicylate intolerance is not well-understood, and often misdiagnosed. This article looks at the evidence-based ways to treat salicylate intolerance.

Comments

  1. joyce howarth says:

    The 3 day diet is not low sals. I have sals intolerance and would be ill if I fo,llowed your diet. For example the only low sals lettuce is iceberg, tomatoes are high sals. They basically rip; my stomach apart my reaction is so bad to them. There are many other examples here of high sals. Plesae ensure your information is correct before publishing. The RPAH in Sydney is the world leder in this – but is not mentioned anywhere. http://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/salicylates.html

  2. I recently been asked to do an elimination diet for three weeks for my 7 years old….heard many mums with ADHD children have found an improvement by removing the high content foods. Not quite convinced as couldn’t find any studies confirming calculates linked to hyperactivity. I can see you haven’t mentioned it at all in your article. I might give him a go with fodmap which is less restrictive.

    • Hi, A complete elimination diet might be going a bit far but taking all the additives out of a diet would a great idea. I’ve heard a lot of wonderful stories come out of the mouths of mothers who have done this. It’s awful when you think of the things that these people can put into packets these days and actually call it food. I go cross eyed trying to read lables, or I did until I stopped and when onto all natural stuff.
      Yours sincerely Toni.

  3. This is the worst list I’ve ever seen. I’ve been salicylate sensitive for more than thirty five years and I know there is probably fifty or sixty items missing off this list. The only one that is nearly right is the herbs which I have to agree with. When It comes to the fruits and vegies it’s only fifty percent right and where there drinks are concerned…..well you can walk through the supermarket with your eyes shut. There’s nothing you can pick up off the shelves except water and milk. All the other stuff which is just frrit and coloured water is off the list. Teas especially.

  4. Toni, what would you consider a good source? I was just informed to start this diet and need to know EXACTLY what I can and can not eat. Any help is greatly appreciated! Ericabeth3@gmail.com

  5. Start with Australian RPAH like Joyce said. Also Sue Dengate’s Fed Up and the Failsafe Cookbook, as well as her website Food Intolerance Network. There is also a blog called Cooking for Oscar that would be helpful for anyone dealing with Salicylate Sensitivy/Intolerance. They’ve been lifesavers for me since the end of March when I became histamine and salicylate sensitive in conjunction with my seasonal allergies.

  6. melanieAvalon.com has a fantastic compiled food sensitivity comparison guide that lists whether a food is low, medium, or high in histamines, amines, glutamates, oxalates, salicylates, sulfites, thiols, and nightshade. It’s proven accurate when compared to lists like the RPAH and the SIGHI list of histamines. I went through and compiled a list of low lows, then low mod foods that saved my sanity when shopping for things I could comfortably eat. A big part is definitely removing the food additives, food colors, and extra sugar that so many commercial products contain. Good Luck.

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