Salicylate sensitivity

Salicylate sensitivity
Salicylic acid
Classification and external resources
ICD-9-CM E935.3

Salicylate sensitivity, also known as salicylate intolerance, is any adverse effect that occurs when a usual amount of salicylate is ingested. People with salicylate intolerance are unable to consume a normal amount of salicylate without adverse effects.

Salicylate sensitivity differs from salicylism, which occurs when an individual takes an overdose of salicylates.[1] Salicylate overdose can occur in people without salicylate sensitivity, and can be deadly if untreated. For more information, see aspirin poisoning.

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 IgE-mediated allergy. However, it is possible for aspirin to trigger non-allergic hypersensitivity reactions.[2][3] About 5-10% of asthmatics have aspirin hypersensitivity.[4]

Samter's triad refers to aspirin sensitivity in conjunction with nasal polyps and asthma.[5]

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.[6][7]

Symptoms

The most common symptoms of salicylate sensitivity are:

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. The range of foods that have no salicylate content is very limited, and consequently salicylate-free diets are very restricted.

Desensitization involves daily administration of progressive doses of salicylate. This process is usually performed as an inpatient, with a crash-cart at the bedside over a six-day period, beginning with 25 mg of I.V. lysine-aspirin and progressing to 500 mg if tolerated.[8]

Montelukast is one form of treatment used in aspirin-intolerant asthma.[9]

See also

References

  1. ↑ "salicylism" at Dorland's Medical Dictionary
  2. ↑ Palikhe NS, Kim SH, Park HS (October 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.
  3. ↑ Narayanankutty A, Resendiz-Hernandez JM, Falfan-Valencia R, Teran LM. "Biochemical pathogenesis of aspirin exacerbated respiratory disease (AERD). Clin Biochem. 2013 May;46(7-8):566-78. doi: 10.1016/j.clinbiochem.2012.12.005. Review. PMID 23246457
  4. ↑ Jang AS, Park JS, Park SW, et al. (November 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.
  5. ↑ Kim JE, Kountakis SE (July 2007). "The prevalence of Samter's triad in patients undergoing functional endoscopic sinus surgery". Ear, nose, & throat journal. 86 (7): 396–9. PMID 17702319.
  6. ↑ Casterline CL (November 1975). "Intolerance to aspirin". Am Fam Physician. 12 (5): 119–22. PMID 1199905.
  7. ↑ 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.
  8. ↑ Pfaar O, Klimek L (Dec 2006). "Eicosanoids, aspirin-intolerance and the upper airways--current standards and recent improvements of the desensitization therapy". J Physiol Pharmacol. 57 (Suppl 12): 5–13. PMID 17244950.
  9. ↑ Kim SH, Ye YM, Hur GY, et al. (September 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.
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