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Salicylate sensitivity | |
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Other names | Salicylate intolerance |
Salicylic acid |
Salicylate sensitivity 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.
The most common symptoms of salicylate sensitivity are: [2]
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. [2]
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. [3] 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. [4]
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. [5]
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. [6] [7]
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. [8] [9] 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. [10]
AERD refers to NSAID sensitivity in conjunction with nasal polyps and asthma. [11]
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of use, but largely include an increased risk of gastrointestinal ulcers and bleeds, heart attack, and kidney disease.
Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of the use of emergency medication on site. It typically causes more than one of the following: an itchy rash, throat closing due to swelling that can obstruct or stop breathing; severe tongue swelling that can also interfere with or stop breathing; shortness of breath, vomiting, lightheadedness, loss of consciousness, low blood pressure, and medical shock. These symptoms typically start in minutes to hours and then increase very rapidly to life-threatening levels. Urgent medical treatment is required to prevent serious harm and death, even if the patient has used an epipen or has taken other medications in response, and even if symptoms appear to be improving.
Sulfites or sulphites are compounds that contain the sulfite ion, SO2−
3. The sulfite ion is the conjugate base of bisulfite. Although its acid is elusive, its salts are widely used.
Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip.
Nasal polyps are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, though face pain may occasionally occur. They typically occur in both nostrils in those who are affected. Complications may include sinusitis and broadening of the nose.
Food intolerance is a detrimental reaction, often delayed, to a food, beverage, food additive, or compound found in foods that produces symptoms in one or more body organs and systems, but generally refers to reactions other than food allergy. Food hypersensitivity is used to refer broadly to both food intolerances and food allergies.
Aspirin-exacerbated respiratory disease (AERD), also called NSAID-exacerbated respiratory disease (N-ERD) or historically aspirin-induced asthma and Samter's Triad, is a long-term disease defined by three simultaneous symptoms: asthma, chronic rhinosinusitis with nasal polyps, and intolerance of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Compared to aspirin tolerant patients, AERD patients' asthma and nasal polyps are generally more severe. Reduction or loss of the ability to smell is extremely common, occurring in more than 90% of people with the disease. AERD most commonly begins in early- to mid-adulthood and has no known cure. While NSAID intolerance is a defining feature of AERD, avoidance of NSAIDs does not affect the onset, development or perennial nature of the disease.
The Feingold diet is an elimination diet initially devised by Benjamin Feingold following research in the 1970s that appeared to link food additives with hyperactivity; by eliminating these additives and various foods the diet was supposed to alleviate the condition.
Drug intolerance or drug sensitivity refers to an inability to tolerate the adverse effects of a medication, generally at therapeutic or subtherapeutic doses. Conversely, a patient is said to be "tolerating" a drug when they can tolerate its adverse effects. Some instances of drug intolerance are known to result from genetic variations in drug metabolism.
Wheat allergy is an allergy to wheat which typically presents itself as a food allergy, but can also be a contact allergy resulting from occupational exposure. Like all allergies, wheat allergy involves immunoglobulin E and mast cell response. Typically the allergy is limited to the seed storage proteins of wheat. Some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy is rare. Prevalence in adults was estimated to be 0.21% in a 2012 study in Japan.
A drug allergy is an allergy to a drug, most commonly a medication, and is a form of adverse drug reaction. Medical attention should be sought immediately if an allergic reaction is suspected.
An elimination diet, also known as exclusion diet, is a diagnostic procedure used to identify foods that an individual cannot consume without adverse effects. Adverse effects may be due to food allergy, food intolerance, other physiological mechanisms, or a combination of these. Elimination diets typically involve entirely removing a suspected food from the diet for a period of time from two weeks to two months, and waiting to determine whether symptoms resolve during that time period. In rare cases, a health professional may wish to use an elimination diet, also referred to as an oligoantigenic diet, to relieve a patient of symptoms they are experiencing.
Asthma is a common pulmonary condition defined by chronic inflammation of respiratory tubes, tightening of respiratory smooth muscle, and episodes of bronchoconstriction. The Centers for Disease Control and Prevention estimate that 1 in 11 children and 1 in 12 adults have asthma in the United States of America. According to the World Health Organization, asthma affects 235 million people worldwide. There are two major categories of asthma: allergic and non-allergic. The focus of this article will be allergic asthma. In both cases, bronchoconstriction is prominent.
Max Samter was a German-American immunologist who first extensively studied the triad between asthma, aspirin allergy, and nasal polyps that became known as Samter's triad, now aspirin-exacerbated respiratory disease. Samter was a third generation doctor and obtained medical training in Europe. After fleeing Nazi occupation in Germany, Samter had a long career in medical research in the United States. He is a pioneer in the field of immunology, having written many of the foundational textbooks of the field. Samter founded The Max Samter Institute for Immunology Research at Grant Hospital in Chicago, and after his death it was renamed in his honor.
Pseudoallergy, sometimes known as nonallergic hypersensitivity, is a type of hypersensitivity reaction mostly described in the context of drug allergy. The mechanism is somewhat similar to the type 1 hypersensitivity in the Gell and Coombs classification in that the effector cell is also mast cell. In pseudoallergic reaction, the mast cell is directly activated, rather than through the mediation of Immunoglobulin E (IgE). Therefore, it is also known as direct mast cell activation.
Dupilumab, sold under the brand name Dupixent, is a monoclonal antibody blocking interleukin 4 and interleukin 13, used for allergic diseases such as atopic dermatitis (eczema), asthma and nasal polyps which result in chronic sinusitis. It is also used for the treatment of eosinophilic esophagitis, prurigo nodularis and COPD.
Alcohol-induced respiratory reactions, also termed alcohol-induced asthma and alcohol-induced respiratory symptoms, are increasingly recognized as a pathological bronchoconstriction response to the consumption of alcohol that afflicts many people with a "classical" form of asthma, the airway constriction disease evoked by the inhalation of allergens. Alcohol-induced respiratory reactions reflect the operation of different and often racially related mechanisms that differ from those of classical, allergen-induced asthma.
NSAIDhypersensitivity reactions encompass a broad range of allergic or allergic-like symptoms that occur within minutes to hours after ingesting aspirin or other NSAID nonsteroidal anti-inflammatory drugs. Hypersensitivity drug reactions differ from drug toxicity reactions in that drug toxicity reactions result from the pharmacological action of a drug, are dose-related, and can occur in any treated individual. Hypersensitivity reactions are idiosyncratic reactions to a drug. Although the term NSAID was introduced to signal a comparatively low risk of adverse effects, NSAIDs do evoke a broad range of hypersensitivity syndromes. These syndromes have recently been classified by the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity.
Cats exposed to allergens may develop allergies or allergic reactions. Allergies tend to become evident and intensify over extended periods of time and can take years to develop. Some allergic diseases and allergies in cats include feline atopic dermatitis, flea allergy dermatitis, feline-mosquito hypersensitivity, and food-induced allergy. In the case of feline atopy, hypersensitivity to allergens is due to genetic predisposition. However, various allergies may arise due to environmental factors. Allergens, ingested, inhaled, or airborne, can be seasonal or non-seasonal, similar to allergies in humans. Suspected seasonal allergens include but are not limited to pollen, fleas, and mosquito bites; suspected non-seasonal allergens include but are not limited to plastic materials, food, dust, trees, and grass. After exposure to suspected allergens, symptoms may be immediate or delayed, arising within a few minutes to two hours. Symptoms can include both dermatological and gastrointestinal signs such as itchy skin, hair loss and excessive scratching. In cases of feline atopic dermatitis or atopy in cats, pruritic skin diseases may result; however, signs can also include miliary dermatitis, symmetrical alopecia, and lesions of the eosinophilic granuloma complex.
Lysine acetylsalicylate, also known as aspirin DL-lysine or lysine aspirin, is a more soluble form of acetylsalicylic acid (aspirin). As with aspirin itself, it is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, antithrombotic and antipyretic properties. It is composed of the ammonium form of the amino acid lysine paired with the conjugate base of aspirin.