Salicylate Sensitivity: Symptoms and Management

Understanding salicylate sensitivity can be challenging. (Almost as challenging as pronouncing “sa-LIS-i-late sensitivity.”) The reason? Salicylates can affect your body in different ways, making it hard to identify the root of your symptoms and confirm a diagnosis.

“People can have different types of reactions, ranging from a mild sensitivity to a life-threatening allergy,” says allergist Dylan Timberlake, MD. “The reactions also vary depending on the type of salicylate.”

Dr. Timberlake explains where you might find these chemicals, symptoms they can cause and what to do if you’re sensitive to them.

What is salicylate sensitivity?

Salicylate sensitivity is when your body reacts poorly to foods, products or medications that contain salicylates. These natural compounds are found in many fruits, vegetables, spices and some pain relievers. Synthetic salicylates (made in a lab) are common ingredients in medications and health and beauty products.

The most well-known salicylate reaction is to aspirin. Aspirin can cause a true allergy, where your immune system sees it as a threat and steps into action, creating a variety of symptoms.

Some people with asthma and nasal polyps can have severe reactions to aspirin — not because of a traditional allergy, but due to a different biological response. This condition is called aspirin-exacerbated respiratory disease (AERD). It happens when your body’s response to COX inhibitors like aspirin is disrupted. COX enzymes help process certain chemicals involved in inflammation and allergic reactions.

In people with AERD, this pathway is out of balance, which can trigger intense, even life-threatening respiratory symptoms after taking aspirin or other NSAIDs (nonsteroidal anti-inflammatory drugs).

Whether other salicylates cause allergies or sensitivities isn’t as clear. “True allergies to other salicylates are unlikely due to their chemical structure,” clarifies Dr. Timberlake. “However, it’s possible to have a milder salicylate sensitivity or intolerance.”

Salicylate sensitivity symptoms

Salicylate sensitivity can show up in different ways and vary from person to person.

Symptoms mimic other allergies, food intolerances and illnesses. They might affect your respiratory system, skin or gastrointestinal tract, causing:

• Fatigue
• Headaches
• Nasal congestion
• Runny nose
• Skin redness, hives and itching
• Sneezing
• Stomach pain, nausea, gas, bloating and diarrhea

What products contain salicylates?

Salicylates are common in health and beauty products and certain medications, like:

• Aminosalicylates, medications to treat inflammatory bowel disease
• Bismuth subsalicylate, the active compound in Pepto-Bismol®
• Magnesium salicylate, a common ingredient in some pain relief medications
• Methyl salicylate (oil of wintergreen), found in topical creams for muscle and joint pain, as well as breath mints, gum, toothpaste and mouthwash

“Many foods are rich in salicylates, too, although the published levels aren’t always consistent,” notes Dr. Timberlake. “This may be due to variations in the foods themselves or the testing methods.”

In general, foods that seem to contain higher levels of salicylates include:

• Fruits: Cherries, berries, grapes, kiwi, pineapples, plums, dried fruits
• Vegetables: Broccoli, peppers, green beans, cucumbers, zucchini, corn, pickled vegetables, tomato sauces
• Herbs and spices: Cumin, turmeric, paprika, cinnamon, oregano, thyme, cilantro, ginger
• Nuts and seeds: Almonds, cashews, pumpkin seeds

Diagnosing salicylate sensitivity

Diagnosing allergies and sensitivities can be challenging. Healthcare providers rely heavily on how you describe your symptoms and reactions.

If you have an aspirin allergy or AERD, a provider may do a graded dose challenge. In this test, you take a small amount of aspirin in a medical setting to see how you respond.

How to manage

Limiting your exposure is the main way to manage salicylate sensitivity. You may do this by:

• Consulting your healthcare provider to be sure nothing else is going on
• Undergoing a process called desensitization — under medical care — to help you tolerate aspirin
• Keeping a food diary to track which foods may be causing your symptoms
• Trying a low-salicylate diet (though this is very restrictive and removes fruits and other benefits that can be good for your health, Dr. Timberlake says)
• Trying a food elimination diet that cuts out many foods and adds them back slowly while monitoring symptoms
• Reading labels to help avoid health and beauty products that contain salicylates
• Considering taking medications to help with symptoms, like runny nose or stomach problems

Allergies and sensitivities tend to change over time. For non-life-threatening reactions, Dr. Timberlake recommends periodically exposing yourself to items you’ve been avoiding. You may find you no longer have a reaction.