Understanding salicylate intolerance

Foods, ingredients, or molecule intolerances appear to be on the rise and whilst some such as gluten or histamine are well known, others, such as salicylates, are more misunderstood. This article will delve into this lesser-known phenomenon exploring: 

• What are salicylates and what is salicylate intolerance? 
• Which symptoms are linked to salicylate intolerance? 
• What does the science say causes this condition? 
• How is salicylate intolerance diagnosed? 
• Suggestions on how to manage a suspected salicylate intolerance.

 
What are salicylates and what is a salicylate intolerance?  
 
Salicylates are natural chemicals found in many plants who use them to defend themselves against pests, bacteria, and environmental stressors. Salicylates are anti-inflammatory and as such have also been synthetically reproduced in laboratories for uses in medications, including aspirin and non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen. 
 
Salicylic acid has excellent anti-fungal and anti-bacterial properties, leading to its common use as an ingredient in processed foods, condiments, cosmetics, and beauty products. 
 
In terms of food, salicylates are found in many plant foods to a higher or lesser extent. Some of the foods that are common triggers are: 

• Berries (especially strawberries), grapes, oranges, and apples
• Tomatoes, peppers, and broccoli 
• Cinnamon, curry powder and chili powder
• Almonds and peanuts
• Tea, coffee, and some fruit juices

 
Salicylate intolerance is where a person’s system has difficulty metabolising and tolerating salicylates, leading to a range of symptoms.  The phenomenon was initially observed in medically diagnosed patients with either aspirin-exacerbated respiratory disease (AERD) or NSAIDs-exacerbated respiratory disease (NERD) (1,2).   In the cases of both AERD and NERD, high doses of chemical salicylates can trigger asthma, rhinosinusitis and urticaria.  
 
Clinical case studies have observed that for some, simply eating a diet high in salicylates can contribute to a variety of symptoms, although this can vary from person to person and may also depend on the quantity of salicylates eaten or exposed to over a short period of time. 
 
Which symptoms are linked to salicylate intolerance? 
 
Whilst respiratory and skin symptoms are the most recognised symptoms of salicylate intolerance, there are others including: 

• Digestive issues: stomach pain, bloating, wind, diarrhoea
• Headaches
• Behavioural changes including irritability, restlessness or difficulty concentrating.
• Joint pain and swelling, similar to arthritis symptoms. 
• Fatigue. Both chronic fatigue and low energy levels are often described.
• Anaphylaxis. Whilst extremely rare, severe allergic reaction has been reported. 

 
What does the science say causes this condition? 
As with so many conditions, the exact cause of salicylate intolerance is not well understood, however there are some areas which are being explored: 

• Inability to metabolise or detoxify salicylates properly. 
• Genetic SNPs. Some studies have identified modifications on genes (SNPs) including on CYP2C9, NAT2 and UGT1A6 which might indicate a susceptibility to salicylate intolerance. (3,4)
• Overexposure from food, medical or topical sources can lead to symptoms.
• Underlying health conditions. It is thought that some health conditions including irritable bowel syndrome (IBS), intestinal permeability (leaky gut) or Inflammatory Bowel Disease (IBD) may increase the risk of salicylate intolerance, however it may also be the salicylate intolerance which triggers the health conditions. Further studies are needed to explore this. (5,6)

 
How is salicylate intolerance medically diagnosed? 
Diagnosis of salicylate intolerance is tricky, mainly because of the number of overlapping symptoms with other conditions.  A medical or nutrition practitioner will undertake: 

• A review of your symptoms and medical history. Could your symptoms be linked to other conditions e.g., IBS, food allergies, auto-immune conditions?
• A dietary analysis. Keeping a food and symptom diary can help identify common food triggers. A nutrition professional can use that information to evaluate whether salicylates may be a cause.  
• Challenge testing. If your medical practitioner suspects AERD or NERD then challenge testing may be undertaken within a hospital setting. 

 
For many, a salicylate intolerance is linked to other conditions or genetics and is not, itself, the root cause.  Sufferers tend to go heavily down the elimination root, which whilst does initially provide relief, is not a sustainable or healthy long-term solution. Working with a practitioner to discover the main trigger of the sensitivity is key. 
 
Suggestions for managing a suspected salicylate intolerance.

1. Review your diet by using a food and symptom diary. (you can download one FREE below). Note, that if you are reacting to everything then you need to work with a professional to find the route cause rather than starting to eliminate foods as the foods aren’t the actual issue.
2. Complete this quiz to see whether salicylates rather than histamines might be a trigger for you. 
3. Consider adopting a low salicylate diet. If you plan on changing your diet, you should consult with a healthcare or nutrition practitioner.  A low salicylate diet shouldn’t be followed for more than 3 weeks as it could lead to nutrient deficiencies. 
4. Pay attention to the ingredients of the foods you eat. Check the food labels. Many processed foods, condiments and sauces contain salicylates. 
5. What gene SNPs may you have that could contribute to a salicylate intolerance? How efficient are your detoxification pathways?  
6. Many over the counter medications are based on salicylic acid, so check with your pharmacist.
7. Skin and personal care products often contain salicylates. Try to choose those that are salicylate free. If in any doubt, contact the manufacturer. 
8. Lifestyle and emotions can influence how well a person can tolerate things. Get regular exercise and manage stress and relaxation. 

 
If on medication, please speak to your GP/consultant before making any changes to your diet. 

 
Sign up for my news to receive the published articles straight to your inbox. 
 
Read more by clicking below to see my previously published articles: 
 

• Motivated to change but struggling to stay on track? Tips for long term transformation.

• Symptoms but no idea what’s triggering them? Here are some tips to unravel the mystery.  
• Top Tips for Eating for the Planet without Compromising Your Nutrition 
• I want to eat more plant-based but pulses give me terrible digestive issues
• What is the atopic march?
• Why is eczema/atopic dermatitis itchier at night?
• You’ve been diagnosed with an atopic condition, but what does that mean? 
• Atopic dermatitis/eczema – a chronic condition that effects all ages 
• The skin microbiome, the key to good skin health  
• Autumnal Allergies – Yes, it is a thing
• If one-size-fits all diets worked, don’t you think we would have the magic formula by now?
  
  

Who Am I? 
I’m Jessica Fonteneau, the Eczema and Digestive Health Nutrition Expert. I’ve worked with hundreds of clients to help them change their diets, better manage their flares, and find relief.
 
My vocation is to help those with eczema and digestive issues, because I have suffered with these interlinked conditions since I was 6 months old, and I truly know what it is like to experience these debilitating conditions. 
 
Every client I have ever worked with has their own triggers and ideal nutrition. There is no such thing as ‘one-size-fits-all’. Whether you work with me one-to-one or use my guided tools, my objective is to help you uncover what works best for you, so that you take back control and experience relief. 
 
My guided programmes are only suitable for adults as children have very specific nutrition requirements. I do, however, work with many child clients as part of my clinic. 
 
I also offer two free communities for adults caring for children with eczema and digestive symptoms, feel free to come and join us and get some well-deserved support. 
 

• Free community for adults with skin and/or digestive issues
• Free community for carers of children with skin and/or digestive issues

 
To easily keep up with my articles, masterclasses, ebooks and online programmes and receive exclusive access to early bird offers, sign-up to my newsletter.  
 
Interested in what I do and who I am? Go to my website: www.jessicafonteneaunutrition.com
 
References: 

1. Skypala IJ, Williams M, Reeves L, Meyer R, Venter C. Sensitivity to food additives, vaso-active amines and salicylates: A review of the evidence. Clin Transl Allergy. 2015;5(1):1–11. 
2. Kęszycka PK, Lange E, Gajewska D. Effectiveness of personalized low salicylate diet in the management of salicylates hypersensitive patients: Interventional study. Nutrients. 2021;13(3):1–14. 
3. Park SM, Park JS, Park HS, Park CS. Unraveling the genetic basis of aspirin hypersensitivity in asthma beyond arachidonate pathways. Allergy, Asthma Immunol Res. 2013;5(5):258–76. 
4. Palikhe NS, Kim SH, Nam YH, Ye YM, Park HS. Polymorphisms of Aspirin-Metabolizing enzymes CYP2C9, NAT2 and UGT1A6 in Aspirin-Intolerant urticaria. Allergy, Asthma Immunol Res. 2011;3(4):273–6. 
5. Raithel M, Baenkler HW, Naegel A, Buchwald F, Schultis HW, Backhaus B, et al. Significance of salicylate intolerance in diseases of the lower gastrointestinal tract. J Physiol Pharmacol [Internet]. 2005;56 Suppl 5:89–102. Available from: http://europepmc.org/abstract/MED/1624719
6. Tuck CJ, Malakar S, Barrett JS, Muir JG, Gibson PR. Naturally-occurring dietary salicylates in the genesis of functional gastrointestinal symptoms in patients with irritable bowel syndrome: Pilot study. JGH Open. 2021;5(8):871–8. 

 ​