Salicylate sensitivity is a group of symptoms people may experience when exposed to salicylic acid and related chemicals. The symptoms include skin reactions, breathing issues, and sometimes digestive problems.

While some reactions to salicylate can cause minor annoyance, some are more serious. Many products may contain salicylate, including certain medications, food, and cosmetics.

There is no diagnostic test to confirm someone has this condition definitively. Someone with salicylate sensitivity may need to avoid products with high volumes of this chemical.

In cases where this is not possible, strategies such as desensitization may be helpful. This process usually involves gradually introducing the salicylate-containing product to a person over time to increase tolerance.

This article describes salicylic sensitivity, including its symptoms, causes, and management.

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People with salicylate sensitivity experience various symptoms when exposed to salicylic acid and related chemicals. Sensitivity occurs at usual doses or amounts of salicylate.

Salicylates can be present in aspirin and medications. Certain foods may also contain salicylates such as lentils and beans.

When exposed to salicylate, people may experience inflammation in the sinuses and nasal passages, asthma, or hives. People with salicylate sensitivity may also report gastrointestinal symptoms, such as:

Symptoms of salicylate sensitivity vary from person to person. Experts group symptoms associated with salicylate sensitivity into three categories:

  • respiratory
  • skin reactions
  • anaphylactoid

Aspirin-exacerbated respiratory disease refers to worsening nasal and breathing symptoms when people with salicylate sensitivity have exposure to salicylate.

Skin reactions from aspirin and other salicylate-containing products include angioedema. Angioedema refers to swelling underneath the skin but usually occurs in the face. Salicylate may also cause hives.

Anaphylactoid vs. anaphylactic reactions

There are critical distinctions between both reaction types. People with anaphylactoid reactions to aspirin develop angioedema with the following signs, usually within minutes of exposure:

  • drop in blood pressure
  • itchiness
  • increased breathing rate
  • swelling in the throat
  • losing consciousness

Doctors do not consider these as anaphylactic reactions as the body does not produce a substance called IgE when exposed to aspirin, as it typically would for this type of reaction. Since the symptoms of anaphylactoid reactions may be severe, doctors may manage them as they would anaphylactic reactions.

Experts remain unclear why some people develop reactions to typical doses or amounts of salicylate. In large doses, anyone can develop toxicity to salicylate.

There are a few underlying mechanisms for aspirin hypersensitivity. A 2017 study proposes that aspirin sensitivity may be pharmacological, meaning that when COX-1 — a protein and target of these drugs — is blocked, it causes the overproduction of leukotrienes and the underproduction of prostaglandin E2. Leukotrienes are inflammatory molecules that lead to tightening of the airways in the lungs. This can be dangerous in people with asthma that is not well-managed. On the other hand, prostaglandins are anti-inflammatory molecules.

Another theory is that aspirin hypersensitivity occurs due to an immunological response, where the body’s immune system has an atypical response to the drug.

Some people may be more at risk of salicylate sensitivity. For example, 7% of people with asthma have aspirin-exacerbated respiratory disease. In addition, aspirin worsens skin reactions in 20–30% of people with chronic hives.

Doctors do not follow a standard procedure for diagnosing salicylate sensitivity. Diagnostic tests and blood tests cannot conclusively confirm a diagnosis. A detailed history, including the timing of the exposure and symptoms, may be helpful to determine whether there is sensitivity.

Diagnosis may involve exposing the person to a controlled amount of salicylic acid while under medical supervision.

Avoiding certain salicylate-containing products may be necessary, including:


Avoiding drugs with salicylates requires knowing which drugs contain salicylate. These include:

This list is not exhaustive, and other medications may also contain salicylate. When purchasing over-the-counter (OTC) medications, people should check the ingredient labels as salicylates can be found in some medications like cold and cough formulations.

A person with any concerns should check with their prescribing doctor or a pharmacist.

Sometimes people with salicylate sensitivity cannot avoid certain salicylate-containing drugs. In these situations, doctors may need to manage symptoms of salicylate sensitivity with other interventions, such as pre-treatments.

Doctors may also use salicylate desensitization when a person cannot avoid salicylates.


Limiting foods with naturally high salicylate levels can be challenging for some people. Fruits and vegetables tend to have higher amounts of salicylates, but other foods may contain them too.

The amount of salicylate in food can vary based on various factors, including:

  • the part of the plant a person is consuming
  • the plant species
  • cultivation method

Experts supporting a low salicylate diet suggest it is low cost and simple to follow. Foods that may have high levels of salicylates include:

  • lentils
  • beans
  • cauliflower
  • pickled vegetables
  • strawberries
  • plums
  • watermelon
  • raspberries
  • buckwheat
  • oats
  • corn

Certain herbs and spices may also have high levels of salicylates, including:

  • thyme
  • rosemary
  • garam masala
  • paprika
  • curry powder

A low salicylate diet might have a positive effect on reducing symptoms in some people with salicylate sensitivity. It could serve as a tool that supports other treatments for salicylate sensitivity. However, further research is necessary to truly understand the effect of reducing salicylates from the diet.


Some cosmetic products contain salicylates. For example, people use salicylic acid in a gel or cream to treat acne.

Doctors and pharmacists recommend salicylic acid treatment for warts due to its exfoliative action. Certain products may also include salicylic acid as a preservative to prevent the growth of bacteria.

Salicylic acid-containing products absorb into the skin. People with salicylate sensitivity may experience symptoms when exposed to topical salicylic acid. Due to this possible risk, people should always check the labels of cosmetics and skin products.

Before trying a product with salicylate, people with salicylate sensitivity should confirm its safety with a doctor.

Management strategies may include:

Avoiding salicylate-containing products

People with salicylate sensitivity must avoid medications with salicylic acid or its related chemicals. This can become challenging for people with cardiovascular disease who require aspirin as a blood thinner to prevent blood clots.

Most people can tolerate the levels of salicylate that are naturally present in plant foods. However, some people with salicylate sensitivity may need to avoid certain foods depending on the severity and nature of their symptoms.

Sometimes doctors may still recommend people with salicylate sensitivity take aspirin. Doctors may give leukotriene-receptor antagonists to prevent certain salicylate sensitivity reactions, such as skin reactions.

Other pre-treatments to manage symptoms of sensitivity include corticosteroids and antihistamines.


Aspirin desensitization is a strategy doctors sometimes use to reduce the severity of reactions to aspirin.

Many desensitization strategies exist. Some begin at a high dose of aspirin, such as 40 milligrams, while other protocols start at a much lower dose. Desensitization requires a consultation with an allergy expert called an allergist.It should only be performed in a closely monitored medical environment.

A personalized low salicylate diet may help lower a person’s exposure to salicylate and reduce their symptoms. In a 2021 study evaluating the efficacy of a personalized low salicylate diet, researchers noted an improvement in asthma symptoms, breathing, and the extent and severity of hives. However, routine recommendation of low salicylate diets is still controversial.

People with salicylate sensitivity may wish to adopt a low salicylate diet due to its low cost and beneficial risk-benefit profile. It is also simple to introduce in daily life.

Salicylate sensitivity is a condition causing various symptoms in people who cannot tolerate typical levels of salicylates. Certain medications, foods, and cosmetics may contain salicylate.

Managing salicylate sensitivity requires an individualized approach. The simplest way to help prevent symptoms is to avoid or limit exposure. However, limiting foods with naturally high salicylate levels or medications containing salicylate as an ingredient can be challenging for some people.

Salicylate desensitization and pre-treatments are methods to safely expose people to salicylate-containing drugs when they are intolerant.