What Are Salicylates, and Why Are They Making Me Sick?

Epipen with Small Fun Glass Bracelet

A few months ago, I shared a story here on the Lauren’s Hope Blog about being at work when my lips and tongue swelled up due to an allergic reaction. As instructed at Urgent Care, I did follow up with my Primary Care Physician right away, and she ran some blood work to test for food allergies. The results came back: Allergic to milk and hazelnuts.

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This was incredibly confusing for me, as I have never had a problem with dairy or nuts. However, as I know we can develop food allergies at any time, I immediately cut dairy and all nuts from my diet while I awaited a follow-up appointment with an allergist for more in-depth testing.

The allergist took a look at my test results and, after an exam, discussion, and further tests, confirmed that I had received false positives. He told me testing done immediately after an allergic event has a higher likelihood of resulting in a false positive, which was why the follow-up testing he did was more accurate. So, no milk or hazelnut allergies. Well, that’s great. But why did my lips and tongue swell up like that? It seemed we were back to Square One.

Fortunately, I am pretty organized, excessively observant, and nerdy. This worked to my advantage, because I had created bullet-point-driven, categorized lists of all foods I had noticed sometimes or always caused issues, new and repeat foods, environmental exposures, medications, and even unrelated events from the week previous to my reaction.  Well…I thought they were unrelated.

As my allergist and I reviewed my (slightly ridiculously) copious notes, he asked more about the migraine I had on the Friday prior to my Monday allergic reaction. How had that come on? What had I taken for it? Was it a, “normal” migraine for me?

Here, I was actually confused. How on Earth would Friday’s migraine have played into Monday’s allergic reaction? But I went along and told the story. Starting with a sudden aura, I had one of those “I need silence and complete darkness” migraines that Friday. I took Ibuprofen, drank water, and laid in the dark. Four hours later, with no relief in sight, I gave in and took Excedrin Migraine. It’s not normal for me to take multiple medications, but I had been advised by my neurologist that this was a safe combination in a real crisis, because I cannot tolerate Imitrex, likely due to my sulfa drug allergy. I laid in the dark again, quite literally just praying for the migraine to pass. I even laid in a warm bath with my head mostly under water, something that has helped my mom and sister when all else fails.

Finally, after about six hours, the pain subsided. I staggered back into the bathroom to wash my face, my vision still blurry, and looked in the mirror to see that my eyelids were swollen. This has often been the first step in an allergic reaction for me, so I reluctantly reached for some Benadryl. As someone who rarely takes medication, I was really nervous, but didn’t see an alternative.

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The Diagnosis

I relayed all of this to the allergist, who nodded and looked over my food and exposure lists again, noting things I eat regularly and things that sometimes or always cause reactions: sweet potatoes, avocados, orange juice, carrots, almonds, honey. I am allergic to eucalyptus, and tree oils tend to give me hives. I’m sensitive to random cosmetics and lotions and powders. And on and on.

“Well,” he said*, taking off his glasses the way doctors do that always makes me think there’s bad news, “…first, you have Oral Allergy Syndrome. And that’s why you have these ‘sometimes’ reactions to things you’re not actually allergic to when we test you. But also, you may be allergic to aspirin. We could put you in the hospital for an oral challenge to confirm that, as there’s no blood test for that, or you could just not take aspirin.” Ok. So no more aspirin. That’s not hard. I mean, I rarely take Excedrin Migraine, and that’s pretty much the extent of my aspirin use, so no big deal. “The other thing is that you may not be allergic to aspirin. You clearly have a very high salicylate intolerance, and aspirin is a salicylate drug.”

I said something pretty articulate here, something along the lines of, “Oral what? Wait, what’s a saly…suh…what did you say? Can you spell that for me?”

With an impromptu flow chart in pen on the exam table’s paper covering, my allergist explained Oral Allergy Syndrome and Salicylate Sensitivity. And suddenly, all of my random, disconnected, intermittent reactions started to make a lot of sense. Even my migraines made more sense. I didn’t know it when I walked in, but by the time I left, I knew that appointment was quite literally one of the most important doctor visits of my life.

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What Is Oral Allergy Syndrome?

So, first, Oral Allergy Syndrome. That’s a biggie deserving of its own blog article, so we’ll cover that here on the Lauren’s Hope Blog soon. In short, however, OAS is a form of allergy in which the immune system basically mistakes specific food proteins for plants that the person actually is allergic to, and reacts as if you’ve been exposed to that plant. So, for example, someone like me, whose whole upper arm itched for a week after a ragweed scratch test, who also has Oral Allergy Syndrome, will experience negative reactions when eating certain melons or tomatoes because the proteins are similar enough that my immune system thinks I’ve been exposed to ragweed. So that explained some of the seemingly random food issues.

What Is Salicylate Sensitivity?

Then we got to the salicylates. Salicylates are found in plants, and they work as a sort of natural pesticide. And apparently, they’re in ….oh, EVERYTHING. The more I listened to him, the more I wondered what I would ever be able to eat again, how I would find cosmetics or shampoos. It felt a lot like learning my son (who we now know has Non-Celiac Gluten Sensitivity) needed a gluten-free diet (and life!) back in 2007, when I didn’t even know what gluten was. I recall asking the doctor, “If gluten is so horrible, why do they put it in EVERYTHING?” Fast-forward 8 years, and gluten-free options are, thankfully, abundant. But at the time? Not so much.

So, I sat there in déjà vu, listening to the allergist explain that my combination of OAS and a serious salicylate intolerance were, on the plus side, unlikely to result in life-threatening allergic reactions and were very manageable. My Monday reaction, the swollen lips and tongue, he explained, were likely caused by the aspirin from Friday working its way out of my system, and my body having a secondary reaction to the salicylates.

Needless to say, I was confused. OAS and salicylate sensitivity are complex. In the next couple of blog articles, I’ll break them down, explain how I’ve made changes over the past few months, and share some of the great resources I’ve found. In the meantime, please chime in if you have something to share on the topics!

Do you have OAS? A salicylate sensitivity? Tell us about it in the comments below.

*Full disclosure: I’m paraphrasing.

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