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. 2008 Feb;105(8):137-42.
doi: 10.3238/arztebl.2008.0137. Epub 2008 Feb 22.

Salicylate intolerance: pathophysiology, clinical spectrum, diagnosis and treatment

Hanns-Wolf Baenkler  1
Affiliations

Salicylate intolerance: pathophysiology, clinical spectrum, diagnosis and treatment

Hanns-Wolf Baenkler. Dtsch Arztebl Int. 2008 Feb.

Abstract

Introduction: Acetylic salicylic acid (aspirin) intolerance relates to altered generation and metabolism of arachidonic acid and eicosanoids, and prostaglandins and leukotrienes ingestion of salicylates or COX-inhibitors.

Methods: Selective review of literature in PubMed and the Cochrane Library.

Results: Rhinitis, asthma and nasal polyposis are typical presentations, but urticaria and gut inflammation are also described. The mechanism involves a specific reaction to COX inhibitor substances in analgesics, cosmetics or plants resulting in an abnormal pattern of eicosanoids (prostaglandins and leucotrienes). The diagnosis is based on symptoms occurring immediately following ingestion of these substances or on refractory polyp formation. Blood tests may be helpful in unclear cases. Avoidance of triggering agents is helpful. Corticosteroids are the mainstay of pharmacological treatment. Biological, desensitization treatment involving the administration of increasing amounts of acetylic salicylic acid may also be used.

Discussion: Asthma, rhinitis and nasal polyps, as well as chronic gastrointestinal irritation and urticaria following acetylic salicylic acid ingestion may suggest intolerance.

Keywords: allergies; asthma; desensitization; nasal polyps; salicylate intolerance.

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Figures

Figure
Figure
Eicosanoids: formation, breakdown, effects (greatly simplified from [3, e1, e2, e3])
See this image and copyright information in PMC

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