Salicylate Sensitivity – What do we know

I have done a recent review of a child with salicylate sensitivity and in dialog with the parent, I realized that I need to get up to speed on this topic. One of the reasons is that we found that some of the recommendations were matches to some studies for salicylate sensitivity. So far the citizen science analysis at microbiome prescription has not found any specific bacteria associated (not sufficient samples). If you have uploaded a sample AND have salicylate sensitivity, please make sure you have updated you symptoms.

There are many web-sites/blog dealing with salicylates — which given the absence of actual studies, may be worth reading. As always, I will attempt to keep to “gold standard” data sources.

Salicylate poisoning can cause vomiting, tinnitus, confusion, hyperthermia, respiratory alkalosis, metabolic acidosis, and multiple organ failure. Diagnosis is clinical, supplemented by measurement of the anion gap, arterial blood gases, and serum salicylate levels. Treatment is with activated charcoal and alkaline diuresis or hemodialysis.

  • “Alkalinisation, the mainstay of therapy for salicylate and phenobarbital poisoning over many decades, is effective, although no more so than charcoal, and less than dialysis” [1990]
  • “Forty-four adults with aspirin poisoning were treated with oral fluids only, standard forced alkaline diuresis, forced diuresis alone, or sodium bicarbonate (alkali) alone. Alkali alone was at least as effective and possibly more effective than forced alkaline diuresis in enhancing salicylate removal. ” [1982]
  • “One of the more popular and successful treatments has been forced alkaline diuresis to encourage excretion. This technique, however, is not without risk and has now been replaced with alkalinisation alone, which has been shown to be safer and equally successful. The use of activated charcoal as an acute absorbing agent for drug still in the upper gastrointestinal tract is beneficial in minimising further absorption. ” [1992]
  • “When the urine pH increases to 8 from 5, renal clearance of salicylate increases 10-20 times. Raising the urinary pH level from 6.1 to 8.1 results in a more than 18-fold increase in renal clearance by preventing nonionic tubular back-diffusion, which decreases the half-life of salicylates from 20-24 hours to less than 8 hours. ” [MedScape]

Treatment of severe salicylate poisoning by forced alkaline diuresis. [1969]

The concept of an alkaline diet is popular.