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ENT Conditions > Allergy Information

Sensitivity to Aspirin, Anti-Inflammatory Painkillers (NSAIDS), Food Additives and Salicylates

This sensitivity can be difficult to diagnose as a number of different medication (painkillers and anti-inflammatory drugs) several common food additive (dyes and preservatives and in some cases a naturally occurring food substance (salicylate) might all be involved. Different symptoms can be caused, including urticaria (nettle rash) angioedema (allergic tissue swelling) nasal polyps and asthma. In rare cases the drugs listed can cause severe and even dangerous reactions, and if you have been advised to avoid them, you should do so with care. Sensitivity to food additives and salicylates is highly unlikely to be as dangerous, but the only way to diagnose it is to see if frequent symptoms disappear when these foods are avoided.

Aspirin (aspirin, acetyl salicylic acid, salicylic acid, salicylate)

Avoiding aspirin itself is not difficult but you need to know that many over-the-counter painkillers may contain it. The following list may not be complete but it gives the most common trade names.

Alka Seltzer Alka Seltzer XS Alka XS Gold Anadin Anadin Extra Anadin Max Strength Angettes 75 Asasantin Retard Askit Aspav

Aspro Clear Beechams Lemon Tabs Beechams Powders Boots Seltzer Caprin Co-Codaprin Codis & Codis 500 Disprin Disprin CV Disprin Direct

Disprin Extra Doans Backache Pills Dristan Tablets Imazin XL Mrs Cullens Nurse Sykes Powders Nu-Seals Phensic Veganin

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

These drugs are anti-inflammatory painkillers; the names in bold are the chemical names; the names in brackets are the trade names. They are similar to aspirin and some patients may need to avoid these as well to clear up symptoms. In the UK, Ibuprofen is the only NSAID available without prescription. Pain-relieving gels containing these drugs may also need to be avoided. Most salicylate-sensitive people tolerate Paracetamol and, for more severe pain a prescription-only painkiller, for example a morphine-like drug such as dihydrocodeine, or a COX-II NSAID.

• Aceclofenac (Preservex)

• cemetacin (Emflex)

• zapropazone (Rheumox)

• iclofenac (Arthrotec, Diclofex, Diclomax, Volraman, Volsaid, Voltarol)

• iflunisal (Dolobid)

• todolac (Lodine)

• enoprofen (Fenopron)

• buprofen (Anadin, Ibuprofen, Anadin Ultra, Arthrofen Boots Fever & Pain Relief, Brufen, Calprofen, Codafen, Codafen Continus Galprofen, Hedex Ibuprofen, Ibrufhalal Ibufem, Inoven, Librofem Migrafen Novaprin, Nurofen (various), Pacifene, Phorpain, Relcofen, Solpaflex)

• ndomethacin (Flexin, Indocid, Indomid)

• etoprofen (Alrheumat Orudis, Oruvail)

• abumetone (Relifex)

• aproxen (Napretec, Naprosy, Nycopren, Synflex)

• henyibutzone (Butacote)

• iroxicam (Brexidol, Feldene)

• ulindac (Clinoril)

• iaprofenic Acid (Surgam)

Food Additives

It has been shown that some people who are affected by aspirin and NSAIDs may be affected by certain food additives, especially food dyes and preservatives. Those considered troublesome are listed below.

Food Dyes

E102 Tartrazine E104 Quinoline yellow E107 Yellow 2G E120 Cochineal, Camine E122 Carmoisine E123 Amarath E124 Ponceau 4R E132 Indigo carmine E127-180 Other food dyes

Food Preservatives E210-219 Benzoates E220 Sulphur dioxide E221-227 Sulphites Food Flavourings E250-251 Nitrites, nitrates E310-312 Gallates E320-321 BHA and BHT E622-623 Glutamates

Low Salicylate Diet

Salicylates are aspirin-like substances found naturally in a number of different foods, especially certain fruits and vegetables, dried herbs, spices , and alcoholic drinks. Some patients who are sensitive to aspirin and the NSAIDs may get symptoms after eating these foods. However, we do not recommend that patients with known aspirin allergy avoid salicylates simply as a matter of course. For example, research has shown that most aspirin sensitive asthmatics are not affected by high salicylate foods.

If you decided to give the diet a try – follow it strictly for a month by avoiding all foods in the left-hand and middle columns. If it does help reduce symptoms, you can then experiment to find out just how strict you need to be, starting by gradually increasing the amounts of foods eaten from the middle column to see if symptoms recur. In theory it is the total salicylate content of your diet that results in symptoms, although some people may find that specific foods from these lists may be a particular problem just for them. This method of testing is the only way to be sure if these foods affect you. You only need to avoid them if you find they cause symptoms.

High (V High) Salicylate	Medium Salicylate	Low or No Salicylate
Drinks	Drinks	Drinks
Ales, Benedictine, Beer, Larger	Champagne, Port & Liqueurs, Cider, Tea, Cola Drinks, Tomato Juice, Flavoured coffees, Soft & fizzy drinks Fruit juice
Bread and cereals	Bread and cereals	Bread and cereals
Breakfast cereals/muesli with Fruit, fruit bread, Raisin breads Current buns, Pasta sauces - (unless ingredients ok)	Corn breakfast cereals, Cornflakes, Polenta, Cornmeal, Corn flour	All others (provided no disallowed fruit/dried fruit/vegetable / spice / dried herb is present) (plain pasta and plain cereals are OK)
Meat and Fish	Meat and Fish	Meat and Fish
Dried Fish, Salami, Fish in – Sausage rolls, tomato sauce, Sausages, Frankfurters, Spicy - Luncheon meats seasoned meats, Meat pies & pasties	Tinned meat, Kidney and liver	All others (plain meats, fish, shellfish, poultry, ham, bacon and corned beef are OK) (sausages and hamburgers are OK if free from spices, preservatives, dried herbs)
Milk, egg, oils and fats	Milk, egg, oils and fats	Milk, egg, oils and fats
Flavoured milk, Sorbets, Flavoured ice, Prepared dips, Creams & Prepared spreads, Sorbets, Milk Shakes, Flavoured Yoghurt		All others (egg, butter, milk, cream, cheese, powdered milk, Soya milk, margarine, vegetable oils and vanilla ice-cream are all OK)(yoghurts – plain, banana, chocolate, mango and pear are all OK)
Fruits	Fruits	Fruits
Apricot, Melon, Blackberry, Orange, Blackcurrant, Pineapple, Cherries, Blueberry, Prune, Cherries (tinned), Raspberry, Currants & raisins, Redcurrant, Date, Strawberry, Gooseberry, Sultana	Apple (if not listed right), Mandarin, Nectarine, Passion Fruit, Cranberry, Banana, Fig (dried), Pears (with skin), Grapefruit, Persimmon, Grapes, Plums, Guava, Watermelon, Kiwi-fruit	Apple (Golden or red delicious), Paw-paw, Pear juice, Figs (fresh), Pears (peeled), Grenadillo, Pears (tinned), Lemon + juice, Pineapple juice, Lychee, Pomegranate, Mango, Rhubarb
Vegetables	Vegetables	Vegetables
Asparagus (fresh), Peppers (capsicum), Mushroom (tinned), Water Chestnut	Aubergine, Broccoli, Radish, Avocado, Courgette, Spinach, Broad beans, Gherkins, Tomato	All others (fresh mushroom and potato are OK)
Snacks and sweets	Snacks and sweets	Snacks and sweets
Almonds, Honey, Aniseed, Ice lollies, Chewing gum, Jams & Jellies, Dessert toppings, Liquorice, Flavoured crisps, Muesli bars and corn chips, Peppermint(s)	Brazil nuts, Peanut butter, acadamia nut, Pine nuts, Peanuts,	All others (other nuts, seeds, coconut, chocolate plain crisps, plain corn chips, tacos, Vegemite and Marmite are all OK)
Sauces, herbs and spices	Sauces, herbs and spices	Sauces, herbs and spices
Chutneys, Salad Dressings, Curry spices (unless ingredients ok), Dried herbs, Sauces (individual or mixed) (unless ingredients ok), Fish paste, Spices (if not listed right), Gravies, Stock cubes (unless ingredients ok), Mixed spices, Tomato paste, Paprika, Tomato sauce, Pickles, Turmeric, Worcester sauce	Aniseed, Garam masala, Cider Vinegar, Ginger (powder), Cumin, Wine Vinegar, Five Spice, Avoid products flavoured with mint wintergreen or menthol including certain toothpastes, mouthwashes and some medicines	All others – including: Allspice, Garlic, Caraway seed, Cardamom, Horseradish, Poppy seed, Cayenne pepper, Malt, Chilli Pepper, Malt Vinegar, Cinnamon, Marmite, Cloves, Mustard, Fresh herbs, Nutmeg, Pepper – black, Pepper – white, Soy sauce, Ginger root, Saffron, Tabasco, Vegemite, Vanilla

We have tried to be as accurate as possible in providing this information, but different sources of information vary a little.  However as it is the total salicylate intake that you are trying to reduce, these small differences should not matter very much.