Food intolerance, Salicylates

Doctors and researchers might find it hard to believe that there are so many MCAD patients affected by both food allergy and intolerance.

Food intolerance, also known as non-IgE mediated food hypersensitivity or non-allergic food hypersensitivity.

An adverse food reaction is a general term for any untoward response to the ingestion of a food. Adverse food reactions can be divided into food allergies, which are immunologically mediated, and all other reactions, which are non immunologic hypersensitivity,.(1)

The recent food allergy guidelines from the European Academy of Allergy and Clinical Immunology give clear advice on how to diagnose an immune-mediated food allergy, " https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604636 / but the majority of us have non-immune related food allergy.

MCAD patients who are on very restricted diets because of food intolerance, it's not uncommon for patients to have around 10 or less safe foods.

Mast cells are 'first line of defense' in both innate/adaptive immune cells, so it makes sense that these activated cells are not helping our immune system to make responsible choices. These cells our contributing to cheating us out of nutritional nourishment.

Over the past decades the prevalence of allergic diseases, and food allergy has increased dramatically.

This failure of "tolerance" is believed to result in the induction of an active immune response to allergens, but what determines what an allergen is in our disease, how does the mast cell detect allergens, on what basis?

There are a vast number of natural chemicals in foods that the mast cell can respond to, these adverse reactions have been attributed to the consumption of a number of both natural and artificial chemicals.

Food intolerance, Salicylates :

Salicylic acid and their derivatives are present in many foods in different concentrations, (3) and are produced by plants as part of their main defense systems against. pathogen attack.

Vitamin S:

It is debatable whether a deficiency in salicylic acid is detrimental

to health. However, there is considerable evidence that in this plant

phenolic acid has a marked bioactivity in mammalian cells (5)

Salicylic acid derivatives :

Methyl salicylate: used as a liniment to soothe joint and muscle pain. pharmaceuticals, including 4-aminosalicylic acid sandulpiride landetimide (via Salethamide) Salicylic acid research is still an important area and innovations continue to arise (6)

Salicylate intolerance is defined as

A nonspecific antigen-induced pseudoallergic hypersensitivity reaction characterized by systemic and local manifestations (4)

The first published estimate of the salicylic acid content of a food

appeared as a letter in the Lancet in 1903. (5)

Average daily intake for Salicylates:

Estimated median daily salicylate intakes

in the UK population in the UK population of 4.4 and 3.2 mg day (5)

The reported level of salicylates in different foods is highly variable between studies.

Different researchers have reported various levels of salicylates in foods (3), one of the main studies by Swan and colleagues took into account a whopping 333 different foods. http://www.sciencedirect.com/science/article/pii/S0308814607002233

Data on the salicylate contents of foods are sparse and

contradictory., however one thing is clear, Herbs and spices appear to be

particularly rich sources of dietary salicylates.

Salicylates have a cumulative effect

Salicylates have a cumulative effect in the body and build up over time. The tolerated amount varies from person to person, though some adults and children have a low level of tolerance to salicylates.

In high enough doses salicylates are harmful to everyone, however most people can handle average amounts without experiencing adverse effects

http://www.allergyclinic.co.nz/salicylate_sensitivity.aspx  (6)

Stay away from lemons but not lemonade!

From the 29 fruits and vegetables analyzed, lemons

yielded the highest total . SA content (3.2 mg/kg)., reported by  Swan and colleagues http://www.sciencedirect.com/science/article/pii/S0308814607002233

One slice of lemon (20 g) would only provide . 0.06 mg

SA. Drinks that contained lemon (bitter lemon, lemon

tea and lemonade) contained significantly less (0.09, 0.03

and <0.01 mg/kg, respectively).

The amount of salicylates can vary from one variety of a fruit to another, and even  the levels in a particular plant can change. http://www.feingold.org/salicylate.php

Foods high in salicylates:

Apples (Granny Smith) 100 g = 0.7

Plums = 55 g 0.5

Grapes (Green) Grapes (Green) 100 g 0.6 0.06

Tomato (fresh)  =85 g 1.3

Carrots (fresh)  80 g = 0.5 0.

Carrots (cooked) Carrots (cooked) 80g=  <0.2 Note cooking decreases levels

An apple a day can keep the doctor away, or can it?

It may actually depend on what kind of apple you eat

Apples (Granny Smith) may cause you to go into anaphylaxis if you have salicylate sensitivity while a Golden delicious might not

Apples (Granny Smith) 100 g 0.7 and Apples (Golden Delicious) 100 g <0.2

Apple - red delicious moderate, the rest of the apples are very high in , salicylates so reach for those Golden Delicious ones

The American Institute for Cancer Research recommends eating apples. The antioxidant content of apples ranks among the highest for fruits. http://www.livescience.com/44686-apple-nutrition-facts.html

Most apples will have pesticides on them, unless they are certified organic," http://www.livescience.com/44686-apple-nutrition-facts.html

Wash the apples!! Apples, a staple in many refrigerators, topped the list with 98 percent testing positive for a pesticide and 92 percent testing positive for two or more pesticides http://abcnews.go.com/Health/pesticides-fruits-vegetables-healthy/story?id=13831054

Apple seeds : poisonous?

Apples are one such fruit: their pips (seeds) contain amygdalin, a cyanide and sugar compound that degrades into hydrogen cyanide (HCN) when metabolized.

Those fond of their Granny Smiths, please know- the body can detoxify cyanide in small doses, and the number of apple seeds it takes to pack a lethal punch is therefore so huge that even the most dedicated of apple eaters is extremely unlikely to ingest enough pips to cause any harm. http://www.snopes.com/food/warnings/apples.asp

There is also uncertainty regarding the bioavailability of dietary salicylate;Jansen et al. reported low  bioavailability of dietary salicylate in most people ; whereas Lawrence and colleagues showed bioavailability to be high (7)

Salicylate intolerance has also been proposed as a cause of other conditions, namely IBS, An equivalent of prick test in the gut mucosa, the so-called colonoscopic allergen provocation test (COLAP), showed promising initial results.

The researchers concluded that allergic reactions may play a part in a subgroup of patients with irritable bowel (4)

Irritable bowel syndrome and food interaction

Most of irritable bowel syndrome patients reported food as a trigger of gastrointestinal symptoms and self-referred intolerance to certain food items.

Food seems to play a critical role, "more than 60% of patients with IBS report the onset or worsening of symptoms after meals, within 15 min in 28% and within 3 h in 93% of these patients" (4)

Diagnosis of Salicylate intolerance:

The history is of primary importance during the first visit to the doctor, who must attempt to establish the link between salicylate contact and the occurrence of the symptoms.

The accepted gold standard is the exposure or provocation test.

These can only confirm or exclude the suspicion for rapid reactions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696737/

Elimination diet represents the best way to diagnose and manage salicylate as well as other food chemicals intolerance ", https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112903/

Products That May Contain Salicylates: http://www.webmd.com/allergies/salicylate-allergy:

Fragrances and perfumes

Shampoos and conditioners

Herbal remedies

Cosmetics such as lipsticks, lotions, and skin cleansers

Mouthwash and mint-flavored toothpaste

Shaving cream

Sunscreens or tanning lotions

Muscle pain creams

Alka-Seltzer

Pepto-Bismol

Bottom line:

If your having uncontrollable issues with your MCAD a low salicylate diet might be worth talking with your doctor.

For adults who have found no other treatments helpful, a low-salicylate diet is worth consideration

However, there is currently no scientific proof in the literature, that this form of elimination diet is of any benefit, because researchers have not taken this into account for MCAD patients, therefore anecdotal reports remain the foundation for our opinions.

We need studies on MCAD patients using elimination diets which would include a low-salicylate diet.

References:

1- Clinical manifestations of food allergy: An overview,

Author

    Wesley Burks, MD

2- http://www.aaaai.org/about-aaaai/newsroom/allergy-statistics

.

Digestion. 2001;63:108-115.

3- Swain AR, Dutton SP, Truswell AS. Salicylates in foods.

J Am Diet Assoc. 1985;85:950-960.

4-Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol. 1998;93:2184-2190

5-

Food Funct. 2011 Sep;2(9):515-20. doi: 10.1039/c1fo10128e. Epub 2011 Aug 30.

Natural salicylates: foods, functions and disease prevention.

Duthie GG1, Wood AD.

6-

Expert Opin Ther Pat. 2011 Dec;21(12):1831-41. doi: 10.1517/13543776.2011.636354.

Salicylic acid derivatives: synthesis, features and usage as therapeutic tools.

Ekinci D1, Sentürk M, Küfrevioğlu Ö

7- Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence.

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