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Salicylate elimination diets in children

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With suitable guidance and monitoring, dietary modification is safe and can improve quality of life

Salicylates are a diverse family of 2-OH benzoic acid derivatives produced in all plants. The parent molecule, salicylic acid (SA), is a ubiquitous phytohormone responsible for pathogen resistance, regulation of growth, and a wide variety of other biological functions.1,2 The medicinal use of salicylate-containing plant extracts was first recorded about 3500 years ago, and was widespread until the mid 19th century, when SA was isolated from willow bark, and acetylsalicylic acid (ASA) was subsequently synthesised and marketed by Bayer as aspirin in 1899.2

The occurrence of urticaria and angioedema from SA was recognised by the 1890s, and the first reports of urticaria, angioedema and asthma induced by ASA began to appear in the early years of the 20th century. Although by then salicylates were known to be present in certain foods, it took over 50 years before low salicylate therapeutic diets were developed. Feingold, an allergist at Kaiser Permanente in the 1960s, was the first to attempt exclusion of natural salicylates in patients with aspirin sensitivity. His claims of efficacy…