Aspirin Allergy May Translate To Food Allergies

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Aspirin Allergy May Translate To Food Allergies

HLA-II linked Aspirin / Salicylic Acid Allergy: How Common is it in Gluten Sensitivity?

"A baby aspirin a day keeps the doctor away!" Sounds familiar?

Estimates vary, but it appears, for instance, that each year we consume around 40,000 metric tons of aspirin, equating to about 120 billion aspirin tablets (300 mg is a standard size).[1]

So, forty thousand tons later, shouldn't our public state of health be better? The above statement may be far from the truth about aspirin keeping the doctor away; and the forty thousand metric tons of aspirin consumed annually clearly do not appear to work either.

(For a historical overview and an >180 research listings on aspirin click here LINK)

Many individuals have reported new health challenges and allergies after starting treatment with aspirin. While salicylic acid is the main metabolite of aspirin, this willow bark-derived substance proves also to cross-react with birch pollen.

Unlike gluten sensitivity, (acetyl)salicylic acid allergy can be a true allergy. This means that the more an individual is exposed to salicylic acid via aspirin, daily foods or topical face washes, etc., the greater the likelihood of increasingly severe allergic reactions as the years go by.

It is common knowledge that many non-celiac and/or celiac gluten sensitive individuals react to grass pollen, birch pollen, ragweed pollen or mugwort. But, did you know that many of our edible and common vegetables, spices and fruits also cross-react with these pollens—quite likely due to the salicylic acid they contain?

Monovalent pollen allergy was observed in 57% (n=68) of patients with pollinosis (57x grass pollen, 11x birch pollen), but only in 15% (n=12) of patients with food allergy (9x grass pollen, 3x birch pollen). Hazelnut (71%), almond (65%), walnut (44%) and apple (41%) were the most common food allergens and frequently associated with birch pollen allergy. Grass pollen allergy was associated with an increased frequency of HLA-DQB1*0301 (RR=2.3; EF=0.4; P=0.0016) when compared with the control population. HLA-DRB *08 conferred a sixfold higher risk for peanut allergy (EF=0.3; P=0.0013) and -DRB1*12 a 13-fold higher risk for carrot allergy (EF=0.3; P<0.000001). The differences on allele frequencies detected among patients with food allergies diminished or turned statistically insignificant when their genotypes were directly compared to those of patients with the corresponding pollen allergies. This was found in the case of birch pollen associated hazel nut allergy for the extended haplotype HLA-DRB1*01, -DQA1*0101, -DQB1*0501 as well as in grass pollen associated peanut allergy for HLA-DRB1*08 (from RR=6, P=0.0013 to insignificant) and in birch pollen associated carrot allergy for HLA-DRB1*12 (from RR=13, P < 0.000001 to insignificant).[2]

Here are some additional examples of common food – pollen cross-reactions:  

Grasses cross-react with

  • tomatoes

Birch pollen cross-reacts with

  • apples, carrots, celery, hazelnuts, peaches, pears, or raw potatoes

Ragweed pollen cross-reacts with

  • tomatoes and bananas, watermelon, cantaloupe or honeydew melon,

Mugwort cross-reacts with

  • carrots, celery, apples, kiwi fruit, but also with peanuts (a legume) and spice seeds such as anise, caraway, coriander, fennel, and parsley seed.

In summary, salicylic acid is not only found in aspirin but also as a possible allergen in many of our everyday "healthy" foods (fruits, vegetables, seeds and nuts)—foods that may have to be avoided if you are sensitive to aspirin. Surprised? The answer is simple:

Genetic Predisposition

The association of human leukocyte antigen genetic alleles and hypersensitivity[3] has been amply documented. Several of the non-celiac and/or celiac gluten sensitivity predisposing HLA-II genotypes provide cross-links and increased risks of developing additional sensitivities and/or allergies. Some of the more frequent non-celiac and/or celiac gluten sensitivity related alleles include HLA-DQB1*0301, HLA-DQA1*0101, HLA-DQB1*0501.

We were able to identify HLA class-II alleles associated with some allergies thus indicating that these alleles might confer susceptibility to the respective allergens....

...Our observations provide evidence for the major importance of antigen presentation on the manifestation of distinct crossreactivity patterns.[4]

For instance, intense itching, skin reactions[5] (and possibly gut ulcers), burning tongue tip, and many other signs may indicate an allergy to aspirin (acetyl salicylic acid) and foods containing natural salicylic acid.[6] Even reversible hearing loss has been described in research.[7] So has aspirin induced asthma (AIA).[8]

Thus, especially non-celiac and/or celiac gluten sensitive individuals may have to avoid aspirin[9] as well as salicylate containing foods.

Other Birch Pollen and HLA-II Cross-Linked Allergies

For instance, kiwi fruit allergy has often been linked with latex allergy.[10] It too appears to carry that HLA-II cross-reaction link to birch pollen... This link further implicates a group of common daily foods:

Many patients showed sensitization to grass and mugwort pollen.

Also, food allergy was found to be associated with kiwi allergy: we found

  • strong reactions to apple and hazelnut;
  • moderate reactions to carrot, potato, and avocado; and
  • weak reactions to wheat and rye flour, pineapple and papaya, and their enzymes bromelain and papain.

RAST inhibition studies revealed cross-reacting antigens between birch pollen and kiwi fruit. Interestingly, patients with birch pollen allergy without clinical signs of kiwi allergy had positive prick test reactions to kiwi. Patients with kiwi allergy showed higher concentrations to birch pollen IgE compared with patients with isolated birch pollen allergy.[11]

Salicylic Acid Containing Foods

The following is not a complete list of foods, and salicylic acid levels may differ greatly. Every individual will need to carefully determine the foods that they can tolerate and those that they better avoid.

Fruits and Berries

  • Apples
  • Apricots
  • Blackberries
  • Boysenberries
  • Cherries
  • Currants
  • Dewberries
  • Gooseberries
  • Grapes
  • Melon
  • Nectarines
  • Oranges
  • Peaches
  • Plums
  • Prunes
  • Dried Raisins
  • Raspberries
  • Strawberries


  • Avocados
  • Cucumbers
  • Green Bell Peppers
  • Potatoes
  • Tomatoes


  • Almonds
  • Cloves
  • Olives
  • Pickles

Processed Foods

  • Green and yellow Candies
  • Cocoa and hot Chocolate mixes
  • Biscuits
  • Cakes and Cake mixes
  • Cereals
  • Crackers
  • Muffins
  • Pastries

Condiments and Preserves

  • Corned Beef
  • Gum
  • Gelatin
  • Jell-O
  • Ketchup
  • Margarine
  • Mayonnaise
  • Salad dressings
  • Tabasco
  • Tartar sauce

Unfortunately, even some of the so-called "glutenfree" products may contain high levels of salicylic acid!

Should you suspect any of these triggers, the way to go is to follow a strict elimination diet. My patients start out by avoiding everything listed above for two weeks while following their glutenfree diet. Then, for a couple of days at a time, they include one of these products in their daily regimen. All going well, they will add something else after a few days. If any reaction occurs they eliminate the culprit for now.

Just to clarify: this process of elimination and slow re-introduction will not work for gluten-containing products because gluten intolerance is determined by an individual's genetic background, which cannot be overcome. Glutenfree diet is for life!

[ contains research on over 50 of aspirin's under-reported adverse effects: aspirin toxicity research.]

[1]  Proc Natl Acad Sci U S A. 2002 Oct 15;99(21):13371-3. Epub 2002 Oct 8.  Cyclooxygenase-3 (COX-3): filling in the gaps toward a COX continuum? 

[2] Clin Exp Allergy. 1998 Apr;28(4):434-41.  Identification of HLA-DR and -DQ alleles conferring susceptibility to pollen allergy and pollen associated food allergy.

[3] Curr Opin Allergy Clin Immunol. 2007 Aug;7(4):317-23.  Human leukocyte antigens and drug hypersensitivity.

[4]  Clin Exp Allergy. 1998 Apr;28(4):434-41.  Identification of HLA-DR and -DQ alleles conferring susceptibility to pollen allergy and pollen associated food allergy. 

[5]  J Dermatol. 2011 Mar;38(3):246-54. doi: 10.1111/j.1346-8138.2010.01196.x.  Pharmacogenetics of cutaneous adverse drug reactions.

[6] Curr Opin Allergy Clin Immunol. 2010 Aug;10(4):280-90.  Genetic and ethnic risk factors associated with drug hypersensitivity.

[7]  HNO. 2004 Apr;52(4):347-51.  [Reversible hearing loss in acute salicylate intoxication].

[8] Clin Exp Allergy. 2005 May;35(5):585-90.  Association of thromboxane A2 receptor gene polymorphism with the phenotype of acetyl salicylic acid-intolerant asthma.

[9]  Curr Opin Allergy Clin Immunol. 2010 Aug;10(4):280-90.  Genetic and ethnic risk factors associated with drug hypersensitivity.

[10]  Ann Allergy Asthma Immunol. 1998 Mar;80(3):252-6.  Latex allergy in operating room nurses. 

[11]  J Allergy Clin Immunol. 1994 Jul;94(1):70-6.  Kiwi fruit allergy: a new birch pollen-associated food allergy.


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