Salicylates are commonly found in a wide variety of foods, such as unripe fruit, vegetables, nuts, seeds and spices. They play a role in growth and development of plants, photosynthesis, transpiration, ion uptake and transport. Non-steroidal exacerbated respiratory disease (N-ERD) is characterised by the co-existence of asthma, eosinophilic rhinosinusitis and nasal polyposis - formerly Samter’s triad. Exacerbations are triggered by ingesting aspirin (acetylsalicyclic acid) or other non-steroidal antinflammatory drugs (NSAIDs). This N-ERD subgroup, which is 16% of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), is often refractory to commonly used medical and surgical therapies. The Chronic Rhinosinusitis Epidemiology Study (CRES) was a prospective, questionnaire-based case control study at 30 tertiary/secondary care sites across the UK between October 2007 and September 2013. Patients with CRS and healthy controls were asked to complete a study-specific questionnaire capturing a variety of socio-economic variables, environmental exposures and medical co-morbidities. There were 873 completed questionnaires included which contained data regarding food and diet. Of these, 402 (46%) were from CRSwNP patients, 336 (38.5%) from chronic rhinosinusitis without nasal polyposis (CRSsNP), 25 (2.9%) allergic fungal rhinosinusitis patients (AFRS) and 110 (12.6%) controls. The controls were generally younger and had a higher proportion of females. CRSwNP and AFRS groups had a higher proportion of asthmatic and aspirin-sensitive patients. Patients were asked a yes/no question: ‘Have you experienced any allergy symptoms such as wheezing, runny nose or itchy skin when taking any of the following?’ Six food groups were used - spicy foods, wine, drinks, nuts, fruit and vegetables - with more detailed questions asked within each group. For example, wine was broken down into red, white and champagne. Patients with polyps were more likely to report symptom exacerbation to one or more food groups when compared to controls. Those with CRSwNP and AFRS reported a statistically significant variation in the proportion of patients reporting sensitivity to wine in particular. Patients with AFRS reported significantly more reactions to nuts than controls. Some other pairs were significant but once a Bonferroni correction was applied they were deemed not statistically significant. These included sensitivity to fruit, more commonly seen in CRSwNP and AFRS groups, and vegetable sensitivity which was more commonly seen in the AFRS group. Interestingly approximately 20% of all groups including controls reported sensitivities to spicy food. In summary, there is an association between foods with high salicylate content, specifically wine, and symptom exacerbation in patients with CRS, especially those with nasal polyps and AFRS.

Exploring the association between ingestion of foods with higher potential salicylate content and symptom exacerbation in chronic rhinosinusitis. Data from the National Chronic Rhinosinusitis Epidemiology Study*.
Philpott C, Smith R, Davies-Husband C, et al.
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Suki Ahluwalia

Cairns Hospital / James Cook University, Queensland, Australia.

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