Effect of Low Salicylate Diet and Blood Salicylate Level on the Symptom Control of Chronic Spontaneous Urticaria

Sercan Guloglu^1,2Ayşe Bilge Öztürk³Said Incir⁴Betul Buyuktiryaki⁵Asli Gelincik⁶Semra Demir⁷Ebru Arik Yilmaz⁸Pinar Uysal⁹Mustafa Arga¹⁰Ozlem Cavkaytar¹⁰Reyhan Gumusburun¹¹Tugba Gokce¹²Merve Poyraz¹³Ayse Baccioglu¹³Emek Kocatürk^14,15,16Tuba Reçber¹⁷Emirhan Nemutlu¹⁷Cansin Sackesen^1,18,5*

• ¹Koç University Research Center for Translational Medicine, Istanbul, Türkiye
• ²Koç University, Graduate School of Health Sciences, Immunology, Istanbul, Türkiye
• ³Istanbul Medeniyet University, Faculty of Medicine, Department of Pulmonary Medicine, Division of Allergy and Immunology, Istanbul, Türkiye
• ⁴Koç University, School of Medicine, Department of Clinical Biochemistry, İstanbul, Türkiye
• ⁵Koc University School of Medicine, Division of Pediatric Allergy, İstanbul, Türkiye
• ⁶Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, İstanbul, Türkiye
• ⁷Istanbul University, Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, İstanbul, Türkiye
• ⁸Pamukkkale University, Faculty of Medicine, Division of Pediatric Allergy, Denizli, Türkiye
• ⁹Adnan Menderes University, School of Medicine, Division of Pediatric Allergy and Immunology, Aydin, Türkiye
• ¹⁰Istanbul Medeniyet University, Faculty of Medicine, Division of Pediatric Allergy and Immunology, İstanbul, Türkiye
• ¹¹Ege University, Faculty of Medicine, Department of Internal Medicine, Division of Allergy and Immunology, İzmir, Türkiye
• ¹²Koç University Hospital, Division of Pediatric Endocrinology and Diabetes, İstanbul, Türkiye
• ¹³Kirikkale University, Faculty of Medicine, Department of Internal Medicine, Division of Allergy and Immunology, Kirikkale, Türkiye
• ¹⁴Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
• ¹⁵Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
• ¹⁶Department of Dermatology, Bahcesehir University School of Medicine, İstanbul, Türkiye
• ¹⁷Hacettepe University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Türkiye
• ¹⁸Koç University, Graduate School of Health Sciences, Immunology, İstanbul, Türkiye

Background: Up to 30% of chronic spontaneous urticaria (CSU) patients and 24% of children with CSU may have an NSAIDs-exacerbated cutaneous disease (NECD). Some vegetables and fruits are rich in salicylate. Salicylates in food can exacerbate symptoms in CSU patients. Aim: Our aim is to investigate the effect of a low salicylate diet on urticaria severity, quality of life, blood salicylate level and urine arachidonic acid pathway metabolites. Methods: Patients followed a four-week low salicylate diet. Chronic urticaria quality of life questionnaire (CU-Q2oL) and 4 Days-Urticaria Activity Scores (UAS4) were recorded and blood and urine samples were collected at baseline and after the low salicylate diet. Urine Leukotriene-E4, Prostaglandin-E2, Prostaglandin-F2α, Thromboxane-A2, and creatinine levels were measured via ELISA. Blood salicylate level was determined by LC-MS/MS. Results: A total of 36 CSU patients were included in the study. The CU-Q2oL scores significantly decreased from 33.7 to 20.7 (p<0.001) and the UAS4 significantly decreased from 14 to 8 (p<0.001) after low salicylate diet when compared to baseline (low scores mean less complaints). The blood salicylate level was significantly lower after the low salicylate diet compared to the baseline (p=0.042). However, there was no significant effect of the diet on urinary LTE4, PGDE2, PGDF2α and TXA2 levels. Conclusion: Our findings suggest that a low salicylate diet may help to reduce the severity of urticaria and improve the quality of life by lowering blood salicylate levels. However, the diet had no impact on urinary LTE4, PGDE2, PGDF2α, and TXA2 levels.