Salicylate elimination diets in children: is food restriction supported by the evidence?

To the Editor: The two contributions by Gray and colleagues1 and Loblay and colleagues2 on the topic of salicylate intolerance illustrate that absence of evidence does not equate to evidence of absence.3 Neither paper quotes the admittedly sparse European peer-reviewed literature on the topic, including an understanding of the basic biochemistry,4,5 a diagnostic test, and clinical prevalence studies of intolerance to dietary salicylate.5-7 A wealth of anecdotal evidence also exists about the benefits of a low salicylate diet on gastrointestinal symptoms in the community, with support groups such as the Food Intolerance Network reporting many “success stories” resulting from dietary interventions (http://fedup.com.au). It is unfortunate that there is a lack of high-quality clinical and epidemiological research into what appears to be a common problem. However, even in the absence of a greater understanding of the underlying causes, selective and appropriately implemented dietary manipulation may be really helpful.