The Pharmaceutical Journal
Vol 276 No 7395 p417
8 April 2006

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· Medicines use reviews
· Packaging (2)
· CVD
· Drug trials
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· Allergy
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Letters to the Editor

Allergy

Link between salicylate and willow bark

From Dr A. Jennings

I report an interesting salicylate allergy, described by a patient during anaesthetic pre-assessment for a routine orthopaedic procedure. When asked if he had any allergies, the patient answered that aspirin caused a widespread rash. He also commented that he worked as a carpenter and, when working with willow wood, he had noticed a similar occurrence of the rash.

In the fifth century BC, Hippocrates used powder extracted from the bark of willows to treat pain and reduce fever. Salicin, the parent of the salicylate drug family, was successfully isolated from willow bark in 1829. Willow bark extract is still used by herbalists and may be a useful treatment for low back pain.¹

There are case reports of allergic reactions to willow bark, including anaphylaxis resulting from the use of a willow bark-containing dietary supplement in a patient with a history of an aspirin allergy.² However, labels of willow bark and willow bark-containing products often lack a safety warning relating to salicylates.³ Counselling patients with salicylate allergy may improve awareness of the risks posed by willow bark.

Adrian Jennings
Anaesthetic Senior House Officer
Horton Hospital,
Banbury, Oxfordshire

References

1. Chrubasik S, Eisenburg E, Balan E, Weinberger T, Luzzati R, Conradt C. Treatment of low back pain exacerbations with willow bark extract: a randomized double blind study. American Journal of Medicine 2000;109:9–14.

2. Boullata JI, McDonnell PJ, Oliva CD. Anaphylactic reaction to a dietary supplement containing willow bark. Annals of Pharmacotherapy 2003;37:832–5.

3. Clauson KA, Santamarina ML, Buettner CM, Cauffield JS. Evaluation of presence of aspirin-related warnings with willow bark. Annals of Pharmacotherapy 2005;39:1234–7.

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