My first anaphylactic reaction (almost ... swollen throat and tongue) came about just about 8 hours after taking Orthoxical for a dry cough. The hives began fairly soon afterwards and got slowly worse, until I saw a specialist and was diagnosed with salicylate intolerance. Had it now for 20 years. -Jackie, NZ

Sue's comment: What causes salicylate intolerance?

It is common for people to report to us that they developed salicylate intolerance after taking a course of salicylate containing drugs such as aspirin or drugs with known salicylate cross-reactivity e.g. anti-inflammatory drugs such as Ibuprofen.

However, in this case, Orthoxicol dry cough mixture contains paracetamol (safe) and Dextromethorphan (an opiate derivative unrelated to salicylates although known to cause rare allergic reactions). Of the inactive ingredients, possible problems include:

-artificial red colour (allura red E129)
-menthol (very high in salicylates and known to cause anaphylaxis
-raspberry flavour (very high in salicylates).

Triggers of food intolerance listed by RPA Hospital researchers include exposure to environmental chemicals, illness, medications and stress. It seems possible that one, or a combination, of the ingredients in this medication, may have led to longterm salicylate intolerance.    

Further reading

Orthoxicol Dry Cough ingredients
Allergy to Dextromethorphan, medical journals
Allergy to Dextromethorphan, patient reported
Anaphylaxis in an infant caused by menthol-containing cologne
Allergic reaction to methol in mint leads to asthma

Salicylates fact sheet