Of thousands of food additives currently in use, only a small number are implicated in allergic or allergic-like reactions. Symptoms include urticaria and/or angioedema, asthmatic reactions and anaphylaxis. Allergy to a nutritive food is far more likely than allergy to an additive, so this must be considered first in the differential diagnosis.
Clues that a patient may be reacting to a food additive
- Reactions that occur within minutes to a few hours of eating
- A convincing history of similar reactions to several apparently unrelated foods
- Reactions to commercially prepared forms of foods that are tolerated when prepared at home.
Symptoms are not caused by food additives but aggravated by them.
- Sulfites can cause potentially serious asthmatic reactions in as many as 5 percent of patients with asthma, whereas individuals without asthma are rarely affected. Sulfite-sensitive patients more often have severe and/or steroid dependent asthma.
- Tartrazine avoidance is not necessary in patients with asthma.
- The preservative sodium benzoate (E211) and the flavorings spearmint, peppermint, and menthol, have each been implicated in causing asthmatic symptoms
- Anaphylaxis has been reported to annatto (E160b), carmine (E120), saffron, erythritol, guar gum (E412), psyllium, carrageenan, lupine flour, gelatin and pectin. These “natural” additives are derived from plants, insects, or animals and the reactions are believed to be IgE-mediated.
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