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  Substance Info: (and synonyms)
Sulphites / Sulfites

Background Info:

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Immune Reactions I Non-Immune Reactions I Occupational
Cross-reactions

One of the most widely used preservatives. Occurs naturally but is produced commercially by sulphur and gypsum combustion. Sulphur dioxide released into the atmosphere as a pollutant is the cause of acid rain.

Sulphiting - used to describe application of sulphur compounds to food. These agents prevent growth of bacteria, but also inhibit enzymes which cause food to discolour, and they have bleaching and antioxidant actions.

Includes: Sodium and potassium sulphite, sulphur dioxide, Sodium and potassium bisulphite, and the metabisulphites.

 

 

Allergens:

No Allergens characterised


Immune Reactions:

Reactions are mostly due to a non-IgE mechanism, but uncommonly IgE may be involved. (Sokol 1990 ref.760 89)

Sokol WN, Hydick IB. Nasal congestion, urticaria, and angioedema caused by an IgE-mediated reaction to sodium metabisulphite. Ann Allergy 1990

 

Intolerance to sodium metabisulfite in beer. (Gall 1996 ref.1898 0)

Gall H, Boehncke WH, Gietzen K. Intolerance to sodium metabisulfite in beer. Allergy 1996

 

Most common reaction is bronchoconstriction and bronchospasm, others may include anaphylaxis, hypotension, flushing and tingling sensations. Asthma sufferers more prone.

Montano Garcia ML. Adverse reactions induced by food additives: sulfites. [Spanish] Rev Alerg Mex 1989

 

Anaphylaxis although unusual can occur - such patients may have positive skin tests to sulphites and attacks characterised by flushing, urticaria, or angioedema as well as bronchospasm. (Weber 1993 ref.2872 8)

Weber RW. Food additives and allergy. Ann Allergy 1993

 

Sulfites may contribute to UVB sensitivity. (Eberlein-Konig 1993 re.2933 8)

Eberlein-Konig B, Bergner T, Diemer S, Przybilla B Evaluation of phototoxic properties of some food additives: sulfites exhibit prominent phototoxicity. Acta Derm Venereol 1993

 

Anaphylaxis although unusual can occur. (Prenner 1976 ref.3032 8) (Yang 1985 ref.1863 5)

Prenner BM, Stevens JJ. Anaphylaxis after ingestion of sodium bisulphite. Ann Allergy 1976

 

Acute urticaria/angioneurotic edema (Montano 1989 ref.4370 2)

Montano Garcia ML, Orea M. Frequency of urticaria and angioedema induced by food additives. Rev Alerg Mex 1989

 

In a survey of 366 asthmatics recruited from an Australian community-based asthma group, 42.6% of respondents reported sensitivities to alcoholic drinks, indicating a diverse range of symptoms including hayfever, cough, facial swelling, itching, eczema and headache as well as asthma. Asthma was once again the most commonly reported symptom, with 33.1% reporting the triggering of asthma following alcoholic drink consumption. Asthmatic responses to alcoholic drinks were, in the main, rapid in onset (< 1 hour) and of mild to moderate severity, although many individuals reported reactions that they considered to be severe or very severe. Wine was clearly the most commonly reported trigger for asthmatic responses in the survey of community-based asthma patients, with 30.3% reporting sensitivities to this drink. While there were many individuals specifically sensitive to either red or white wines, most individuals reported sensitivities to both, suggesting that a component present in significant levels in both these wine types was important in triggering asthma. More detailed analyses of this cohort -indicated an association between sensitivity to sulphite additive-containing foods and sensitivity to wine, implicating the sulphites in wine as playing an important role in wine-induced asthma. (Vally 2000 ref.6621 0)

Vally H, de Klerk N, Thompson PJ. Alcoholic drinks: important triggers for asthma. J Allergy Clin Immunol 2000

 

A 44-year-old woman with a 12 year history of both chronic urticaria and perennial rhinitis which responded to ceterizine 10 mg daily. Symptoms improved after an additive free diet but recurrred 30 minutes after ingesting 10 mg butylated hydroxyanisole and about 4 h after 25 mg sodium metabisulfite. (Asero 2002 ref.8132 6)

Asero R Multiple intolerance to food additives. [Letter] J Allergy Clin Immunol 2002

 

Alcoholic drinks are capable of triggering a wide range of allergic and allergic-like responses, including rhinitis, itching, facial swelling, headache, cough and asthma. Limited epidemiological data suggests that many individuals are affected and that sensitivities occur to a variety of drinks, including wine, beer and spirits. In surveys of asthmatics, over 40% reported the triggering of allergic or allergic-like symptoms following alcoholic drink consumption and 30 - 35% reported worsening of their asthma. Sensitivity to ethanol itself can play a role in triggering adverse responses, particularly in Asians, which is due mainly to a reduced capacity to metabolize acetaldehyde. In Caucasians, specific non-alcohol components are the main cause of sensitivities to alcoholic drinks. Allergic sensitivities to specific components of beer, spirits and distilled liquors have been described. Wine is clearly the most commonly reported trigger for adverse responses. Sensitivities to wine appear to be due mainly to pharmacological intolerances to specific components, such as biogenic amines and the sulphite additives. Histamine in wine has been associated with the triggering of a wide spectrum of adverse symptoms, including sneezing, rhinitis, itching, flushing, headache and asthma. The sulphite additives in wine have been associated with triggering asthmatic responses. Clinical studies have confirmed sensitivities to the sulphites in wine in limited numbers of individuals, but the extent to which the sulphites contribute to wine sensitivity overall is not clear. The aetiology of wine-induced asthmatic responses may be complex and may involve several co-factors. (Vally 2003 ref.20686 9)

Vally H, Thompson PJ. Allergic and asthmatic reactions to alcoholic drinks. Addict Biol 2003

 

The aim of this study was to assess whether changes in bronchial hyperresponsiveness (BHR) occur following wine challenge of asthmatic patients who report sensitivity to wine, and whether such changes could help clarify the role of sulphite additives in wine-induced asthmatic responses. Eight self-reporting wine-sensitive asthmatic patients completed double-blind challenges with high- and low-sulphite wines on separate days. FEV(1) and histamine PC(20) were measured before and after consumption of 150 mL of wine. None of the eight subjects demonstrated a clinically significant >or=15%) reduction in FEV(1) following challenge with either high- or low-sulphite wine. In contrast, one patient demonstrated clinically significant increase in BHR following challenge with both high- and low-sulphite wines, and a smaller increase in BHR following placebo challenge. A second patient showed a significant increase, while another showed a significant decrease in BHR following challenge with low-sulphite wine. A fourth patient showed borderline increases in BHR following challenge with both high- and low-sulphite wines. The aetiology of wine-induced asthma is likely to be complex and appears to vary among individuals who are sensitive to these drinks. (Vally 2007 ref.21125 8)

Vally H, Thompson PJ, Misso NL. Changes in bronchial hyperresponsiveness following high- and low-sulphite wine challenges in wine-sensitive asthmatic patients. Clin Exp Allergy 2007

 

Flush and dyspnea after alcohol drinking. Is it a "wine allergy"? (Wüthrich 2002 ref.21126 2)

Wüthrich B. Flush and dyspnea after alcohol drinking. Is it a "wine allergy"? [German] MMW Fortschr Med 2002

 

In study 1, 24 asthmatic patients with a strong history of wine induced asthma were screened. Subjects showing positive responses to single blind high sulfite (300 ppm) wine challenge were rechallenged on separate days in a double blind, placebo controlled fashion with wines of varying sulfite levels to characterise their responses to these drinks. In study 2, wine sensitive asthmatic patients (n=12) and control asthmatics (n=6) were challenged cumulatively with wine containing increasing concentrations of sulfite in order to characterise further their sensitivity to sulfites in wine. Four of the 24 self-reporting wine sensitive asthmatic patients were found to respond to sulfite additives in wine when challenged in a single dose fashion (study 1). In the double blind dose-response study all four had a significant fall in forced expiratory volume in one second (FEV(1)) (>15% from baseline) following exposure to wine containing 300 ppm sulfite, but did not respond to wines containing 20, 75 or 150 ppm sulfite. Responses were maximal at 5 minutes (mean (SD) maximal decline in FEV(1) 28.7 (13)%) and took 15-60 minutes to return to baseline levels. In the cumulative dose-response study (study 2) no significant difference was observed in any of the lung function parameters measured (FEV(1), peak expiratory flow (PEF), mid phase forced expiratory flow (FEF(25-75))) between wine sensitive and normal asthmatic subjects. Only a small number of wine sensitive asthmatic patients responded to a single dose challenge with sulfited wine under laboratory conditions. This may suggest that the role of sulfites and/or wine in triggering asthmatic responses has been overestimated. Alternatively, cofactors or other components in wine may play an important role in wine induced asthma. Cumulative sulfite dose challenges did not detect an increased sensitivity to sulfite in wine sensitive asthmatics (Vally 2001 ref.21128 3)

Vally H, Thompson PJ. Role of sulfite additives in wine induced asthma: single dose and cumulative dose studies. Thorax 2001

 

Sixteen adults with a strong history of wine-induced asthma were challenged with both low-sulfite red and white wines and wine-placebo drinks. Challenges were performed double blind, using a Latin square design, with lung function being assessed before the challenge and at 5, 10, 15, 30, and 60 minutes after the challenge. Subsequently, single-blind challenges with high-sulfite white wine were also completed in 10 individuals whose lack of reactivity to low-sulfite white wine suggested possible reactivity to sulfite additives. The mean FEV1; forced expiratory flow, mid-expiratory phase; and peak expiratory flow of subjects to low-sulfite red and white wines and red and white placebo wines were not significantly different. Furthermore, with a predetermined criterion of a fall in FEV1 of more than 15% representing a positive challenge, only one individual exhibited a positive reaction in the presence of a negative response to placebo. Only 2 of the 10 test individuals who were challenged with a high-sulfite wine demonstrated a marked and rapid fall in FEV1. Reactivity to low-sulfite wines appears to occur only in a small number of individuals who report sensitivity to wines, suggesting that the sulfite additives may be the major cause of wine-induced asthmatic reactions. However, direct challenge with high-sulfite wine revealed only 2 clear reactions in this asthma cohort. (Vally 1999 ref.21131 7)

Vally H, Carr A, El-Saleh J, Thompson P. Wine-induced asthma: a placebo-controlled assessment of its pathogenesis. J Allergy Clin Immunol 1999

 

Drinking red wine may provoke bronchospasm in subjects with asthma. In order to reveal some of the possible agents involved in this reaction, 18 patients with a history of red wine-induced asthma were studied. They received, in a double-blind fashion, red wine with low sulfur dioxide (SO2) and high amine, high SO2 and high amine and low SO2 and low amine content. In each challenge, the wine was administered in stepwise increasing quantities until a total of 385 ml or a fall in peak expiratory flow of greater than 15% was reached. Nine subjects demonstrated a significant fall in peak flow in one or more challenges. In all cases the most severe reaction was observed after the wine with high SO2 content. The study suggests that SO2 is the most important factor in red wine-induced asthma. (Dahl 1986 ref.21137 0)

Dahl R, Henriksen JM, Harving H. Red wine asthma: a controlled challenge study. J Allergy Clin Immunol 1986

 

Sulfites are rarely suspected as causative agents of immediate-type hypersensitivity. We report on a 49-year-old male patient who developed recurrent severe hypotension after food ingestion. A diagnosis of monoclonal mast cell activation syndrome was established. In the double-blind, placebo-controlled food challenge, the patient reacted to potassium metabisulfite with anaphylaxis. (Cifuentes 2013 ref.29117 7)

Cifuentes L, Ring J, Brockow K. Clonal mast cell activation syndrome with anaphylaxis to sulfites. Int Arch Allergy Immunol 2013

 

Sodium metabisulphite allergy with multiple food and drug hypersensitivities in a five-year-old child: A case report and literature review. (Vitaliti 2014 ref.29694 5)

Vitaliti G, Guglielmo F, Giunta L, Pavone P, Falsaperla R. Sodium metabisulphite allergy with multiple food and drug hypersensitivities in a five-year-old child: A case report and literature review. Allergol Immunopathol (Madr ) 2014

 

Systemic sodium metabisulfite allergy. A 54-year-old man presented with a 6-week history of a non-pruritic rash affecting his axillae and groins, which had developed while he was on holiday in Italy. There had been two previous episodes of the rash over the preceding 4 years. The patient was patch tested and a strong positive reaction (++) to 1% sodium metabisulfite (E223) in pet. was observed. A list of sulfite-containing foods, found a high consumption of grapes, wine, shrimps and French fries during his trips to Italy. In view of this, it was likely that a systemic sulfite allergy was the cause of his rash. He was given a list of foods that contain high sulfite levels, and since avoiding these he has had no recurrence of the rash. (Cussans 2015 ref.32696 7)

Cussans A, McFadden J, Ostlere L. Systemic sodium metabisulfite allergy. Contact Dermatitis 2015

 

Drug eruption following high-calorie infusion: a possible systemic type IV allergic reaction to sulphites. (Honda 2015 ref.32723 9)

Honda T, Kitoh A, Miyachi Y, Kabashima K. Drug eruption following high-calorie infusion: a possible systemic type IV allergic reaction to sulphites. Acta Derm Venereol 2015

 


Non-Immune Reactions:

Many other symptoms also attributed to this substance. Destroys Vit B1 which can be hazardous for anyone on a poor diet. Banned from use on food recognised as a source of B1, like fresh fruit and vegetables, and also in meat products (USA).

Editor Comment Editorial comment, common knowledge, or still to add - -

 

Reactions are mostly due to a non-IgE mechanism, but uncommonly IgE may be involved. (Sokol 1990 ref.760 89)

Sokol WN, Hydick IB. Nasal congestion, urticaria, and angioedema caused by an IgE-mediated reaction to sodium metabisulphite. Ann Allergy 1990

 

Affects asthmatics and allergic individuals. Results in asthma attacks, coughing and urticaria. Approximately 10% of adult asthmatics and 21% of childhood asthmatics develop marked bronchospasm following ingestion of a sulphite containing drink. (Steinman 1993 ref.764 89) (Stevenson 1981 ref.2701 8) Most asthmatic children develop bronchospasm without becoming symptomatic. Deaths from severe bronchospasm have been reported. (Steinman 1993 ref.764 89).

Steinman HA, Le Roux M, Potter PC. The incidence of Sulfite sensitivity in South African asthmatic children. S Afr Med J 1993

 

Migraine, especially red wine and beer. Migraine from caffein withdrawal. (Millichap 2003 ref.7971 1)

Millichap JG, Yee MM. The diet factor in pediatric and adolescent migraine. Pediatr Neurol 2003

 

A patient with documented primary sclerosing cholangitis associated with chronic ulcerative colitis, who developed hepatic toxicity following ingestion of metabisulfite. (Stormont 2003 ref.8549 4)

Stormont JM, Flaherty M, Condemi J. Hepatic metabisulfite sensitivity in a patient with sclerosing cholangitis. Ann Allergy Asthma Immunol 2003

 

Adult subjects (ages 18-39 years) with asthma were exposed to 0.5 ppm SO2 for 10 minutes during moderate exercise. Of the 47 subjects screened, 53% had a drop in FEV1 > or = 8% (ranging from -8% to -44%). These results show that the response to SO2 among adults with mild to moderate asthma is very diverse. Severity of asthma defined by medication category was not a predictor of sensitivity to SO2. Lung function values were associated with beta-carotene and ascorbate concentrations in plasma; however, plasma antioxidant nutrient concentrations were not associated with sensitivity to inhaled SO2. (Trenga 1999 ref.11525 7)

Trenga CA, Koenig JQ, Williams PV. Sulphur dioxide sensitivity and plasma antioxidants in adult subjects with asthma. Occup Environ Med 1999

 

UK population study of children and adults, 7.4% reported adverse reactions. 3 subjects had a positive challenge to groups of food additives, i.e. colourings, preservatives, and antioxidants. Symptoms included headache, upper abdominal pain, eczema, and mood swings. Prevalence of food additive intolerance was 0.026%. (Young 1987 ref.15486 2)

Young E, Patel S, Stoneham M, Rona R, Wilkinson JD. The prevalence of reaction to food additives in a survey population. J R Coll Physicians Lond 1987

 

Chronic generalized pruritus induced by food additive intolerance - as a result of nitrates and one case of sodium metabisulphite-intolerance. (Asero 2005 ref.15489 8)

Asero R. Food additive-induced chronic pruritus: further evidence. Clin Exp Dermatol 2005

 

In this study 37 asthmatic children attending an Allergy Clinic were challenged with SO2 in apple juice in a dose similar to that commonly ingested in soft-drinks containing this preservative. Sixteen out of 37 children (43.2%) challenged with SO2 reacted with a fall in forced expiratory volume in 1 second (FEV1) of more than 10% compared with none of the 22 control asthmatic children challenged with apple juice alone (P = 0.0016). Girls were found to be more sensitive than boys. A 20% or more fall in FEV1 occurred in 8 (21.6%) of the children challenged with SO2 compared with none in the control group (P = 0.039). There was an individual variability in the responses of sensitive individuals to the SO2 challenge. Reactions occurred in spite of maintenance medication and occurred within 5-30 minutes of challenge. (Steinman 1993 ref.21144 8)

Steinman HA, Le Roux M, Potter PC. Sulphur dioxide sensitivity in South African asthmatic children. S Afr Med J 1993

 


Occupational:

Chemical & lab workers, textile worker, food industry, hairdressing, paper maker, pharmaceutical industry, animal pelt workers, wine manufacturer

Editor Comment Editorial comment, common knowledge, or still to add - -

 

Occupational eosinophilic lung in a grape grower. (Marguerie 1995 ref.2047 8)

Marguerie C, Drouet M Occupational eosinophilic lung in a grape grower: role of sulfites [French] Allerg Immunol (Paris) 1995

 

Occupational asthma caused by sodium disulphite in Norwegian lobster fishing. (Madsen 2004 ref.9975 4)

Madsen J, Sherson D, Kjoller H, Hansen I, Rasmussen K. Occupational asthma caused by sodium disulphite in Norwegian lobster fishing. Occup Environ Med 2004

 

Sulfite treatment of wine involves the use of liquified gas, aqueous solutions or bisulfites, i.e. the salts of sulfurous acid which slowly release SO2. This procedure can result in repeated exposures of operators to significant amounts of SO2. However, risks associated with the use of SO2 are greatly under-estimated by wine producers and wine-cellar workers. This study reports on 6 cases of respiratory symptoms attributable to SO2 identified during a survey of wine-cellars in the French Beaujolais district. Their pathogenesis is discussed after an overview of the occupational toxicology of SO2. (Testud 2000 ref.21130 7)

Testud F, Matray D, Lambert R, Hillion B, Blanchet C, Teisseire C, Thibaudier JM, Raoux C, Pacheco Y. Respiratory manifestations after exposure to sulfurous anhydride in wine-cellar workers: 6 case reports. [French] Rev Mal Respir 2000

 

Contact allergy to sodium metabisulfite: an occupational problem. (Kaaman 2010 ref.25507 8)

Kaaman AC, Boman A, Wrangsjo K, Matura M. Contact allergy to sodium metabisulfite: an occupational problem. Contact Dermatitis 2010

 


Cross-Reactions:

CCS: Proximal

No Panallergen CCS

No Panallergen CCS

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http://allergyadvisor.com/index.html

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Allergy Advisor  - Food Additive and Preservative Allergy and Intolerance Database


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