Adverse reactions to food additives

• Published in: Annals of allergy, asthma, & immunology Vol. 95; no. 6; p. 499
• Main Authors: Wilson, Brian G, Bahna, Sami L
• Format: Journal Article
• Language: English
• Published: United States 01.12.2005
• Subjects: Allergens - adverse effects; Allergens - immunology; Food Additives - adverse effects; Food Additives - chemistry; Food Additives - classification; Food Coloring Agents - adverse effects; Food Hypersensitivity - diagnosis; Food Hypersensitivity - etiology; Food Preservatives - adverse effects; Humans
• ISSN: 1081-1206
• DOI: 10.1016/S1081-1206(10)61010-1

To summarize the literature related to the classification of food additives and their reported adverse reactions and to provide a practical approach for evaluation of patients suspected of having such reactions. Information was derived from selected reviews and original articles published in peer-reviewed journals and from authoritative textbook chapters, supplemented by the clinical experience of the authors. Priority was given to studies that used blinded, placebo-controlled oral challenges to confirm adverse reactions to food additives. In addition, selected, appropriately evaluated case reports are included. A large number of food additives are widely used in the food industry. Adverse reactions to additives seem to be rare but are likely underdiagnosed in part due to a low index of suspicion. Numerous symptoms have been attributed to food additive exposure, but the cause-and-effect relationship has not been well demonstrated in all. Reactions to food additives should be suspected in patients who report symptoms to multiple unrelated foods or to a certain food when commercially prepared but not when homemade and the allergy evaluation rules out a role for food protein. It is also prudent to investigate food additives in patients considered to have idiopathic reactions. There is a minor role for skin testing or in vitro testing. Oral challenge testing with common additives, preferably preceded by a trial of an additive-free diet, is the definitive procedure for detecting the offending agent. Once the specific additive is identified, management is basically avoidance of all its forms.