Allergy to Food Additives

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Dr. fawzeia abo aliProf. Of int. medicine &clinical immunology

Ain shams faculty of medicine

Allergy to foodadditives


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'food additive

means any substance not normallyconsumedas a food by itself andnotnormally used as a typical ingredient of

food.

contaminants orsubstances added fornutritional qualities.

does notinclude


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Types of food

additives


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1) Preservatives(to give food a longer shelf-life)

The SulphitesThe Sulph

itesused to preserve processeed meats, and dried fruit

According to the FDA, about 5 percent of asthmatics

are sensitive to sulfites.

Sodium nitrite, &benzoic acid

These agents are added to food products and occur naturally in,cinnamon, tea and berries.They may cause urticaria, asthma and angioedema. (E 210 - E

219 )


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2) Colourings(make food visually more attractive).

(tartrazine) is used to color beverages,

candy and other foods.

Nitrates and Nitrites - give meat a pink colour tolook more attractive and found in frankfurters

They can trigger hives, urticaria, asthma and

generalized allergic reactions. ( E 100 - E 180 )


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3)3) Antioxidants Antioxidants: (prevent fat rancidity)

Synthetic phenolic antioxidants prevent this spoilage happening but can

trigger asthma, rhinitis and urticaria. (E320 321)

4) Flavour enhancers (to enhance palatability).

Aspartame: a low calorie sweetener can trigger urticaria and itchy hives.

Monosodium Glutamate (MSG) which can trigger the "Chinese RestaurantSyndrome" of headache and burning plus tightness in the chest.

( E 620 - E 635 )


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5) Emulsifiers and stabilisers

Stop oil and water componentsStop oil and water componentsseparating, as inseparating, as in

ketchup andketchup and

mayonnaise,mayonnaise,

Occasionally cause adverseOccasionally cause adverse

reactions.reactions.


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6)6) Naturally occurring substances inNaturallyoccurring substances in

foodfood

Vaso-active amines. Natural Histamine, Serotonin and Tyramine

occur in some cheeses, fish, sausage, red

wine, chocolate and pickled vegetables

can induce cramping, flushing, headacheand palpitations in a dose related manner.

Caffeine

found in foods, medication, tea, coffee andCoca-Cola

induces dose dependent agitation,palpitations, nausea and tremors.


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Salicylates (aspirin-like naturally occurring

chemicals).Salicylates induce urticaria, asthma

and nasal polyps.

They are found in Curry powder, paprika, driedthyme, oranges, apricots, honey, berries and

fruit skins, tea and almonds. Salicylate sensitive individuals also tend to

have adverse reactions to benzoates and

tartrazine


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E numbers


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E numbers are number codes for

food additives and are usually found on foodlabels throughout the European Union.

the 'E' prefix which stands for Europe.

If a food additive has an E number this showsit has passed safety tests and been approved

for use throughout the European Union.
http://en.wikipedia.org/wiki/Food_additivehttp://en.wikipedia.org/wiki/Foodhttp://en.wikipedia.org/wiki/European_Unionhttp://en.wikipedia.org/wiki/European_Unionhttp://en.wikipedia.org/wiki/Foodhttp://en.wikipedia.org/wiki/Food_additive


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2.1 E100E199 (colours)

2.2 E200E299 (preservatives) 2.3 E300E399 (antioxidants, acidity regulators)

2.4 E400E499 (thickeners, stabilizers, emulsifiers)

2.5 E500E599 (acidity regulators, anti-caking agents

2.6 E600E699 (flavour enhancers)

2.7 E700E799 (antibiotics)

2.8 E900E999 (miscellaneous) 2.9 E1000E1999 (additional chemicals)
http://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_numberhttp://en.wikipedia.org/wiki/E_number


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ALLERGIC REACTIONS TO FOOD

ADDITIVES


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(FDA) estimates 1 percent to 3 percent of adults

and 6 to 8 percent of children may experience

some sort of sensitivity to food additives.

Adverse reactions to food additives could be oftwo

different types:

Intolerance :

where no

immunological

basis is apparent.

allergy orhypersensitivity,

which results from an

immunologicalmechanism.


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Skin urticaria/angioedema

atopic dermatitis sweating itching flushing

Gastrointestinal abdominal pain nausea/vomiting diarrhea

Respiratory asthma symptoms cough rhinitis
http://allergies.about.com/od/skinallergies/a/urticaria.htmhttp://allergies.about.com/od/skinallergies/a/atopicderm1.htmhttp://allergies.about.com/od/glossaryofallergyterm1/g/rhinitis.htmhttp://allergies.about.com/od/glossaryofallergyterm1/g/rhinitis.htmhttp://allergies.about.com/od/skinallergies/a/atopicderm1.htmhttp://allergies.about.com/od/skinallergies/a/urticaria.htm


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Musculoskeletal muscle aches

joint aches fatigue weakness

Neurologic behavior mood changes and bedwetting.

attention deficit and hyperactivity disorder migraine headaches mood swings, difficulty falling asleep, frequent night

waking, night terrors, restless legs

Cardiac palpitations arrhythmias
http://allergies.about.com/od/noseandsinusallergies/a/ar_migraines.htmhttp://allergies.about.com/od/noseandsinusallergies/a/ar_migraines.htm


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Anaphylactic shock.

Can occur with sulfites. Without treatment, asevere reaction (anaphylaxis) may quicklyprogress to anaphylactic shock.


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1.adverse hyperactive behavioural changes in children

have been documented with excess amounts of artificial

food colourings and sodium benzoate preservatives .

2.Melkersson-Rosenthal Syndromea rare disorder

possibly triggered by sodium benzoate tends to occur in

atopic individuals.characterised by

c. lip granulomas,d. facial paralysis and

e. a fissured tongue.

.

Special consideration


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diagnosis of allergy to food

additives


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Diagnosis for additive sensitivity

1.HISTORY:Itis suspected when a person experiences

various reactions to prepared foods or when

eating at restaurants, but not from foods

prepared at home.

2.food diary The first step often involves an

individual creating a complete food diary withthe help of a physician.


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While keeping this diary, patients will be asked

to record all the foods they consume, the time

food is eaten and the time reactions occur.

By closely observing which foods trigger a

response, a physician can often pinpointadditives that are more likely to blame.


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3) Elimination diet

an elimination diet, which involvesavoiding any foods that may contain the

problem additives.

By observing the patients reactions orlack of reactions through this stage, the

physician can further determine theindividuals susceptibility.


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4) Provocative Tests for Food or Food

Additives

The method includes administration of thefood extract, followed by observation for any

of a broad variety of subjective and objectivesigns and symptoms that could be

interpreted as the presence of a food

allergy.


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Treatment


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Treatment and prevention of additive

sensitivity

there are no established treatment or preventionmethods for additive sensitivities.

However, if a person is diagnosed with anadditive sensitivity by a physician, the most basic

and effective way of preventing further reactions

is:

avoidanceavoidance


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Ingredient lists must be carefully.

Individuals with additive sensitivities should also learn toinquire at restaurants about cooking methods that mightpresent a problem.

A physician will often recommend anti allergic medications to

provide relief for reactions .

individuals who could potentially have an anaphylacticresponse should carry a syringe of epinephrine and know how

to self-administer the medication.


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Reactions against additives are rising .Reactions against additives are rising .

Additives are responsible of a lot of adverse effectsAdditives are responsible of a lot of adverse effects

They are mainly due to intolerance, yet true allergy areThey are mainly due to intolerance, yet true allergy areevident in atopic individualsevident in atopic individuals

No accurate diagnostic tests are yet available.No accurate diagnostic tests are yet available. Always read all packaged food labels, it is now FDAAlways read all packaged food labels, it is now FDA

ensured that additives must be clearly labeled.ensured that additives must be clearly labeled.

All additives used within the European Community mustAll additives used within the European Community must

have an E number.have an E number.

General rules for preservatives and additives:


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References:1.www.fedup.com.au

2.www.naturalstandard.com

3.A complete listing of food additives by E number isavailable at:www.food.gov.uk/safereating/chemsafe/additivesbranch/enumberlist. (Accessed on May 12, 2008).

4.Simon, RA, Bosso, JV, Daffern, PD, Ward, B. Prevalence ofsensitivity to food/drug additives in patients with chronicidiopathic urticaria (CIUA). J Clin Immunol 1998; 101:S154.

5.Asero, R. Food additives intolerance: a possible cause ofperennial rhinitis. J Allergy Clin Immunol 2002; 110:937.

6.McCann, D, Barrett, A, Cooper, A, et al. Food additives and hy
http://www.fedup.com.au/http://www.naturalstandard.com/http://www.uptodate.com/patients/content/abstract.do?topicKey=~IUUBAEgJzrr5Z&refNum=9http://www.uptodate.com/patients/content/abstract.do?topicKey=~IUUBAEgJzrr5Z&refNum=9http://www.uptodate.com/patients/content/abstract.do?topicKey=~IUUBAEgJzrr5Z&refNum=9http://www.naturalstandard.com/http://www.fedup.com.au/


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