PURPOSE: To review the role of food additives in asthma and provide a practical approach for evaluation, diagnosis, and management of additive-induced asthma. METHODS: Information was gathered from original articles, selected reviews and abstracts published in peer-reviewed journals and from selected textbook chapters, supplemented by the clinical experience of the authors. RESULTS: In some patients, food additive ingestion can induce bronchospasm or exacerbation of symptoms in patients with chronic asthma. The most implicated agents are sulfites, followed by tartrazine, monosodium glutamate and others. However, geographic variations exist depending on the dietary habits. CONCLUSION: Food additives are worth considering as possible causes of bronchospasm or worsening of asthma. The medical history may be suggestive, particularly when symptoms occur to commercially prepared foods or to multiple unrelated foods. Physicians should also think of food additives in patients whose asthma is poorly controlled in spite of appropriate routine allergy evaluation, environmental control, and optimal pharmacologic therapy. Except for a few natural additives, allergy skin test and in-vitro tests are unreliable. A titrated oral challenge testing, preferably in a blind fashion would be the definitive diagnostic procedure.
Asthma* ; Bronchial Spasm ; Coloring Agents ; Diagnosis ; Eating ; Food Additives* ; Food Habits ; Humans ; Hypersensitivity ; Skin Tests ; Sodium Glutamate ; Sulfites ; Tartrazine