. Allergopedia

Dictionary of Allergies .. Additives

The production of food and drugs implies the use of additives for example preservatives, dyes, antioxidants, stabilizers, emulsifiers, thickeners, sweeteners, flavours of vitamins. Idiosyncratic reactions to some of these substances have been described since the 1950s and classified among "pseudoallergic reactions" in European literature.

Those reactions have a broad spectrum of clinical manifestations such as: rhinitis, asthma, urticaria, angioedema, and more rarely anaphylactic shock, headache, or gastrointestinal dysfunction. The first observations of additive intolerance were made with dyes: first with tartrazine, then with new coccine and sunset yellow, amaranth, indigotin, quinoline yellow and erythrosin, and later on canthaxanthine. It is estimated that, of all additives used in pharmaceuticals, only parabens and sulfites have been well documented to cause hypersensitive reactions.

The risk of exposure to additives present in the drugs is more limited than for additives present in food [1]. (See additives, drug).
Contrary to common believing, the prevalence of the intolerance to food additives in the general population is rather low. Nowadays many doubts persist with regard both to the pathogenetic mechanisms and to the clinical and diagnostic aspects in this field. Symptoms due to, or exacerbated from, food additives usually involve non-IgE-mediate mechanisms (pseudo-allergic reactions, PAR) and are usually less severe of those induced by food allergy. The most frequent clinical feature of the intolerance to food additives still remains the urticaria-angioedema syndrome, although these substances are really involved only in a minority of patients. Other possible clinical features include anaphylaxis, atopic eczema, behaviour disturbances, asthma and non-allergic rhinitis. The diagnostic approach consists in diary cards, reporting symptoms and food habits, elimination diet and double blinded placebo-controlled oral challenge with suspected additives. However, such procedure still remains poorly standardized and numerous uncertainties persist with regard to optimal conditions for performing and interpret the challenge results. The therapeutic approach consists in the exclusion of foods and products containing the additive involved, and, in patients not compliant to the diet, in treatment with symptomatic drugs[2].


1. Kolly, M. et al: Additives contained in drug formulations most frequently prescribed in Switzerland. Annals of Allergy: Vol. 62: 21-25, 1989.
2. Cardinale F, Mangini F, Berardi M, Sterpeta Loffredo M, Chinellato I, Dellino A, Cristofori F, Di Domenico F, Mastrototaro MF, Cappiello A, Centoducati T, Carella F, Armenio L. Intolerance to food additives: an update. Minerva Pediatr. 2008 Dec;60(6):1401-9.

Γκέλης Ν.Δ. - Λεξικό Αλλεργίας - Εκδόσεις ΒΕΛΛΕΡOΦΟΝΤΗΣ - Κόρινθος 2013

Gelis Ν.D. - Dictionary of Allergies - VELLEROFONTIS Publications - Corinth 2013