Testing and challenge procedures to evaluate allergic and asthmatic reactions to food additives
- Jinny E Chang, MD
Jinny E Chang, MD
- Scripps Clinic
- Ronald A Simon, MD
Ronald A Simon, MD
- Head, Division of Allergy, Asthma, and Immunology
- Scripps Clinic, San Diego, CA
Food additives are synthetic or natural substances added to foods for multiple purposes. Despite the great number of additives used in the food and pharmaceutical industry, only a few have been implicated in true allergic (immunoglobulin E [IgE]-mediated) or other (immunologic or nonimmunologic) adverse reactions .
This topic review will discuss testing and challenge procedures used in the evaluation of allergic and asthmatic reactions to food additives. Specific food additives that have been implicated in causing allergic and asthmatic reactions are reviewed elsewhere. (See "Allergic and asthmatic reactions to food additives".)
Other topics that discuss adverse reactions to food additives include:
●Occupational asthma and rhinitis in food workers caused by allergens and irritants used in food production and processing (see "Occupational asthma: Definitions, epidemiology, causes, and risk factors" and "Occupational rhinitis").
●Food additives and hyperactivity or behavioral changes in children (see "Attention deficit hyperactivity disorder in children and adolescents: Epidemiology and pathogenesis", section on 'Dietary influences').
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- Lists of allergens for which ImmunoCAP testing is available can be found under the categories "Foods of animal origin" and "Foods of plant origin." http://www.phadia.com/en/Allergen-information/ImmunoCAP-Allergens/ (Accessed on May 18, 2012).
- Lists of allergens for which IgE immunoassays are available through Mayo Medical Laboratories. Example search "Guar gum IgE": http://www.mayomedicallaboratories.com/test-catalog/ (Accessed on May 18, 2012).
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- The Joint FAO/WHO Expert Committee on Food Additives (JECFA) is described. http://www.who.int/foodsafety/chem/jecfa/en/index.html (Accessed on May 18, 2012).
- The website of the International Programme of Chemical Safety contains links to monographs and evaluations of the Joint Expert Committee on Food Additives (JECFA) http://www.inchem.org/ (Accessed on July 20, 2012).
- 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; 37:1062.
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- INDICATIONS FOR ALLERGY EVALUATION
- Reactions to multiple food additives
- OBJECTIVE TESTING
- Skin prick testing
- - Obtaining food additives
- Blinding and masking additives
- Appropriate challenge doses
- Safety issues
- Patient preparation
- Specific types of challenges
- - Sulfite challenges in asthmatic patients
- - Mixed additive challenge
- Administering challenges
- - Monitoring
- - Subjective symptoms
- - Reactions to placebo
- - Treating symptoms during challenge
- - Reasons to abort challenge
- - Observation after challenge
- MANAGEMENT OF PATIENTS WITH CONFIRMED REACTIONS
- Patients with anaphylaxis
- SUMMARY AND RECOMMENDATIONS