Sulphite intolerance T78.1

The term sulphite allergy/tolerance/intolerance is used to describe a group of symptoms that occur after the application of food/medicines containing sulphite.

A defect of the sulfite oxidase is discussed. Such a defect could increase the sulphite effects.

Real allergic symptoms (IgE-mediated reactions): In principle, such a sensitization pathway is possible in individual cases. Sulphites are haptens; it can be assumed that they are completed with the body's own components. IgE antibodies with a corresponding specificity could not be detected so far (Simon RA 1994).

Bradykinin-beta2-receptors: Animal experiments have shown that these receptors are activated by sulfites Mansour (E et al. 1992)

Cholinergic reflexes: Atropine blockade prevented the reaction in some patients (Guninson AF et al.).

Sulphur dioxide (SO2) and sulphites, are contained in:

• salted dried fish (max. 200 mg/kg)
• Starch, sago, barley (maximum 50 or 30 mg/kg)
• Chips and other dried potato products (max. 50 mg/kg)
• white vegetables dried (max. 400 mg/kg) or frozen (max. 50 mg/kg)
• dried tomatoes (max 200 mg/kg)
• Dried fruits incl. nuts with skin (depending on the type of fruit max. 500 - 2,000 mg/kg)
• Meat, fish and seafood substitutes (max. 200 mg/kg)

The use of sulphur dioxide and potassium sulphites (E 224, E 228) is widespread in wine production. Sulphur contents of more than 10 mg/l in the end product must also be indicated on wine labels. Sulphur dioxide and sulphites are also used in cosmetics and as disinfectants in the food industry.

The symptoms of a sulphite intolerance correspond in part to an acute food allergy.

• Nausea, vomiting
• Abdominal cramps, diarrhea
• headaches, mood swings, drowsiness
• However, the clinical symptoms are mainly asthmatic complaints.
• Less frequent are itching, urticaria, extensive erythema, swelling of the hands and feet and angioedema.
• Anaphylactic reactions are possible but very rare (especially after intravenous or inhalative application). The frequency of asthmatic reactions in manifest asthma is between 2% and 5% (Meggs et al. 1985).

Contact allergic reactions to sulphites are also observed. These play an increasing role (Ralph N et al. 2015). In a larger study (n=996) 3.68% of patients showed a positive Pattest reaction to 1% sodium metabisulfite. Clinically, contact allergic dermatitis was observed on the face and hands as well as in the genito anal area.

Clinical, provocation with metabisulfite solution (0.5, 1, 0; 5.0; 10; 15; 25; 50; 75; 100; 150 and 200mg/20ml in an indifferent aqueous base. The triggering doses are usually 20-50mg of metabisulfite, less frequently at lower doses (Simon RA 1994).

Sulphites in foodstuffs must be identified by E numbers.

1. Cussans A et al (2015) Systemic sodium metabisulfite allergy. Contact dermatitis 73:316-317.
2. Gunnisson AF et al (1987) Sulofite hypersensitivity: a critical review. CRC Crit Rev Toxicol 184-214
3. Simon RA (1994) Pulmonary reactions to sulfites in foods. Respiratory Lung Crow 20: 155-158
4. Mansour E et al (1992) Mechanisms of metabisulfite-induced bronchoconstriction: Evidence for bradykinin beta2-receptor stimulation. J Appl Physiol 72: 1831-1834
5. Ralph N et al (2015) What is the relevance of contact allergy to sodium metabisulfite and which concentration of the allergen should we use? Dermatitis 26:162-165.
6. Meggs WJ et al (1985) Failure of sulfites to produce clinical responses in patients with systemic mastocytosis or recurrent anaphylaxis: results of a single-blind study. J Allergy Clin Immunol 76:840-846.