Are you also sensitive to sulfites? (Sulfite Sensitivity) Let's talk about this!

Have you ever wondered why certain foods suddenly make you sick, make you have trouble breathing, or make you feel sick? Sometimes the reason is something we don't know. That's what sulfites are. It's important to be aware of them, especially if you have asthma.

So what are these sulfites?

Simply put, sulfites are chemicals. They are often used as preservatives, meaning they keep food, drinks, and medicines from spoiling. You may have seen them used to stop some foods from turning brown or spoiling quickly. For example, winemakers have been using sulfites for years to preserve the color and flavor of their wines. Also, some foods may contain sulfites naturally. But it's important to remember that sulfites are not :

• Sulfur - This is a naturally occurring element.
• Sulfa drugs - These are a type of antibiotic . Some people can also develop sulfa allergies to these, but this is not the case with sulfites .
• Sulfates - These are salts of sulfuric acid, often found in things like toothpaste, shampoo, and soap.

Are sulfite allergy and sensitivity the same thing?

Yes, there is a slight difference between the two. Sulfite sensitivity is the most common. This is when your asthma symptoms get worse. That means things like wheezing and coughing. A true IgE-mediated sulfite allergy is a little different, in that our immune system is responding to it.

How common is this condition?

It is said that about 4 to 5 out of 100 people with asthma may have this sulfite sensitivity.

What symptoms do you experience if you are sensitive to sulfites?

If sulfites don't work for you, you may experience symptoms like:

• Wheezing ( whistling )
• Difficulty breathing, feeling like you're suffocating (Shortness of breath / dyspnea)
• Chest tightness
• Cough
• Sneezing
• Stuffy or runny nose
• Hives

Very rarely , some people can have a severe allergic reaction called anaphylaxis . This is an emergency . This can include:

• Difficulty breathing and swallowing
• Redness, swelling, and warmth of the skin (Flushing)
• Rapid heartbeat (Tachycardia)
• It's very tiring .
• Dizziness
• Vomiting
• Diarrhea

Why are these sulfites making it difficult for us?

Doctors don't really know why some people develop allergies or asthma from sulfites. But they think there are a few possible reasons:

• Sulfur dioxide inhalation: When you eat foods and drinks that contain sulfites, a gas called sulfur dioxide is released. When you breathe this in, your airways can swell and narrow, which can worsen asthma symptoms .
• Reactions through IgE antibodies : IgE is a type of protein in our body. What these do is tell the immune system to recognize harmful substances and destroy them. But sometimes, these antibodies mistakenly recognize and react to even harmless substances. That's when allergies occur.
• Sulfite oxidase deficiency: Sulfite oxidase is an enzyme that breaks down sulfur dioxide. Some people with asthma have low levels of this enzyme in their bodies. This means they are unable to properly eliminate sulfites from their bodies. This can also cause allergies.

Who is more likely to develop sulfite sensitivity?

People with asthma are often more likely to react to sulfites than people without asthma. Also, if you have allergies to other foods, that can add a small risk.

Can people without asthma also develop sulfite sensitivity?

Yes, some people can be sensitive to sulfites even without asthma. However, it is very rare for someone without asthma to have a serious reaction to sulfites.

How do you find out exactly whether this is there or not?

A doctor will determine whether you have a sulfite allergy or sensitivity by looking at the following:

• Your symptoms.
• Your medical history.
• Whether you have asthma or other allergies.
• A food challenge test was performed.

There is currently no blood test or skin test that is accurate for this.

What is this food challenge test?

In this, an allergist will give you small, gradually increasing doses of sulfites. Most often, they will be given as a liquid or capsule. They will then give you a dose and see if you have any reactions. If so, the doctor will use a spirometer.They measure your lung function with a device called a "lung monitor." Don't worry, they're not waiting for a severe reaction, they have the medicine for that.

How is sulfite sensitivity treated?

If you have a sulfite allergy or sensitivity, the most important thing is to avoid foods and medications that contain sulfites as much as possible. In addition, a doctor may prescribe medications such as:

• Cromolyn: This is a drug that reduces inflammation and stabilizes mast cells that cause allergies.
• Corticosteroids.
• Bronchodilators: These are medications that open the airways and are given to people with asthma.
• Antihistamines: These are more helpful for minor allergic reactions, such as skin rashes or allergic rhinitis, than for asthma-related reactions.
• Vitamin B12: There is some evidence that vitamin B12 may reduce the risk of allergic reactions to sulfites.

How do I avoid foods containing sulfites?

If you have a sulfite allergy, you should avoid foods that contain them. This is similar to how someone with asthma would be wary of other allergens or irritants. In many countries, it is required by law to list sulfite-containing foods and medications on the label. You can also look for ingredients that have names like these:

• Sulfur dioxide
• Potassium bisulfite
• Potassium metabisulfite
• Sodium bisulfite
• Sodium metabisulfite
• Sodium sulfite

What foods are high in sulfites?

These are the foods that are likely to contain high or moderate amounts of sulfites:

• Beer
• Wine
• Some dried fruits
• Lemon juice
• Molasses
• Sauerkraut - This is a German dish made from cabbage.
• Gravies and sauces
• Some soft drinks, fruit juices and other nonalcoholic beverages
• Dried potatoes
• Shrimp, lobster and other crustaceans
• Food made with dough, like biscuits, pie and pizza crusts

However, in countries like the United States, the Food and Drug Administration (FDA) has banned the addition of sulfites to fresh fruits and vegetables since the 1980s.

Do medicines contain sulfites?

Yes, some medications may contain sulfites. Some examples are:

• Epinephrine (Epinephrine / adrenaline), norepinephrine (norepinephrine / noradrenaline)And similar medications. Some dental anesthetics may also contain these.
• Dexamethasone and some other corticosteroids. These can be found in creams and injectable corticosteroids.
• Some topical antifungals.
• Dopamine.
• Aminoglycoside antibiotics.
• Doxycycline ( Doxycycline ) .
• Propofol - a drug used for anesthesia.
• Some topical anesthetics.

If I have a sulfite sensitivity, what should I expect?

If you have a sulfite allergy, or if sulfites make your asthma worse, you should avoid foods and medications that contain high amounts of sulfites as much as possible. As with any allergy, you should also be prepared to have emergency medication on hand in case you accidentally ingest sulfites.

When should I see a doctor?

If you feel like your allergies or asthma are not well controlled, see a doctor. He or she can help you identify and avoid triggers.

When should you go to an Emergency Treatment Unit (ETU) ?

If your asthma is severe and not controlled by medication , or if you have any of these symptoms of a severe allergic reaction , call 1990 (Safety Ambulance Service) immediately or go to the nearest emergency room :

• Difficulty breathing or swallowing.
• Swelling of the lips, tongue, face, or throat.
• Heart rate increases.
• Feeling weak or dizzy.
• Losing consciousness.

What questions should I ask the doctor?

When you see a doctor, it's helpful to ask questions like these:

• What should I do to prevent reactions from sulfites?
• What foods, drinks, and medications should I avoid?
• What are the alternatives to medications containing sulfites?
• What symptoms should I look out for?
• What should I do if I have a reaction?
• When should I go to the emergency room?
• When should I come see you again?

A few final things to remember (Take-Home Message)

When you have asthma and allergies, it's important to be aware of your triggers. Some triggers may be harder to avoid than others.

Fortunately, due to increased awareness of the reactions caused by sulfites, sulfites are not as common in food and medicine as they used to be. In Sri Lanka, they are often mentioned on labels. If you have a sulfite allergy, talk to your doctor about how to avoid severe reactions and what to do if one occurs. Taking care of your health is the most important thing.

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