Have you ever wondered why after eating certain dried fruits, some wine, or some sauces, you suddenly feel like you're going crazy, have trouble breathing, and feel sick to your stomach? Maybe your asthma is suddenly getting worse. The reason for this may be simpler than you think. Most of the time, the person responsible for this is a chemical called sulfite. Today, we'll talk about this sulfite allergy or sensitivity.
Simply put, what is sulfite?
Sulfites are chemicals used as preservatives. That is, they are added to foods and medicines to keep them from spoiling. You may have noticed that a sliced apple turns brown after a while. Sulfites are used to prevent such foods from discoloring and to stop bacteria from growing and spoiling. For example, sulfites have been used in winemaking for hundreds of years to preserve the color and flavor of wine. Some foods and drinks may contain sulfites naturally.
The most important thing to remember: Sulfite is not an allergy to sulfa drugs. The two are completely different. And they are not the element sulfur, nor the sulfates found in soaps and shampoos.
It has been found that between 4% and 5% of people with asthma may have this sulfite sensitivity. In fact, this sulfite sensitivity is more common than a true sulfite allergy (IgE-mediated allergy).
What are the symptoms of a sulfite allergy?
The symptoms of sulfite poisoning can vary from person to person. Some people experience mild discomfort, while others may experience severe symptoms. Let's take a look at what these symptoms are.
| Type of symptom | Description |
|---|---|
| Common symptoms (often associated with asthma) |
|
| Very rare severe symptoms (Anaphylaxis) |
Why are these sulfites bad for our bodies?
Scientists still don't know exactly why some people's bodies react to sulfites this way, but there are a few things they think might play a role.
- Sulfur dioxide gas inhalation: When we eat or drink food containing sulfites, it produces a gas called sulfur dioxide. When this gas enters our airways, it can stimulate the cells in the airways, causing them to swell and narrow. For someone with asthma, this can make their asthma worse.
- IgE-mediated reaction: Our body's immune system has a type of antibody called `IgE`. It's like our body's sentinels. Their job is to recognize harmful substances, such as germs, that enter the body and give signals to destroy them. But sometimes these sentinels make mistakes. They mistake something that is actually harmless, like sulfites, for a big enemy and send an alert to the immune system. That's when allergy symptoms appear.
- Sulfite oxidase enzyme deficiency: This is an enzyme in our body. Simply put, an enzyme is a protein that helps with chemical processes in our body. This sulfite oxidase enzyme breaks down sulfur dioxide and removes it from the body. Some asthma patients have low levels of this enzyme in their bodies. Then, sulfites can accumulate in the body instead of being broken down and removed properly, causing allergies.
Who is at higher risk for this? And how do you recognize it?
People with asthma are most likely to develop sulfite sensitivity, and people with other food allergies may also be at slightly higher risk.
Can someone without asthma develop sulfite sensitivity? Yes, but it's very rare. And it's also very rare for someone without asthma to have a severe reaction to sulfites.
Diagnosis
There is currently no blood test or skin test that can accurately diagnose a sulfite allergy. Therefore, your doctor will diagnose this condition by asking you a few questions.
- What are your symptoms?
- Your complete medical history
- Whether you have asthma or other allergies
- By doing a food challenge test
In this food challenge test , a doctor will start you on a very small dose of sulfites and gradually increase it. It is usually given as a liquid or capsule. The doctor will watch you to see if you have any reactions. If you do have a reaction, your lung function will be measured using a device called a spirometer. This is done in a hospital setting with emergency medical facilities, so there is no need to panic.
How to treat and manage?
If you are diagnosed with a sulfite allergy or sensitivity, the most important and best thing to do is to avoid foods, drinks, and medications that contain sulfites as much as possible.
However, your doctor may prescribe some medications to control the symptoms.
- Cromolyn: This is a drug that stabilizes mast cells that cause allergies.
- Corticosteroids: Medications that reduce swelling and inflammation in the body.
- Bronchodilators: These are the types of inhalers used by people with asthma. They widen the airways and make breathing easier.
- Antihistamines: These help with allergy symptoms, such as itchy skin and runny nose, rather than asthma symptoms.
- Vitamin B12: Some studies have shown that vitamin B12 can reduce allergic reactions to sulfites. However, it is important to talk to your doctor about this.
How to avoid things containing sulfites?
This is the most important part. Let's look at the foods and medications that contain the most sulfites. Make it a habit to read the label when you buy something from the store.
| Check if these names are mentioned on the label. | |
|---|---|
| Sulfur dioxide | Potassium bisulfite |
| Potassium metabisulfite | Sodium bisulfite |
| Sodium metabisulfite | Sodium sulfite |
Foods that may contain high levels of sulfites
| Food/drink type | Examples |
|---|---|
| Types of alcohol | Beer, wine (especially white wine) |
| Dried food | Dried fruits (grapes, apricots), dried potatoes |
| Prepared drinks | Bottled lime juice, fruit drinks, soft drinks |
| Sauces and Gravy | Bottled sauces, gravy mixes, molasses |
| Seafood | Shrimp, lobster, and other shelled sea creatures |
| Bakery products | Some types of baked goods (biscuits, pies, pizza) |
Medications that may contain sulfites
Some medications may also contain sulfites as a preservative, so it is essential to tell your doctor about your sulfite sensitivity when you are prescribed any medication.
Some examples:
- Medications such as adrenaline (Epinephrine), noradrenaline (Norepinephrine) (including some dental anesthetics)
- Some corticosteroid medications (ointments and injections), such as dexamethasone
- Some topical antifungals
- Dopamine
- Antibiotics such as some aminoglycosides and doxycycline ( Doxycycline )
- Propofol (a drug used for anesthesia)
When should you see a doctor?
If you feel like your asthma or allergies are not well controlled, be sure to see a doctor. They can help you identify exactly what triggers you and advise you on how to avoid them.
When should you go to the Emergency Treatment Unit (ETU)?
If you develop severe asthma that is not controlled by your medications (e.g. inhalers), or if you experience one or more of the following severe allergic symptoms , go to the nearest hospital Emergency Department (ETU) immediately.
- Having great difficulty breathing or swallowing
- Swelling of the lips, tongue, face, or throat
- Heart palpitations
- Feeling light-headed or dizzy
- Loss of consciousness
If you have a sulfite allergy, it is very important to talk to your doctor and be aware of the medications you should use in an emergency (e.g., epinephrine auto-injector).
Take-Home Message
- Sulfite sensitivity is a real condition, especially common among asthmatics.
- This is completely different from an allergy to "sulfa" drugs.
- The main management is to avoid foods, drinks, and medications containing sulfites. For this, reading food labels is very important.
- If you have symptoms like these, don't guess and see a qualified doctor for an accurate diagnosis.
- Be aware of the symptoms of a severe allergy and what to do immediately in such an event.
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