Allergy to Food Additives and Preservatives

Reactions to food additives and preservatives

Food Additives
Many packaged foods and drinks contain additives and preservatives. Peter Dazeley Collection/Getty Images

There are thousands of substances added to various foods for the purposes of coloring, flavoring, and preserving. Additives are usually only a very small component of foods but have been suspected of causing various reactions. Food additives include the following groups:

  • Food dyes and colorings (such as tartrazine, annatto, and carmine)
  • Antioxidants (such as BHA and BHT)
  • Emulsifiers and stabilizers (such as gums and lecithin)
  • Flavorings and taste enhancers (such as MSG, spices, and sweeteners)
  • Preservatives (such as benzoates, nitrates, and sulfites)

The Food and Drug Administration (FDA) keeps a list of all of the food additives currently used in the United States.

How Common are Reactions to Food Additives and Preservatives?

Since it is probable that many reactions to food additives are not diagnosed, the exact rate of reactions is not known. However, various studies estimate that the rate is probably less than 1% of adults and up to 2% of children.

What Reactions Occur as a Result of Food Additives?

There are many types of reactions that can occur as a result of food additives. Some of these reactions suggest an allergic cause, while many others do not appear to be allergic, but rather an intolerance. Reports of reactions to food additives have included the following:

  • Gastrointestinal
    • abdominal pain
    • nausea/vomiting
    • diarrhea
  • Respiratory
  • Musculoskeletal
    • muscle aches
    • joint aches
    • fatigue
    • weakness
  • Neurologic
    • behavior and mood changes
    • attention deficit and hyperactivity disorder
    • migraine headaches
    • numbness
  • Cardiac
    • palpitations
    • arrhythmias

How is Allergy to Food Additives Diagnosed?

A diagnosis of allergy to food additives is suspected when a person experiences various reactions to prepared foods or when eating at restaurants, but not from foods prepared at home.

Various seemingly unrelated foods might, in fact, have common ingredients, such as food colorings or preservatives.

Once a food or food additive is suspected, allergy testing (using skin testing or RAST) may be possible to certain natural substances such as annatto, carmine, and saffron. Testing for synthetic substances is not possible or reliable, and therefore a trial of a preservative-free diet may support a diagnosis of food additive reactions.

In many instances, the only way to truly diagnose an adverse reaction to food additives is for the person to undergo an oral challenge with the suspected additive under the close supervision of an allergist.

Allergy to Tartrazine

Also known as FD&C Yellow #5, tartrazine has been suspected as the cause of many reactions, including urticaria (hives), asthma and other illness. Recent studies have disproven the thought that aspirin-allergic asthmatics were especially sensitive to tartrazine. Other studies suggest a role of tartrazine as worsening atopic dermatitis.

Allergy to Carmine

Carmine is a red food coloring made from a dried insect called Dactylopius coccus Costa, which can be found on prickly pear cactus plants. This coloring is also found in various cosmetics, drinks, red yogurt and popsicles.

Reactions to carmine are probably due to allergic antibodies.

Allergy to Annatto

Annatto is a yellow food coloring made from the seeds of a South American tree, Bixia orellana. This additive has been found to cause allergic reactions, including anaphylaxis and urticaria/angioedema.

Allergy to Saffron

This yellow food coloring, obtained from the flower of the Crocus sativa plant, has been reported as a cause of anaphylaxis.

Many other food colorings are less common, but possible, causes of adverse reactions. These include sunset yellow (yellow #6), amaranth (red #2), erythrosine (red #3), and quinoline yellow, among others.

Allergy to Antioxidants

Antioxidants such as BHA (butylated hydroxyanisole) and BHT (butylated hydroxytoluene) are added to prevent the spoilage of fats and oils. Both BHA and BHT are suspected of causing urticaria and angioedema.

Allergy to Emulsifiers and Stabilizers

Allergy to Lecithin. Lecithin in an emulsifier made from soybeans and eggs and may contain soybean proteins. Reactions to soy lecithin are rare, even in soy-allergic people, since the level of this additive is usually very low in most foods.

Allergy to Gums. Various gums are used as food additives and function as emulsifiers and stabilizers. Major gums include guar, tragacanth, xanthan, carrageenan, acacia (Arabic) and locust bean. Many of these gums are known to worsen to worsen asthma, particularly in the occupational setting, when airborne. Others are known to cause allergic reactions when present in foods.

Monosodium Glutamate Allergy

Monosodium glutamate is a flavor enhancer added to various foods, and also occurs naturally. Reactions to MSG have been called the “Chinese Restaurant Syndrome,” and symptoms include numbness on the back of the neck, shoulders and arms, weakness and palpitations. Other symptoms include facial pressure/tightness, headaches, nausea, chest pain and drowsiness. MSG is also suspected of worsening asthma symptoms.

Allergy To Spices

Spices are the aromatic part of various weeds, flowers, roots, barks, and trees. Because they are derived from plants, spices have the ability to cause allergic reactions, just like pollens, fruits, and vegetables. The most common spices used include chili peppers, celery, caraway, cinnamon, coriander, garlic, mace, onion, paprika, parsley, and pepper.

Allergy to Aspartame

Aspartame is a sweetener used in many sugar-free foods and drinks. This food additive has been suspected of causing such symptoms as headaches, seizures, and urticaria.

Allergy to Sulfites 

Sulfites or sulfate agents (in the forms of sodium sulfite, sodium bisulfite, sodium metabisulfite, potassium bisulfite and potassium metabisulfite) are common preservatives used in various foods and medications. Sulfites cause little to no problems in most people without allergies and asthma, even when large amounts are consumed. Sulfites are known to increase asthma symptoms in approximately 5% of asthmatics, particularly in adults with severe disease.

Allergy to Nitrates and Nitrites

These additives are used as curing agents in meat products. Few reports of reactions to nitrates and nitrites exist and include urticaria, itching, and anaphylaxis.

Allergy to Benzoates

Benzoates are used in foods as antimicrobial preservatives and have been responsible for worsening asthma, allergic rhinitis, chronic urticaria, and flushing in some people.

Allergy to Sorbates and Sorbic Acid 

Sorbates are added to foods as antimicrobial preservatives. Reactions to sorbates are rare but have included reports of urticaria and contact dermatitis.

Treatment of Allergy to Food Additives and Preservatives

Many of the reactions to food additives, such as with MSG, are mild and resolve without treatment. More severe reactions, including urticaria, angioedema, worsening asthma, and anaphylaxis may require immediate medical attention. These reactions are treated much the same way as other food allergies. If reactions are severe, it may be necessary for a person to be prepared for a severe reaction (such as carrying injectable epinephrine and wearing a medical alert bracelet.

Otherwise, the mainstay of therapy for people with adverse reactions to food additives is avoidance of the culprit food additive.


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Wilson BG, Bahna SL. Adverse Reactions of Food Additives. Ann Allergy Asthma Immunol. 2005; 95:499-507.

Bush RK, Taylor SL, Hefle SL. Adverse Reactions to Food and Drug Additives. In: Adkinson NF, Yunginger JW, Busse WW, et al, eds. Middleton’s Allergy Principles and Practice. 6th edition. Philadelphia: Mosby Publishing; 2003:1645-1663.

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