Sulfite Allergy: Symptoms, Treatments and Foods to Avoid

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Sulfites are preservatives commonly added to wine and other alcoholic beverages, dried fruits, and many other processed foods. They also occur naturally in some foods, such as garlic and onions. Sulfites are associated with food-triggered asthma attacks, and in rare instances they may cause other common food allergy symptoms.

The U.S. Food and Drug Administration estimates that 1% of the general U.S.

population and 5% of asthmatics are sensitive to sulfites.

What Exactly Are Sulfites?

Sulfites are a group of chemical compounds that combine the elements sulfur and oxygen. Examples of sulfites include sodium sulfite, sulfur dioxide, sodium and potassium bisulfite, and sodium and potassium metabisulfite.

They are sometimes naturally occurring, but they may also be added to food during the manufacturing process to prevent browning or serve as a preservative.

Foods that contain high concentrations of sulfites include dried fruits, some fruit juices, wine, pickled foods (such as sauerkraut and onions), and molasses. Dried potatoes, some corn-based foods, and wine vinegars contain lower (but still detectable) concentrations of sulfites. You can find a list of sulfite-containing foods here.

Symptoms of Sulfite Allergies

The vast majority of people with sulfite allergies react with asthma attacks.

Different people have different thresholds of the amount of sulfites they need to trigger an asthma attack, however, which makes this allergy different than many food allergies.

Just as for anyone else with asthma, you'll need to manage your asthma in partnership with your doctor by coming up with an asthma management plan.

This may include a combination of medications and lifestyle changes. Avoiding foods with high concentrations of sulfites, along with avoiding any other asthma triggers you may have, will certainly be among those lifestyle changes if you react to sulfites.

Rarely, sulfite allergies can cause symptoms such as hives, redness and swelling, or anaphylaxis.

Medication Issues with Sulfites

While sulfites are a potential trigger of asthma attacks, people with sulfite allergies and asthma should know that many asthma medications actually include sulfites as a preservative.

If you react to sulfites, your allergist can help you choose an inhaler or other asthma medication that is sulfite-free. Injectible epinephrine is among the other medications that generally includes sulfites; however, doctors generally agree that the potentially life-saving benefits of epinephrine outweigh the risks of a reaction.

Other medications can include sulfites, too, including general anesthesia and other drugs in inhaled or liquid forms.

While the prevailing opinion among doctors is that the benefits of sulfite-containing epinephrine outweigh the risks, this is not the case for many other medications.

You can stay safe by telling your pharmacist about your allergy, asking about any new medication before you start taking it, and designating someone to speak on your behalf before hospitalizations or outpatient surgeries. You may also wear a Medic-Alert bracelet listing your sulfite allergy, which should help protect you in emergency situations.

Fortunately, many medications do have sulfite-free alternatives.

Eating with Sulfite Allergies

In addition to avoiding sulfites in medications and managing your asthma, you'll need to avoid sulfites in restaurants and in packaged foods.

Avoiding sulfites in packaged foods is fairly simple, thanks to FDA labeling rules, which:

  • forbid sulfites from being added to foods intended for raw consumption (such as salad bars)
  • require that sulfites in excess of 10 parts per million (ppm) be indicated on food labels, whether those sulfites are naturally occurring or added during manufacturing
  • require that sulfites added for purposes such as preserving foods be labeled, regardless of whether they are in concentrations higher than 10 ppm

You'll see the phrase "contains sulfites" on packaged foods with a sulfite content above 10 ppm.

You and your doctor may find that you're able to eat some foods with relatively low concentrations of sulfites without triggering a reaction; this can be determined through testing in your allergist's office.

In addition to looking for the phrase "contains sulfites" on packaged foods, you should learn the names of added sulfites, as they can appear on food labels, and avoid foods that commonly have high concentrations of sulfites. Your doctor will likely give you such a list.

The FDA also recalls foods from time to time for undeclared high concentrations of sulfites, so you may want to subscribe to e-mailed allergy recall lists.

Restaurant Dining with a Sulfite Allergy

Avoiding sulfites in restaurants is trickier than it is at home, but you can reduce your risks by following basic principles of eating safely in restaurants with food allergies.

Be aware that even in restaurants with food allergen charts available for menu items, many restaurants still won't have gathered the necessary information on sulfites in their dishes (they're more likely to be prepared for guests who have more common allergies).

This means you'll need to be very clear with the chef and waitstaff about your allergy. A list of high-sulfite foods that you can give to the chef may be useful in helping to come up with safe dishes. And just in case, make sure that whenever you eat food away from home, you should carry your asthma medication and epinephrine (if prescribed).

In addition to avoiding pickled foods, juices that tend to contain sulfites and other foods that are known hazards, you should be aware of some foods that are particularly risky to eat in restaurants.

For example, potato dishes in restaurants are frequently made from dried potatoes treated with sulfites. French fries, hash browns, and similar potato dishes should be considered risky unless you can confirm with the kitchen that they're prepared onsite from fresh potatoes. Also ask about wine or lemon juice (which may be bottled and high in sulfites) in soups, sauces, or rice dishes.

Sulfites and Alcohol: Yes, It's a Problem

There's no such thing as a truly sulfite-free wine or beer, since sulfites occur naturally in alcoholic beverages. However, low-sulfite wines (which fall below the 10 ppm threshold) are available, and these may be viable alternatives for you if your doctor has told you that you have some tolerance of sulfites.

However, avoid these low-sulfite wines if you're an asthmatic who's extremely sensitive to sulfites or if you're at risk of anaphylactic reactions to sulfites. Some restaurants may, for a corkage fee, allow you to bring in and drink your own wine.

Alcohol Allergies and Intolerances

Sources:

Adkinson, N. Franklin, et al. Middleton's Allergy: Principles and Practice. "Chapter 90: Food and Drug Additives Known or Suspected To Cause Adverse Reactions." 6th ed. Philadelphia: Mosby, Inc., 2003.

Papazian, Ruth. "Sulfites: Safe for Most, Dangerous for Some." U.S. Food and Drug Administration. Internet Resource. 17 March 2008.

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