Sulfite Allergy What you need to know Complied by M. McKee
Note: Much of the information that follows has been gleaned from various sources; including Medical Journals, Sulfite Allergy web- sites and personal experience.
If you are the victim of an allergy, you know that life can be difficult and sometimes downright miserable. Allergic reactions can range from mild – virtually unnoticeable – to fatal, and everything in between. There are several approaches to dealing with allergic reactions: Take something like an antihistamine to counteract the allergy, or remove the source of the allergen. In my case, the Benadryl or Claritin, which had been working fairly well for about a year, were no longer able to control my symptoms and so I had no choice but to remove the source of my allergic reactions. But first, I had to figure-out the cause.
Diagnosis Initially, I had gone to my regular doctor who did not know what the problem was, other than to say it was likely some kind of dermatitis. He sent me to a doctor specializing in these sorts of things, who subsequently prescribed a steroid cream for me. While I can’t necessarily say that this made my symptoms worse, it certainly did not do anything to help the situation – and so I decided that I needed to diagnose myself. While there have been some case reports of people being diagnosed with sulfite allergy using skin testing, there is no reliable, commercially available skin test for sulfite allergy. Typically, the diagnosis is suggested by a history of adverse reactions after consuming sulfite- containing foods or medications. However, in order for the diagnosis to be confirmed, an allergist may perform an oral metabisulfite challenge for a patient suspected of having sulfite allergy. This procedure involves giving a person increasing amounts of sulfites to swallow, with close monitoring of lung function and vital signs. A significant drop in lung function confirms sensitivity to sulfites. This test should only be performed under direct supervision of a physician who has been trained and is experienced with such a procedure. In my case, it was fairly easy to diagnose – after just 1 glass of wine I would see welts appearing on my neck within a few minutes. This coupled with my significant loss of strength and asthma were all good indicators of the source of my allergic reactions.
As in my case, specific reactions to a Sulfite allergy might be more apparent after ingestion of a moderate to high-sulfite food and may include; fatigue, flushing, itching, asthma, strength loss and rashes. For myself, my allergy had, over the course of about a year, developed into asthma, a significant loss of strength, and a severe case of hives. This would be most noticeable just minutes after I had ingested something with even a moderate level of sulfites, such as Wine, Beer or French Fries.
Sulfa, Sulfite, Sulfate and Sulfur There is much confusion regarding allergy to sulfa-containing drugs, sulfites as a preservative agent in foods and medications, sulfate salts of medications and the chemical element sulfur. Many people assume that if they are allergic to one of these agents, then they are allergic to all of them. This is not necessarily true.
Sulfa Sulfa-containing medications are a common cause of drug allergy, and perhaps the reason for most of the confusion. The majority of the time, a person with a sulfa allergy has experienced an allergic reaction to a sulfa-containing antibiotic. The antibiotic sulfonamides are different structurally from the non-antibiotic sulfonamides, and appear to be much more likely to result in allergic reactions. Many of the sulfa non-antibiotics, therefore, do not cause problems in people with sulfa antibiotic allergy.
Sulfite Sulfites (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 have been used for centuries, mainly as food additives, but can also occur naturally in foods such as fermented beverages and wines. Sulfites are best known to cause worsening breathing problems in certain people when foods or beverages containing sulfites are eaten. Other people have experienced severe allergic reactions after eating foods or taking medications that contain sulfites.
Sulfate Sulfates are salts of sulfuric acid, and are commonly used in the making of various drugs, such as albuterol sulfate, iron sulfate, chondroitin sulfate and codeine sulfate. Sulfates can also be used in Dry Cleaning solvents and other industrial applications. While allergic reactions to these medications are possible, it’s not likely that it’s because of the sulfate group. There does not appear to be any specific reason for people with sulfa or sulfite allergies to avoid medications that contain a sulfate salt (though this may not necessarily be the case for severe allergic reactions – as in my case).
Sulfur Sulfur is a chemical element that is used in the production of countless pharmaceutical and commercial chemicals, and is present in (and responsible for the names of) sulfa drugs, sulfite preservatives, and sulfates. The current belief is that the element Sulfur is too small to cause allergic reactions by itself; therefore, there does not appear to be a reason for people with sulfa and/or sulfite allergy to specifically avoid sulfur-containing compounds – which is fortunate since many foods contain sulfur compounds. What is a Sulfite Allergy? Sulfites usually 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. Numerous well-controlled studies show that some asthmatics can have severe asthma symptoms with eating sulfite-containing foods/beverages or inhaling sulfite fumes or vapors.
Less is known about hives and anaphylaxis as a result of sulfites, although various cases have been described in which the consumption of sulfite-containing foods/beverages leads to severe allergic reactions. This was particularly true in my case as the consumption of wine, beer or potatoes resulted in severe reactions.
Some very sensitive people even had positive skin tests to sulfites (myself included), suggesting the presence of allergic antibodies to the preservative. Other people have experienced severe reactions from sulfite-containing medications, including intravenous drugs and inhaled medications. These reactions included flushing, hives and a drop in lung function as a result of the medications being given.
It’s not completely known how sulfites cause reactions in certain people. Some people clearly make allergic antibodies against sulfites, while others do not. The gases generated from sulfites might cause muscle spasms in the lungs of some asthmatics, or could be related to the inability in some people to metabolize the sulfites appropriately.
Why are Sulfites Added to Medications? Sulfites are added to some medications for their antioxidant properties as well as the prevention of browning of medications. Sulfites are added to injectable epinephrine to prevent browning, which decreases the effectiveness of the drug. However, epinephrine has not been reported to cause adverse reactions in people with sulfite allergy, and should not be withheld in an allergic emergency. Injectable epinephrine may prove life saving in people with sulfite allergy experiencing anaphylaxis. Some inhaler solutions used to treat asthma contain sulfites, although many asthma drugs have had sulfites removed due to safety concerns.
Why are Sulfites Added to Foods? Sulfites are added to foods for various reasons. These include: • Reduction of spoilage by bacteria • Slows the browning of fruit, vegetables and seafood • Inhibits of growth of bacteria during fermentation of wines • Conditioning of dough in frozen pie and pizza crust • Bleaching effect for maraschino cherries and hominy
In the past, sulfites were added to fresh foods in restaurants and grocery stores to prevent browning. An increase in reactions led the Food and Drug Administration (FDA) to ban the use of sulfites in fresh foods in 1986, particularly on fresh lettuce in salad bars. The FDA now requires that any food containing more than 10 parts per million (ppm) concentration of sulfites to be declared on the label. Except in rare cases (myself included) foods that contain less than 10 ppm of sulfites have not been shown to cause symptoms, even in people allergic to sulfites.
Which Foods Contain Sulfites? Greater than 100 ppm of sulfites Very high levels, strict avoidance advised in people with sulfite allergy • dried fruits • bottled lemon juice (non-frozen) • bottled lime juice (non-frozen) • wine • molasses • sauerkraut (and its juice) • grape juices (red, white and sparkling, juices) • pickled cocktail onions Between 50 and 99.9 ppm of sulfites Moderate to high levels of sulfite, avoidance advised in people with sulfite allergy. • dried potatoes • wine vinegar • gravies/sauces • fruit toppings • Maraschino cherries
Between 10 and 49.9 ppm of sulfites Low to moderate levels of sulfite, may cause symptoms in people with severe sulfite allergy. • pectin • fresh shrimp • corn syrup • pickled peppers • pickles/relish • corn starch • hominy • frozen potatoes • maple syrup • imported jams and jellies • fresh mushrooms • imported sausages and meats • cordials (alcoholic) • dehydrated vegetables • various cheeses • corn bread/muffin mix • canned/jarred clams • clam chowder • avocado dip/guacamole • imported fruit juices and soft drinks • ciders and cider vinegars • Breads Less than 10 ppm of sulfites Very low sulfite levels, generally do not pose a risk, even for people with sulfite allergy. • malt vinegar • canned potatoes • beers • dry soup mix • soft drinks • frozen pizza and pie dough • beet sugar • gelatin • coconut • fresh fruit salad • domestic jams and jellies • all crackers • all cookies • fresh grapes • high fructose corn syrup
Varying amounts of sulfites (and/or sulfates) May have medium to low sulfite levels, may pose a risk for people with sulfite allergy. • sunflower seeds • garlic • lentils • soybeans • yogurt • turnips • canned tuna • eggs • dry cereals • vegetable juices, canned vegetables, frozen vegetables • pickled vegetables (cauliflower, peppers and sauerkraut) • hot sauces • baked goods • potato chips • trail mix and trail mix bars • apple ciders • teas • most bottled condiments • grain products: cornstarch, modified food starch, spinach pasta, gravies, hominy, breading, batters, noodle and rice mixes • breads containing dough conditioners, cookies, crackers, pie and pizza crusts, tortillas, waffles • beverages containing sugar or corn syrup, dried citrus fruit beverages • processed cheese foods • scallops frozen, canned or dried clams, shrimp, lobster, crab, scallops, dried cod • fresh grapes, dried fruits (including raisins and prunes and especially pale fruits that have not discolored) • frostings: fruit fillings, flavored and unflavored gelatin, pectin, jelling agents, canned frostings and frosting mixes • hard candies • soy protein products including tofu, textured vegetable protein, infant formula • filled crackers • flour tortillas, corn tortillas, tortilla chips • white and wheat breads • sugars: brown, white, powdered and raw sugars • vegetarian (and other) refried beans • virtually all alcohols and alcoholic drinks except sake (if made in the traditional fashion) and most vodkas • bottled waters (such as Dansani, etc.) • well water (at my house: 12 ppm)
Examples of non-food items that may contain sulfites (and/or sulfates) include:
• Avon products (some, not all) • Avon Skin-So-Soft • Bag Balm • Burt’s Bee’s products (some, not all) • hand lotions • toothpastes • deodorants • eye drops (some, not all) • most hand soaps • most laundry detergents • dry cleaning solvents • vitamins (many, not all)
What to look for… As can be seen above, sulfites may hide in various food (and non- food) ingredients, without being obvious. However, some sulfite- containing ingredients are listed on food labels. This will include (but not necessarily be limited to):
• Sulfur dioxide • Potassium bisulfite • Potassium metabisulfite • Sodium bisulfite • Sodium metabisulfite • Sodium sulfite
Now what do I do? Now that you’ve been diagnosed as having at least some sensitivity to sulfites (and/or sulfates), the question is what to do about it – or, in other words, how screwed are you? Well, the answer depends on how much you like to cook. Essentially, you will not be able (at least until your sensitivity decreases over time) to buy much of anything at your local Supermarket that you can open and eat directly. Virtually everything falling into this category will contain some amount of a sulfite preservative.
For some period of time, it may be necessary to adhere to a sulfite (and perhaps even sulfate) free lifestyle. The more severe your reaction, the longer you may to detoxify your body of sulfites. Note that diets such as Vegan ( www. ExploreVeg.org ) and the popular Paleo- diets ( www. paleodiet.com ) are not sufficient in removing sulfites from your intake. Your needs here will be much more restrictive – almost as bad as a prisoner on bread and water; except you can’t have bread.
You may, for the most part, need to cook your own food for all meals. Most fish (except Salmon) and raw meats should be sulfite-free as will most raw vegetables. Fresh fruit can be safely eaten as long as it’s peeled, as sulfites may be present on the skins. While most breads will contain some amount of sulfites, natural substitutes like Lavash (whole grain wrap) and Pita are less likely to contain these chemicals.
Misinformation It is VERY important to note that virtually all wait-staff in restaurants as well as staff at food markets DO NOT KNOW whether the food they serve [or sell] contains sulfites. Many people have ended-up in the ER as a result of taking the advice of these folks. The staff [for the most part] has no knowledge of sulfite allergies in general, or your particular sensitivities in particular. Also, be aware that various markets (such as; Whole Foods, Holistic Foods, etc) will say that almost none of their foods contain sulfites, which is NOT TRUE. Although a small percentage of the foods sold in these places will be sulfite-free, most will contain ingredients containing sulfites. It will be up to you to protect yourself against the wealth of misinformation concerning this [potentially fatal] allergy.
And, while on the subject of misinformation, I have read several articles stating that if sulfites do not appear on the ingredients labels of a given food – and, if that food has not been processed using the same equipment as foods containing sulfites – then the food in question will be safe to eat. This is NOT TRUE. Sulfites will most certainly be lurking in a variety of ingredients that are not obviously labeled so. Also, sulfites may exist in food at less than 10 ppm, and not need to be present on the ingredients list.
One additional thing to note: As you’ll be on a very restrictive diet, you will likely lose some amount of weight. It is important to know that sulfites – much like other toxins – can be stored in your fat cells. As your body processes these fat cells, the sulfites contained therein will be released into your blood stream. You may experience a sulfite reaction during this phase of your diet for some period of time.
Restaurants If you choose to eat in a restaurant, once you’ve been diagnosed as having sulfite sensitivity, you will be taking a very big risk. Although most restaurants have some sort of allergen information sheet, only one I’ve found (Denny’s) includes sulfites on their spreadsheet. The bottom line is, unless you’ve prepared the meal yourself, you may be taking a risk in consuming that food. Vitamin B-complex There is a growing body of evidence to suggest that vitamin B- complex may help in the alleviation of the symptoms resulting from a sulfite allergy [sulfites are known to destroy vitamin B1 (thiamin)]. See the following reference for an excellent discussion of vitamin B and its relation to sulfite sensitivity: http://www.housemouse.com/sulfites.htm
Molybdenum There is some evidence to suggest that sulfite sensitivities are not necessarily an allergic reaction, but the result of a metabolic imbalance resulting from the lack of molybdenum. Sulfite sensitivity may be caused by a relative deficiency of the enzyme sulfite oxidase which breaks down sulfites and requires molybdenum as a cofactor. If this is true, this is a metabolic problem and not an allergic one and, perhaps, curable. Additional studies concerning this issue are currently in progress.
Molybdenum is a trace mineral found in most plant and animal tissues. Molybdenum is an essential cofactor for many of the enzymes involved in protein synthesis and the mobilization or iron use in the body. Most people are not deficient in this mineral if the food they eat comes from nutrient-rich soil. Molybdenum also helps with metabolism of fats and carbohydrates.
Usage Guidelines: The RDA for molybdenum is 75 mcg, and recommended use varies from 75-500 mcg. Toxicity is rare, but symptoms produced may include stiffness and swelling of the joints, stunted bone growth, diarrhea and anemia.
Some Natural Sources: Meats, whole grains, buckwheat, barley, wheat germ, legumes, lima beans, canned beans, and dark green leafy vegetables
Black Beans: Black beans are an excellent source of molybdenum, an integral component of the enzyme sulfite oxidase, which is responsible for detoxifying sulfites. If you have ever reacted to sulfites, it may be because your molybdenum stores are insufficient to detoxify them. A cup of black beans will give you 172.0% of the daily value for this helpful trace mineral. References and Links
Find out more about sulfite allergy and the treatment for sulfite allergy, at these sites. Find out more about sulfa allergy, and what medications should be avoided in someone with a sulfa allergy. Additional references: http://foodallergies.about.com/od/foodallergybasics/f/intolerances. htm www.moondragon.org/health/disorders/allergiessulfite.html http://allergies.about.com/od/foodallergies/a/sulfites.htm http://allergies.about.com/od/foodallergies/a/sulfites_2.htm http://archive.longhaircommunity.com/showthread.php?t=34009 www.orthomolecular.org/nutrients/micronutrients.shtml www.drugs.com/sfx/ferrous-sulfate-side-effects.html www.scribd.com/search?cat=solr&q=sulfates http://www.cancure.org/cancer_fighting_foods.htm http://www.diagnose-me.com/cond/C488839.html
Sulfite Free/Low Sulfites Products
Sulfite-Free Dried Fruit: Newman’s Own Organics - www.newmansownorganics.com Made in Nature - www.madeinnature.com
Wines with Low Sulfites: Frey Vineyards www.freywine.com Vida Orgánica Wine - www.vidaorganica.com
Sulfite-free shampoos: killerstrands.blogspot.com/2008/01/sulfate-free-shampoo-list.html
Soaps & Detergents:
Sulfite-free detergent (such as ECOver 2.0 and All Free and Clear) as well as sulfite-free hand soaps can be found at a variety of locations.