title: Adverse reactions to food additives.
abstract: OBJECTIVE
  To summarize the literature related to the classification of food additives and their reported adverse reactions and to provide a practical approach for evaluation of patients suspected of having such reactions.
  
  
  METHODS
  Information was derived from selected reviews and original articles published in peer-reviewed journals and from authoritative textbook chapters, supplemented by the clinical experience of the authors.
  
  
  METHODS
  Priority was given to studies that used blinded, placebo-controlled oral challenges to confirm adverse reactions to food additives. In addition, selected, appropriately evaluated case reports are included.
  
  
  RESULTS
  A large number of food additives are widely used in the food industry. Adverse reactions to additives seem to be rare but are likely underdiagnosed in part due to a low index of suspicion. Numerous symptoms have been attributed to food additive exposure, but the cause-and-effect relationship has not been well demonstrated in all.
  
  
  CONCLUSIONS
  Reactions to food additives should be suspected in patients who report symptoms to multiple unrelated foods or to a certain food when commercially prepared but not when homemade and the allergy evaluation rules out a role for food protein. It is also prudent to investigate food additives in patients considered to have idiopathic reactions. There is a minor role for skin testing or in vitro testing. Oral challenge testing with common additives, preferably preceded by a trial of an additive-free diet, is the definitive procedure for detecting the offending agent. Once the specific additive is identified, management is basically avoidance of all its forms.
authors.affiliation: Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130-3932, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Wilson
authors.forename: Sami L
authors.initials: SL
authors.lastname: Bahna
mesh_terms: D000485:Allergens / Q000009:adverse effects* / Q000276:immunology; D005503:Food Additives / Q000009:adverse effects* / Q000737:chemistry / Q000145:classification; D005505:Food Coloring Agents / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D005520:Food Preservatives / Q000009:adverse effects; D006801:Humans
chemical_list: D000485:Allergens; D005503:Food Additives; D005505:Food Coloring Agents; D005520:Food Preservatives