Additive sensitivity is a reaction that may occur when an individual consumes or comes into contact with a food additive – an ingredient that is not considered a part of a food’s basic raw ingredients.

A reaction to an additive may be triggered when the additive is ingested or comes into contact with the skin. It is unknown what mechanism causes symptoms to appear in the body.

Additives are found in a variety of foods. They include:

• Flavor enhancers
• Added nutrients, such as vitamins and minerals
• Preservatives
• Stabilizers, emulsifiers and thickeners
• Food colorings
• Artificial sweeteners

Some cosmetics contain additives also found in foods and may be able to cause a reaction when they come into contact with the skin.

Though additive sensitivities are reported by many people, there is currently only clinical proof that confirms the existence of sulfite allergies. More research is required before other sensitivities can be recognized by the medical community.

Sulfite allergies are an allergic reaction to the commonly used additive sulfites. Like other types of food allergies, sulfite allergies are capable of causing symptoms such as hives, breathing problems and even life-threatening anaphylactic shock. Though sulfites were heavily used in some foods in the recent past, their use is now strictly limited by the U.S. Food and Drug Administration (FDA).

Reactions caused by additives other than sulfites are considered food intolerances. Food intolerance is not the same as a food allergy, which always involves the response of the immune system. Despite the difference, some of the reactions from food additives are reported to be similar to those of food allergies.

Individuals who believe they may have an additive sensitivity should avoid that additive and consult their physician. Managing additive sensitivities involves first identifying the specific ingredient that triggers the response, then working carefully to avoid further contact with that ingredient. Most of the prevention occurs at supermarkets and restaurants, where informed individuals must carefully avoid any additives that may trigger a response.  The FDA is working to identify the additives that are most frequently reported to cause a response so that they can be more effectively identified on food labels.

Many of today’s food manufacturers add additives to their products to enhance the flavor, improve the nutritional content, extend shelf-life or just change the color, texture and appearance of the product. Though these additives are safe for the vast majority of people, a small minority may experience a reaction to the additives – though the existence of additive sensitivity is a hotly debated issue itself. Statistics vary, but the U.S. Food and Drug Administration (FDA) estimates 1 percent to 3 percent of adults and 6 to 8 percent of children may experience some sort of sensitivity to food additives. Only one type of additive, sulfites, are known to cause allergic reactions in some people.

An allergic reaction to sulfites is very rare, though symptoms can include hives, stomach cramps, nausea, difficulty breathing and even life-threatening anaphylactic shock. Sulfites are commonly used for preservation in many kinds of food (e.g., wine, dried fruits), though the use of the additives is strictly limited by the FDA. Sulfites also occur naturally in a variety of foods (e.g., salmon, tomatoes, onions). 

Some physicians and clinical researchers deny the existence of additive sensitivities other than sulfite allergies. Though widely reported, no conclusive clinical data exists to confirm them as a medical condition. More studies and research are needed before the medical community reaches a final decision on food additive sensitivities.

Reactions caused by additives other than sulfites are food intolerances, not true allergies. Intolerance occurs when the body has difficulty digesting a certain food. An allergy is caused by the immune system's perception that a substance is a foreign invader. An intolerance to additives is reported to cause temporary symptoms such as headache and abdominal pain, especially when the additive has been consumed in large amounts.

Some of the most common additives that have been associated with sensitivities include:

• Sulfites. FDA-regulated food additives. According to the FDA, about 5 percent of asthmatics are sensitive to sulfites. Sulfites are capable of causing food allergy reactions in some people. By law, sulfites cannot be sprayed on vegetables and fruits meant to be consumed raw, but are used in some processed foods and to preserve seafood. Sulfites appear in wine and, to a lesser extent, beer and other alcoholic drinks. They must be declared on the label, if there is a detectable amount in the finished food. The FDA’s regulation defines a detectable amount of sulfite to be 10 parts per million.
  
  
• Monosodium glutamate (MSG). A common preservative and flavor enhancer, especially popular in Asian dishes. When consumed in large amounts, MSG has been reported to cause flushing and headaches.
  
  
• Aspartame. An artificial sweetener commonly found in soft drinks, chewing gum, tabletop sweeteners and 6,000 other food products. Aspartame is considered safe by the FDA but some people have reported a wide number of allergy-like symptoms, some of which may be due to an intolerance. Certain people, such as those with the genetic disease phenylketonuria (PKU), those with advanced liver disease and pregnant women with hyperphenylalanine (high levels of phenylalanine in blood), may not be able to digest aspartame.
  
  
• Benzoic acid. A preservative frequently found in processed foods, such as juices, chocolate, chewing gum, nut flavorings and baked goods.
  
  
• Butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT). Commonly used to prolong the life of fats, oils and oil-containing foods, such as potato chips, vegetable oils and cereals.
  
  
• Tartrazine. A yellow food coloring, also known as FD&C yellow number five.
  
  
• Cochineal extract (also known as carmine dye). A color additive used for centuries in foods, drink and cosmetics. On food labels, it may appear by name, but other labels may only list it as color added or artificial color.
  
  
• Nitrates/nitrites. Used to prevent botulism and enhance the flavor of red meat, poultry and meat/poultry products (such as hot dogs, salami, bacon, turkey, chicken and ham).
  
  
• Parabens. A common preservative used in many foods (e.g., mustard, processed vegetables, mayonnaise, salad dressings, soft drinks, jellies and jams, syrups), drugs (e.g., eye, ear and nose drops, local anesthetics, rectal/vaginal medications) and cosmetics (e.g., makeup removal products, blushes, lip sticks, mascaras and eye shadows, nail products).

Food additive sensitivities are usually reported to occur when an additive in a food is ingested. However, some additives used in foods are also used in cosmetics. Direct contact with these substances on the skin may also be able to produce a reaction.  

The FDA closely monitors the additives currently on the market and keeps track of the many complaints it receives on adverse food reactions. Because of the FDA’s work, food manufacturers are currently required to list all additives by name on their product’s packaging. The FDA also maintains a Generally Recognized as Safe (GRAS) list that includes foods that have been in use for five years without any known problems.

Some individuals who report suffering from additive sensitivities have worked with a physician or a physician-recommended dietician to identify and avoid problematic additives. For those patients who have already identified problem additives, new FDA requirements for the labeling of foods make it easier to quickly check to see if a potentially problematic additive is present.

Because of limited clinical data available on additive sensitivity, it can be difficult to determine if an added ingredient triggered actual symptoms. Therefore, the treatment of additive sensitivities can be more involved than treatment of food allergies. People who find they are sensitive to certain additives are encouraged to pay close attention to what they eat.

Additive sensitivity is reported to cause a wide range of symptoms depending on the additive and the sensitivity of the individual. Most reported reactions occur after the additive is ingested. Some additives used in foods are also used in cosmetics and can cause reactions when applied directly to the skin.

Some of the most common reported reactions to food additives include:

• Skin irritations. Includes itching, hives, rashes and contact dermatitis. For instance, monosodium glutamate (MSG) is associated with a burning sensation along the back of the neck, forearms and chest.
  
  
• Headaches.
  
  
• Angioedema.
  
  
• Dizziness or lightheadedness.
  
  
• Numbness in the limbs.
  
  
• Respiratory reaction or asthmatic symptoms. Includes difficulty breathing, wheezing and shortness of breath. Tartrazine, for instance, may be able to induce serious, life-threatening asthmatic symptoms in individuals who are aspirin sensitive.
  
  
• Abdominal pain, diarrhea, nausea or vomiting.
  
  
• Memory loss, depression and anxiety attacks.
  
  
• Muscle spasms.
  
  
• Anaphylactic shock. Can occur with sulfites. Without treatment, a severe reaction (anaphylaxis) may quickly progress to anaphylactic shock. Signs of anaphylaxis include shortness of breath, tightness in the chest or throat, choking and loss of consciousness. Anaphylactic shock is characterized by difficulty breathing and a dangerous drop in blood pressure.

The timing of symptoms may differ depending on the type of additive involved. People may experience a reaction immediately after the additive is consumed or symptoms may occur up to 24 hours later.

Individuals who suspect that they are sensitive or allergic to a food additive should consult an allergist/immunologist.

Though it is often difficult to determine if an individual is sensitive to some kind of additive, it is often even more difficult to determine which additive is responsible and what level of sensitivity is involved. The first step often involves an individual creating a complete food diary with the help of a physician. While keeping this diary, patients will be asked to record all the foods they consume, the time food is eaten and the time reactions occur. By closely observing which foods trigger a response, a physician can often pinpoint additives that are more likely to blame.

After determining which additives may be responsible for causing symptoms, some physicians recommend an elimination diet, which involves avoiding any foods that may contain the problem additives. By observing the patient’s reactions or lack of reactions through this stage, the physician can further determine the individual’s susceptibility.

Because some reported symptoms may be similar to food allergies, a physician may recommend one or more allergy tests to rule out an allergic cause.

Because the general medical community has yet to conclusively confirm that additive sensitivities exist apart from rare sulfites allergies, there are no established treatment or prevention methods for additive sensitivities. However, if a person is diagnosed with an additive sensitivity by a physician, the most basic and effective way of preventing further reactions is avoidance. This means not eating foods that contain any of the additives to which they appear susceptible.

Avoidance is not easy. Ingredient lists must be carefully read and people must be aware of any alternate names for the problem additive. For example, an individual who reacts to sulfites should avoid sulfur dioxide, sodium sulfate, potassium sulfate, bisulfate and metabisulfate. A physician or dietician should be consulted to determine which types of additives should be avoided. Patients with sulfite allergies should also be aware of foods that naturally contain sulfites.

Foods that commonly contain sulfites, either naturally or as an additive, include:

• Lettuce
• Tomatoes
• Asparagus
• Eggs
• Onions
• Garlic
• Chives
• Leeks
• Dried fruits
• Canned vegetables
• Soy products
• Baked goods
• Jam
• Gravies
• Molasses
• Maple syrup
• Shrimp
• Salmon
• Dried cod
• Soup mixes
• Corn starch

Beverages that may contain sulfites include:

• Wine
• Beer
• Hard cider
• Fruit and vegetable juices
• Tea

Individuals with additive sensitivities should also learn to inquire at restaurants about cooking methods that might present a problem. Parents may want to warn school personnel, caregivers, friends and other people who frequently interact with children who may have an additive sensitivity.

Though there is no known drug treatment available to prevent a food additive reaction, there are certain treatments available for the symptoms themselves. A physician will often recommend an antihistamine to provide relief for reactions to sulfites such as, hives, sneezing, runny nose and gastrointestinal symptoms. For relief from symptoms associated with asthma, a physician will often recommend bronchodilators.

Some individuals appear to be dangerously sensitive to certain additives (e.g., sulfites). It is a good idea for these people to wear a medical alert bracelet or necklace to alert healthcare providers in the event of an emergency. Physicians may also recommend that individuals who could potentially have an anaphylactic response carry a syringe of epinephrine and know how to self-administer the medication.

Though dietary avoidance involves a great deal of care on the part of the individual with an additive sensitivity, groups such as the U.S. Food and Drug Administration (FDA) are continuing to work to identify potentially problematic additives and either limit their use, ban them or require the additive be listed on food packaging. The FDA’s Adverse Reaction Monitoring System (ARMS) was set up specifically for the purpose of monitoring additives and dealing with complaints from consumers. An additive cannot be used in the United States until the FDA has approved its use.

The FDA has also taken action against the use of certain types of food and cosmetic colorings used as additives. Originally, in 1960, almost 200 colors were included on the provisional approval list. Today only seven types of these colorings are approved for use in the United States. The FDA has banned the use of sulfites from many types of fruits and vegetables, removing the substance entirely from salad bars, where it used to be found. Today, sulfites can be used in foods only at an extremely low level, and foods that contain more than 10 parts per million must list the additive on their ingredient label.

The FDA also maintains a Generally Recognized as Safe (GRAS) list, which includes food items that are regarded as safe by the scientific community. If the FDA views an additive as potentially harmful, it may remain on the GRAS list only if it is packaged in a safe, tiny quantity. Still, individuals with additive sensitivities should always check to make sure that problem additives are not present in any food, drug or cosmetic before using.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about additive sensitivity:

1. Do my symptoms indicate additive sensitivity or a food allergy?
   
   
2. What methods will you use to determine the substance causing my symptoms?
   
   
3. Does my sensitivity to certain additives pose a danger to my overall health?
   
   
4. Are there medications available to treat my symptoms? If so, how effective are they?
   
   
5. What foods commonly contain the additive causing my symptoms?
   
   
6. Is it safe to eat the problem additive in small amounts or must I avoid it completely?
   
   
7. What terms should I look for when reading ingredient labels?
   
   
8. What should I do if I accidentally ingest a large amount of the additive?
   
   
9. Are my children more likely to have additive sensitivity because I have the condition?