Bisulfite Intolerance Manifest as Bronchospasm Following Topical Dipivefrin Hydrochloride Therapy for Glaucoma

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Abstract
To the Editor. —Sulfites are widely used in the food and pharmacology industry as sanitizing and preservative agents. Sulfiting agents include potassium metabisulfite, potassium bisulfite, sodium bisulfite, sodium sulfite, and sulfur dioxide. These chemicals are also used in the fast-food and restaurant industry in a wide variety of foods, including salads, fresh fruits, potatoes, wine, and shellfish.1 Sensitivity to sulfiting agents has been recognized as a cause of wheezing in a substantial number of asthmatic patients, when exposed both via the oral2-6 or inhaled routes,7-10 but anaphylaxis, generalized urticaria, flushing, and acute gastrointestinal tract symptoms can also be the initial manifestion of sulfite sensitivity. A sterile ophthalmic topical solution, containing dipivefrin 0.1% and sodium metabisulfite as an antioxidant preservative, presents the unsuspecting asthmatic patient with an additional source of exposure to an agent capable of triggering an idiopathic flare of respiratory tract difficulty. To our knowledge,

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