Effect of Inhaled Preservatives on Asthmatic Subjects: I. Sodium Metabisulfite

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Abstract
Sodium metabisulfite (MBS) is used as a preservative in food and wine and frequently triggers attacks of asthma. To determine the characteristics of responses to inhaled MBS, 30 asthmatic subjects and 16 nonasthmatic subjects inhaled MBS, in concentrations of 6.2, 12.5, 50, and 100 mg/ml, from a DeVilbiss No. 40 nebulizer (DeVilbiss Co., Somerset, PA) in doses ranging from 0.1 to 12.8 .mu.mol. Response was measured as the dose that caused a 20% fall in FEV1 (PD20FEV1). All the asthmatic subjects responded; one of the atopic, nonasthmatic subjects responded and none of the nonatopic, nonasthmatic subjects responded. The response occurred within 1 min, and most subjects recovered to within 10% of baseline after 30 to 40 min. Dose-response curves to MBS were steep and were reproducible, within a 7-day period, to within one doubling dose, with mean PD20FEV1 values of 2.17 and 2.11 .mu.mol in 11 subjects. There was no correlation between PD20FEV1 values to MBS and histamine, and inhalation of MBS did not enhance responses to subsequent challenge with histamine (mean PD20FEV1 to histamine was 0.65 .mu.mol and to histamine 1 h after MBS was 0.74 .mu.mol). Challenge with MBS (mean PD20FEV1 4.07 .mu.mol) did not cause refractoriness to a second challenge 1 h later (mean PD20FEV1 5.39 .mu.mol). Of 20 subjects tested, prior inhalation of 8 mg nedocromil sodium blocked the response to MBS in 15 subjects and reduced it in two others. Cromolyn sodium (4 mg) blocked the response to MBS in three subjects but did not alter the mean PD20FEV1 in the remaining 17 subjects. The characteristics of responses to MBS suggest that the response is due to the effect of inhaled SO2. Its mode of action, like that of SO2, appears to be different from that caused by mediator release and may be due to an effect on sensory nerves.