Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks

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Abstract
Of 272 patients with asthma, 30 (11%) gave a history of exacerbations occurring after ingestion of orange drinks. Fourteen of these were given provocation tests by drinking, on separate occasions, solutions of sulfur dioxide, sodium benzoate and tartrazine, which are present in all orange drinks. Eight reacted to sulfur dioxide with a fall in FEV1 [forced expiratory volume in 1 sec], 4 to sodium benzoate and 1 to tartrazine, and 4 did not react to any of these agents. Three of the benzoate patients were also sensitive to sulfur dioxide. The sulfur dioxide sensitive patients were predominantly young, with extrinsic asthma. The benzoate sensitive patients were predominantly middle-aged and the proportion with intrinsic asthma was higher. Prior inhalation of sodium cromoglycate by 4 patients inhibited the reaction to these substances. Sulfur dioxide was not previously reported to cause exacerbations of asthma when ingested as a food preservative. It is used as a preservative in a wide range of acidic beverages and foods, and should be considered as possibly causal in patients suffering from apparently cryptogenic asthma, and asthma seemingly due to food allergy.