Considerations for the diagnosis and management of sulphite sensitivity.

The review article by Vally and Misso (1) published in the current edition of this journal outlines the broad range of signs and symptoms associated with sulphite sensitivity. These include bronchoconstriction, wheezing, dyspnea, nausea, stomach cramps, diarrhoea, urticaria/angiodema, diaphoresis, hives, laryngeal oedema, generalised itching and swelling, tingling sensations, flushing, hypotension, cyanosis, shock and loss of consciousness (2). Many of the symptoms mirror those of anaphylaxis. Indeed reactions to sulphites can be life threatening, as a number of fatal cases have been reported (3, 4). In many areas of the world, sulphites are now one of the potential allergens (along with the likes of peanuts, fish, crustaceans, gluten and milk) that have to be labelled on food and drink products. In the European Union (EU), levels in foods and drinks above 10 mg/kg or 10 mg per litre have to be labelled. Warning labels are now commonplace, yet in practice there is still a huge amount of ignorance and misinformation about the use of sulphites in food, drinks and pharmaceutical products. Hence, Clinicians need to be aware of sulphite sensitivity in order to enable appropriate diagnosis and provide recommendations for treatment.