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J Allergy Clin Immunol Pract. 2014 Mar-Apr;2(2):168-71. doi: 10.1016/j.jaip.2013.10.002. Epub 2013 Dec 8.

Prevalence of sensitivity to food and drug additives in patients with chronic idiopathic urticaria.

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  • 1Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif. Electronic address:
  • 2Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
  • 3Allergy & Asthma Consultants of Rockland and Bergen, West Nyack, NY.



Chronic idiopathic urticaria (CIU) is defined as the presence of urticaria most days of the week for a period of 6 weeks or longer. There have been reports of food additive sensitivity in CIU previously, but the prevalence has not been precisely determined.


To determine the prevalence of reactions to food and drug additives in patients with CIU.


We challenged 100 patients in our allergy/immunology division with CIU to the 11 additives most commonly associated with reactions: tartrazine (FD&C Yellow 5), potassium metabisulfite, monosodium glutamate, aspartame, sodium benzoate, methyl paraben, butylated hydroxy anisole, butylated hydroxy toluene, FD&C Yellow 6, sodium nitrate, sodium nitrite. All of the patients had a history of CIU for longer than 6 weeks, and 43 reported possible history of food or drug additive sensitivity. Single-blind challenges to all of the additives were performed in the clinic and skin scores were recorded. Subjects with positive challenge tests underwent double-blind placebo controlled challenges.


Of 100 subjects, only 2 had a positive urticarial response on single-blind challenge. Neither of these patients had a positive urticarial response on double-blind placebo-controlled challenge. There were no gastrointestinal, respiratory, or other symptom, and no patients reported late reactions.


We were able to conclude, with 95% confidence intervals that sensitivity to any of the 11 food and drug additives occurs in fewer than 1% of patients with CIU. Food and drug additives appear to be a rare cause of CIU, and avoidance is not recommended.


Chronic idiopathic urticaria; Drug additives; Food additives

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