[Suspicion on sulfites]

The sulfites have anti-oxygen and anti-microbial properties, which explain their great use in the food and drug industry. They may be responsible for anaphylactoid type episodes or more often asthmatic crises. 4 to 8% of asthmatics are sensitive to sulfites. The majority of asthmatics who are sensitive to sulfites are steroid dependent asthmatics. The pathophysiology is not clear: either a reaginic mechanism, reflex bronchoconstriction to SO2, a partial deficit in sulfite-oxidases. The diagnosis rests on oral provocation tests. These tests should be carried out according to a rigorous methodology, because there are frequent false positives (57 to 70%). Tests of alimentary provocation do not always correlate with the results from oral provocation tests to sulfites and pose the double question of sensitivity to the combined forms of sulfites which are present in food, and the reality of the risk of exposure of asthmatics to these foods. The prevention of any such mishaps rests on the eviction of such substances from the food which is often difficult and also of drugs. Vitamin B12, atropine, doxepin and sodium cromoglycate are capable of preventing totally or partially the bronchospasm induced by the absorption of sulfites.