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Perioral contact urticaria from sorbic acid and benzoic acid in a salad dressing
Insights
Contact urticaria from mayonnaise salad dressing affected 18 of 20 children. Sorbic acid and benzoic acid were identified as key allergens, but widespread food preservative use is still recommended.
Area of Science:
- Dermatology
- Allergology
- Food Science
Background:
- Contact urticaria is a common skin reaction.
- Mayonnaise salad dressing has been implicated in outbreaks.
- Identifying specific causative agents is crucial for prevention.
Purpose of the Study:
- To investigate the cause of contact urticaria in children exposed to mayonnaise salad cream.
- To identify the specific components of the salad dressing responsible for the reaction.
- To evaluate the role of sorbic acid and benzoic acid in food preservative-induced urticaria.
Main Methods:
- Observational study in a kindergarten setting.
- Clinical testing including stinging tests and patch tests on adult controls and patients.
- Dose-response testing with sorbic acid and benzoic acid.
Main Results:
- 18 of 20 children developed contact urticaria from mayonnaise salad dressing.
- Sorbic acid and benzoic acid were identified as the primary irritants.
- Positive reactions to sorbic acid and benzoic acid were concentration-dependent and partially inhibited by antihistamines.
Conclusions:
- Sorbic acid and benzoic acid can cause non-immunologic contact urticaria.
- The reactions are transient and likely mediated by non-immunologic mechanisms.
- Current widespread use of sorbic acid and benzoic acid as food preservatives should not be restricted.
Abstract:
Contact urticaria was observed in a kindergarten in 18 of 20 children following the intake and accidental perioral application of a mayonnaise salad cream. In healthy adult controls, stinging tests and closed 20 minute patch test with the salad dressing were positive in 9 out of 12 and 4 out of 10 cases respectively. Twenty minute patch tests with the different components of the salad dressing were positive only so sorbic acid (SA) and benzoic acid (BA). Urticaria was provoked by inunction of the salad dressing periorally in two healthy boys. Serial 20 minute closed patch testing with varying concentrations of SA in 91 patients and BA in 41 patients gave almost identical results: positive reactions in two thirds of the patients with the highest concentrations. The response was only partially blocked by antihistamine applied locally before testing. Non-immunologic mechanisms are probably responsible for the transient reaction, and no restriction in the extensive use of SA or BA as preservatives in food should be considered.