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Adverse reactions to food additives in children with atopic symptoms
G Fuglsang1, G Madsen, S Halken
1Department of Pediatrics, Viborg Hospital, Denmark.
Insights
This study found that 2% of children with allergy symptoms showed intolerance to food additives via double-blind challenge. Children with atopic dermatitis had a higher risk of positive reactions to additives.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Nutrition
- Dermatology
Background:
- Food additive intolerance is a concern in children with allergic conditions.
- Previous studies have varied in their findings regarding the incidence and specific additives involved.
Purpose of the Study:
- To determine the incidence of food additive intolerance in children with asthma, atopic dermatitis, rhinitis, or urticaria.
- To identify specific food additives that trigger reactions in this pediatric population.
Main Methods:
- A multicenter study involving 335 children (4-15 years) with allergy symptoms.
- An initial 2-week additive-free diet followed by open and double-blind challenges with coloring agents, preservatives, citric acid, and flavoring agents.
Main Results:
- The incidence of food additive intolerance was 2% (6/335) based on double-blind challenges.
- Positive reactions were observed for preservatives, coloring agents, and citric acid.
- Children with atopic skin symptoms showed a statistically increased risk of positive reactions.
Conclusions:
- A small but significant incidence of food additive intolerance exists in children with allergic diseases.
- Atopic dermatitis may indicate a higher susceptibility to food additive reactions.
- Findings may influence future clinical evaluations of children with atopic cutaneous symptoms.
Abstract:
In a multicenter study conducted at four Danish hospital pediatric departments, the parents of 472 consecutive children were informed of this project to determine the incidence of intolerance of food additives among children referred to an allergy clinic with symptoms of asthma, atopic dermatitis, rhinitis, or urticaria. After a 2-week period on an additive-free diet, the children were challenged with the eliminated additives. The food additives investigated were coloring agents, preservatives, citric acid, and flavoring agents. Carbonated "lemonade" containing the dissolved additives was used for the open challenge. Two doses were used: a low dose and a 10-fold higher dose. Gelatin capsules were used for a double-blind challenge. The children were 4-15 years old, and they were attending an outpatient pediatric clinic for the first time. Of the 379 patients who entered the study, 44 were excluded and 335 were subjected to open challenge. A total of 23 children developed positive reactions after the open challenge. Sixteen of these patients accepted the double-blind challenge, and six showed a positive reaction to preservatives (atopic dermatitis, asthma, rhinitis), coloring agents (atopic dermatitis, asthma, urticaria, gastrointestinal symptoms), and citric acid (atopic dermatitis, gastrointestinal symptoms). The incidence of intolerance of food additives was 2% (6/335), as based on the double-blind challenge, and 7% (23/335), as based on the open challenge with lemonade. Children with atopic skin symptoms had a statistically increased risk of a positive reaction. This may have consequences for the future clinical investigation of children with atopic cutaneous symptoms.