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  • Title: [Hypersensitivity reactions to food additives].
    Author: Velázquez-Sámano G, Collado-Chagoya R, Cruz-Pantoja RA, Velasco-Medina AA, Rosales-Guevara J.
    Journal: Rev Alerg Mex; 2019; 66(3):329-339. PubMed ID: 31606017.
    Abstract:
    Food additives are ingredients that are intentionally added to food in order to modify its physical, chemical, biological, or sensorial characteristics. Food additives may act as allergens and generate IgE-mediated immune reactions, or they may act as pseudo allergens and generate non-IgE-mediated immune reactions. Such reactions can generate diverse clinical pictures or they may exacerbate diseases as diverse as eosinophilic esophagitis, bronchial asthma, atopic dermatitis, contact dermatitis, chronic urticaria, or anaphylaxis. Thousands of food additives are being used daily in industrialized countries and, although their use has been globalized, there is not much science information about their adverse effects; especially about their hypersensitivity reactions that, despite being reported in literature as rare, it is probably because they are under-diagnosed due to the fact that they require a high level of clinical suspicion by the physician, and the proof of a causal connection between the symptomatology and the food additive. Hypersensitivity reactions to food additives must be suspected in patients who report symptoms with the intake of multiple commercially prepared foods or to a commercially prepared food without presenting symptoms with the intake of the natural or homemade version of the same food or with the presence of idiopathic reactions. The diagnostic role of the in vivo or in vitro test against IgE (Skin Tests or RAST) is limited to some natural food additives. The gold standard diagnosis that shows causality between the additive and the symptoms is the oral food challenge. The treatment shall always be the elimination of the food additive from the patient's diet. Los aditivos alimentarios son ingredientes agregados intencionalmente para modificar las características físicas, químicas, biológicas o sensoriales de los alimentos; pueden actuar como alérgenos y generar reacciones inmunológicas mediadas por IgE o como pseudoalérgenos y generar reacciones inmunológicas no mediadas por IgE. Dichas reacciones pueden provocar diversos cuadros clínicos o exacerbar diferentes enfermedades: esofagitis eosinofílica, asma bronquial, dermatitis atópica, dermatitis de contacto, urticaria crónica o anafilaxia. Diariamente, miles de aditivos alimentarios son utilizados en países industrializados y aunque su uso se ha globalizado, se dispone de poca información científica sobre sus efectos adversos, particularmente sobre las reacciones de hipersensibilidad, las cuales son raras en la literatura, muy probablemente porque son infradiagnosticadas debido a que requieren un alto grado de sospecha clínica por parte del médico y la demostración de una relación de causalidad entre la sintomatología y el aditivo alimentario. Las reacciones de hipersensibilidad a aditivos alimentarios deben ser sospechadas en paciente con reporten síntomas a múltiples alimentos o a un alimento de preparación comercial sin sintomatología ante la ingesta natural o casera del mismo o ante reacciones idiopáticas. El papel diagnóstico de la prueba in vivo o in vitro contra IgE (pruebas cutáneas o RAST) está limitado a algunos aditivos alimentarios naturales. La prueba diagnóstica que demuestra causalidad entre el aditivo y la sintomatología es el reto oral alimentario. El tratamiento deberá ser siempre la eliminación del aditivo de la dieta.
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