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Month: July 2019

Reactions to Food Additives

More and more natural and artificial chemicals are being added to our food as preservatives, flavor enhancers, and coloring agents.  The U.S. Food and Drug Administration (FDA) lists close to 4,000 substances as food additives.

Despite widespread use of these chemicals in food, adverse reactions are fortunately uncommon.  Most cases are described in the literature as single case reports or reports of a small cluster of patients.


Sulfites:  These chemicals in the gaseous form can cause lung irritation and may trigger asthma in sensitive asthmatics.  They are commonly found in liquid form in processed cold drinks and fruit juice concentrates in order to extend their shelf lives.  Sulfites are also added to most wines and sprayed onto cut foods in order to keep them fresh and prevent discoloration or browning. They are used to preserve smoked and processed meats, dried fruit (e.g., apricots), and salads.  In its solid form, sulfites can cause hives when ingested.

Benzoic acid (i.e., benzoate) and Parabens:  Benzoates and parabens have antibacterial and anti-fungal properties in order to help with the prevention of food spoilage.  These agents are added to pharmaceutical and food products such as drinks (e.g., sugar-free cola). They occur naturally in prunes, cinnamon, tea, and berries.  These substances may cause urticaria (i.e., hives), asthma and angioedema (i.e., swelling) in sensitive individuals.

Antioxidants:  Synthetic phenolic antioxidants [e.g., BHA (butylated hydroxyanisole) and BHT (butylated hydroxytoluene)] are typically added to processed foods such as dry cereals and potato flakes in order to prevent the fats and oils in these foods from turning rancid when exposed to air.  Unfortunately these antioxidants may trigger asthma, rhinitis, and urticarial in some sensitive individuals.

Flavor Enhancers:

Aspartame (e.g., NutraSweet, Equal), a low-calorie sweetener, can occasionally trigger itchy hives and swelling of the body.  It is also important to note that individuals with genetic condition phenylketonuria should avoid aspartame. Aspartame breaks down into an essential amino acid called phenyalanine which is toxic to individuals with phenylketonuria since these patients are unable to metabolize phenyalanine.


Azo dyes [e.g., tartrazine (i.e., yellow dye #5)] and Non-azo dyes (e.g., erythrocine) can trigger hives, asthma, and generalized allergic reactions.

Nitrates and Nitrites give meat a pink color to look more attractive.  These food colorings are typically found in bacon, salami, and frankfurters.

Monosodium Glutamate (MSG) may trigger the “Chinese Restaurant Syndrome” which causes individuals to experience headaches as well as burning and/or tightening of the chest, neck, and face.  MSG may be found in soups, pot noodles, and instant drinks, among other foods.

Naturally Occurring Substances:

Vasoactive amines: Natural histamine, serotonin, and tyramine occur in some ripe cheeses, fish, cured sausage, red wine, chocolate, and pickled vegetables and may induce cramping, flushing, headache, and palpitations in a dose-related manner.  Of note, there is a condition known as “scombroid poisoning” which occurs in individuals who eat spoiled fish. In this condition, there are abnormally high quantities of histamine in the fish due to improper storage or processing.  The typical fish affected may include tuna, mackerel, herring, sardine, anchovy, marlin, and bluefish. The symptoms may include flushing, headache, generalized itching, blurred vision, abdominal cramps, and/or diarrhea. Scombroid poisoning is often wrongly diagnosed as a fish allergy since similar symptoms may be associated with a true fish allergy.  One key factor to look for is to see if other individuals eating the same piece of fish exhibited symptoms. If so, it is more likely to be scombroid poisoning due to eating spoiled fish as opposed to a fish allergy.

Caffeine found in foods, medication, tea, coffee, and carbonated beverages induces dose-dependent agitation, palpitations, nausea, and/or tremors.

Salicylates (i.e., aspirin-like naturally occurring chemicals) may induce urticaria, asthma, and/or nasal polyp growth.  They are found in curry powder, paprika, oranges, apricots, ginger, honey, berries, fruit skins, tea, and almonds.  Salicylate sensitive individuals also tend to have adverse reactions to benzoates and tartrazine.


The precise mechanism how food additives cause reactions is not well understood in many instances.  The IgE antibody, which plays a crucial role in immediate-type (i.e., Type I) allergic reactions to food, is usually not involved in adverse reactions caused by food additives.

Skin prick tests and allergy blood tests are not helpful in identifying the food additive culprit in most cases.  Careful observation and maintaining food and symptom diaries are sometimes useful in narrowing down the offending additive. Oral challenges under close monitoring in controlled environments may be needed to arrive at a specific diagnosis.


Avoidance of the suspected food additive is the only certain way of preventing adverse effects.  One should be vigilant about reading food labels and asking restaurants about ingredients and cooking methods.

If there is a history of anaphylaxis, carrying an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick) is extremely helpful in emergency treatment.  It is important to emphasize that if a self-injectable epinephrine device is used, one should go immediately to the closest emergency room.

The board certified allergists at Black & Kletz Allergy have been diagnosing food additive sensitivitis, food allergies, and food intolerances routinely for many years on both adults and children.  Black &Kletz Allergy has 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking.  The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day.  The allergists of Black & Kletz Allergy are eager to help you with your allergy, asthma, sinus, and immunology needs.  We are dedicated to providing excellent care and service to you as we have been doing in the Washington, DC metro area for more than 5 decades.

Fatigue Can Be Due to Allergies?

In the hectic days we live in, many individuals feel fatigued or exhausted.  Fatigue is a very common symptom that can be either chronic or intermittent. Many people seek help by seeing a physician in order to find out the cause of their fatigue, as there are many potential causes.  Despite the numerous causes of fatigue, underlying allergies is a fairly common reason for fatigue in many individuals.

Usually patients with allergic rhinitis (i.e., hay fever) and allergic conjunctivitis exhibit many of the classic symptoms of allergies which may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, itchy ears, clogged ears, itchy eyes, watery eyes, redness of the eyes, puffy eyes, sinus pressure, and/or sinus headaches.  The typical symptoms in individuals with asthma may include wheezing, chest tightness, shortness of breath, and/or coughing.  It should also be noted that food allergies can cause fatigue in certain individuals in addition to the more typical abdominal symptoms (e.g., abdominal pain, diarrhea), skin symptoms (e.g., hives, itching, swelling), lung symptoms (e.g., wheezing, shortness of breath, coughing), and of course anaphylaxis.  Even though the symptoms listed above are the “more typical” symptoms associated with allergies, asthma, and food allergies one should realize that fatigue is not an uncommon symptom that occurs in allergic individuals. There are in fact people that only complain of fatigue and do not have any of the more typical symptoms of allergies.  You may be asking: How do you know if your fatigue is due to allergies?  It should be noted that there are a whole host of conditions and/or reasons that can cause fatigue.  Likewise, it is important to rule out these “other” causes of fatigue before declaring one’s fatigue is due to allergies.

What are some common causes of fatigue besides allergies?  Here are some of the more common reasons/conditions that may cause fatigue, but keep in mind that there are numerous other conditions or reasons that may cause fatigue that are not listed below:

  • Thyroid disorders (e.g., hypothyroidism)
  • Anemia
  • Sleep apnea
  • Heart disease
  • Lack of sleep
  • Infection (e.g., hepatitis, mononucleosis, urinary tract infection)
  • Diabetes mellitus
  • Autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome)
  • Fibromyalgia
  • Anxiety/Depression
  • Dehydration
  • Chronic obstructive pulmonary disease (COPD)
  • Medication side effects

Fatigue Can Be Due to Allergies?Assuming that there are no other reasons for one’s fatigue, seeing a board certified allergist in the Washington, DC, Northern Virginia, and Maryland metropolitan area is important in order to rule out allergies as a cause.  In fact, even if you have another condition that can cause fatigue, it is still possible that some or all of your fatigue may be coming from allergies.  The board certified allergists at Black & Kletz Allergy are experts in the field and can find out if you have allergies via blood and/or skin testing.  It is first important for the allergist to perform a comprehensive history and physical examination.  Allergy testing is done in order to identify if, what, and how allergic one is to specific allergens. Once an allergy is identified, preventive measures are discussed in order to minimize one’s exposure to the offending allergens.  In addition, the use of allergy medications are usually beneficial in alleviating those unwanted allergy symptoms which also includes fatigue. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy hyposensitization) may be utilized to treat the underlying allergies as they are very efficacious and are beneficial in 80-85% of individuals who take them.  Most individuals are on allergy shot for 3-5 years.

The allergists at Black & Kletz Allergy see both pediatric and adult patients and have over 50 years of experience in the field of allergy, asthma, and immunology.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC metropolitan area for over 5 decades and we look forward to providing you with the highest state-of-the-art allergy care in a friendly and comfortable environment.