Home Medizin Sulfite zum ACDS-Allergen des Jahres gewählt

Sulfite zum ACDS-Allergen des Jahres gewählt

von NFI Redaktion

Sulfites, found in foods, beverages, medications, and personal care products, have been named the „Allergen of the Year“ for 2024 by the American Contact Dermatitis Society (ACDS).

Currently, sulfites are not commonly included in most screening patch test panels, leading to the potential oversight of this relevant contact allergen, stated Dr. Donald V. Belsito, MD, Professor Emeritus in the Department of Dermatology at Columbia University, during his presentation on March 7 at the ACDS Annual Meeting in San Diego. He emphasized that sulfites differ from sulfates and do not cross-react with each other.

Sodium disulfite, an inorganic compound, belongs to a group of sulfiting agents containing the sulfite ion SO32−. This group includes ammonium sulfite, potassium sulfite, and sodium sulfite, explained Belsito. Sulfites function as antioxidants and preservatives in a variety of products, including food and beverages, personal care products, and medications.

The type of sulfite allergy diagnosed through patch testing is a Type IV hypersensitivity or delayed-type hypersensitivity, where patients may exhibit itchy, red, scaly macules, papulovesicles, and patches, as reported by Belsito in Medscape Medical News. He highlighted that it is not the immediate Type I hypersensitivity that causes hives and, in some cases, anaphylaxis. However, sulfites can also provoke these reactions, underscoring the importance of accurate labeling on foods and beverages.

Common non-occupational sources of sulfites include hair coloring and bleaching agents, hairspray, tanning lotions, makeup, sunscreen, and deodorants, Belsito noted in his presentation. Medications like topical antifungals, topical corticosteroids, and nasal solutions may also be culprits, as well as water in swimming pools, he added.

In the occupational setting, sulfites can be present not only in foods and beverages but also in manufacturing processes, such as those used for sterilization during beer and wine fermentation, as highlighted by Belsito. Other potential occupational sources of sulfite exposure include healthcare settings, as well as the textile, chemical, rubber, and pharmaceutical industries.

Foods with high sulfite content (>100 ppm) include dried fruits (with raisins and prunes as exceptions), bottled lemon or lime juice (but not frozen products), wine, molasses, grape juice (white or red, including rosé), and pickled cocktail onions, according to Belsito.

Identifying a Sulfite Allergy

„Most cases of allergic contact dermatitis occur at the site of allergen application,“ he stated in Medscape Medical News. Depending on the location of dermatitis, a detailed history of exposures, including cosmetics, topical medications, work-related materials, as well as foods and beverages, can help point towards a sulfite allergy, he suggested.

Given the diversity of potential clinical presentations and varied exposure to sulfites, Belsito’s advice for physicians is to routinely screen for sulfites and evaluate the many exposure possibilities when a patch test yields a positive result.

Belsito expressed that, in his opinion, further research on sulfites as allergens is not currently necessary; instead, sulfites like sodium metabisulfite/sodium disulfite should be included in all physicians‘ basic screening series, he recommended.

In a recent issue of Dermatitis, sulfites were also named the Allergen of the Year. The authors, Samuel F. Ekstein, MS, and Erin M. Warshaw, MD, from the Department of Dermatology at Park Nicollet Health Services in Minneapolis, Minnesota, pointed out that the ACDS aimed to raise awareness of sulfites as a „significant allergen“ and called for their increased inclusion in screening patch test panels.

Patients with sulfite allergies can find alternative products on the ACDS CAMP (Contact Allergen Management Program) website, as noted by Warshaw in an interview.

Warshaw also highlighted some instances of sulfites as allergens, particularly in healthcare settings. She described a patient presenting with dermatitis at a site where three hand orthopedic procedures had been performed previously.

„Although surgical cleansing agents were suspected, the patient reacted to sodium metabisulfite. Reviewing the contact agents in the operating room confirmed the use of sulfites as preservatives in an injectable anesthetic and antibiotic for wound irrigation,“ she stated. Another patient, treated for recurrent otitis externa and seborrheic dermatitis, was found to have an allergy to sulfites in an antibiotic suspension in the ear and in a ketoconazole cream product, she added.

In their paper, Warshaw and Ekstein advocated for the addition of sulfites to testing panels. While the NACDG included sodium metabisulfite in its series in 2017, sulfites are not part of the American Contact Dermatitis Core Series, they wrote. They also noted that sodium metabisulfite was included in the European baseline standard series after reviewing patch test reactivity and clinical relevance data for 2019-2020.

The ACDS meeting takes place annually on the day before the American Academy of Dermatology’s annual meeting.

Belsito had no financial conflicts to disclose. Warshaw had no financial conflicts to disclose.

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