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Food additives include:

  • Artificial colorings and flavorings
  • Antioxidants
  • Preservatives
  • Emulsifiers
  • Sweeteners
  • Flavor enhancers


Some reactions to additives may be similar to food-allergic reactions such as hives and swelling while other symptoms include:

  • Flushing
  • Headaches
  • Chest discomfort
  • Asthma

There are few studies on food additive reactions, but they are estimated to be quite rare (under one percent in adults). Among people with allergies, the occurrence can range from 2 to 7 percent.

There are thousands of additives, yet a relatively small number seem to cause reactions, including:

  • MSG, associated with headaches
  • Sulfites, which can prompt asthma people with sulfite sensitivity
  • Red (carmine) and yellow (annatto) food coloring, which have been linked to anaphylaxis (a serious reaction that occurs rapidly and may cause death); and
  • Nitrates, which have reportedly caused hives and itching.


Food additive intolerance may be suspected if you have reactions to unrelated foods. Diagnosis can be difficult, because skin tests routinely used in food allergy diagnosis may only be helpful when considering natural, not synthetic additives. There are no allergy testsspecifically for food additive intolerance.

Your allergist may ask you to:

  • Avoid certain additives for several weeks to determine the cause of your reactions.
  • Make a complete list of everything you eat and note if you have a reaction.
  • Take a blinded, placebo-controlled oral food challenge to confirm that food additives are causing your reaction. You will be given a series of foods that may or may not contain the additive suspected of causing your reaction.

Management and Treatment

If you have been diagnosed with food additive intolerance:

  • Avoid the offending ingredient.
  • Read ingredient labels carefully.
  • Be aware that the ingredient may be “hidden” in a food product under terms such as “flavors” or “spices.”
  • Contact the manufacturer if you have questions.
  • If you cannot be certain of the ingredients, avoid eating that food.
  • If your allergist prescribes an epinephrine auto-injector, carry it with you at all times. Epinephrine is the first-line treatment for anaphylaxis.

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