Volume 3 Supplement 3

Food Allergy and Anaphylaxis Meeting (FAAM 2013): Abstracts

Open Access

Anaphylaxis due to sulfite intolerance: a protective effect from cyanocobalamin

  • PM Ojeda1,
  • I Ojeda1 and
  • G Rubio1
Clinical and Translational Allergy20133(Suppl 3):P15

DOI: 10.1186/2045-7022-3-S3-P15

Published: 25 July 2013

Background

The mechanisms of sulfite intolerance are unknown. It has been suggested that, in some cases, it could be due to a partial sulfite-oxidase deficiency. In these patients, this enzyme is unable to metabolize adequately an overload of ingested or inhaled exogenous sulfite, triggering a bronchospasm. Cyanocobalamin is able to catalyze the extracellular oxidation of sulfites, preventing sulfite accumulation and the subsequent symptoms due to this excess.

Methods

A 36 y.o. woman was attended at our allergy Clinic after suffering repeated anaphylactic episodes and an anaphylactic shock, 60 minutes after eating different foods. The allergic study confirmed sensitization to pollens, animal dander, dust mites, molds and PR-10 proteins (ImmunoCAP Isac, Thermofisher, Sweden). We performed a double-blind placebo controlled challenge (DBPCC) with sulfites. She reacted with 50 mg of metabisulfite with facial flushing, rhinitis and bronchospasm (FEV1 decrease > 20%).

We recommended a sulfite avoidance diet, but two months later she came back complaining of great difficulty to avoid sulfite given the ubiquity of this additive in nearly all foods.

We performed another sulfite challenge with cyanocobalamin pretreatment.

Results

We pre-treated the patient with 4 mcg of cyanocobalamin 1 hour before repeating de sulfite challenge. We increased the sulfite dose every 20 minutes, from 5 mg to 200 mg. The challenge test was negative. We recommended the patient to take every day 4 mcg of cyanocobalamin in order to prevent anaphylactic reactions from inadvertent exposure to sulfites and to continue with a sulfite avoidance diet. Since then, she has been stable, without asthma exacerbation or anaphylactic reactions.

Conclusion

We describe a case of sulfite intolerance with anaphylactic reactions, in which we have been able to demonstrate a protective effect from cyanocobalamin.

Disclosure of interest

None declared.

Authors’ Affiliations

(1)
Allergy, Clínica de Asma y Alergia Dres. Ojeda

References

  1. Simon RA: Sulfite sensitivity. Ann Allergy. 1987, 59: 100-5.PubMedGoogle Scholar
  2. Añibarro B: Asthma with sulfite intolerance in children: a blocking study with cyanocobalamin. J Allergy Clin Immunol. 1992, 90: 103-9. 10.1016/S0091-6749(06)80016-3.View ArticlePubMedGoogle Scholar

Copyright

© Ojeda et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.