Skip to main content
Download PDF

Volume 3 Supplement 3

Food Allergy and Anaphylaxis Meeting (FAAM 2013): Abstracts

Anaphylaxis due to sulfite intolerance: a protective effect from cyanocobalamin

Clinical and Translational Allergy volume 3, Article number: P15 (2013) Cite this article

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.

References

  1. 1.

    Simon RA: Sulfite sensitivity. Ann Allergy. 1987, 59: 100-5.

    CAS  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Allergy, Clínica de Asma y Alergia Dres. Ojeda, Madrid, Spain

    PM Ojeda, I Ojeda & G Rubio

Authors
  1. PM Ojeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I Ojeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G Rubio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I Ojeda.

Rights and permissions

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.

Reprints and Permissions

About this article

Cite this article

Ojeda, P., Ojeda, I. & Rubio, G. Anaphylaxis due to sulfite intolerance: a protective effect from cyanocobalamin. Clin Transl Allergy 3, P15 (2013). https://doi.org/10.1186/2045-7022-3-S3-P15

Download citation

Keywords

  • Rhinitis
  • Asthma Exacerbation
  • Anaphylactic Reaction
  • Anaphylactic Shock
  • Cyanocobalamin

Clinical and Translational Allergy

ISSN: 2045-7022

Contact us