The commonest food additives thought to cause adverse reactions are tartrazine (E102), sunset yellow (E110), annatto, aspartame, benzoic acid and sulphites (Fuglsang et al. 1993). Key epidemiological studies are shown in Table 10.9. Adverse reactions to food additives can occur at any age. A UK study showed a higher reporting of adverse reactions to food additives in the first ten years of life, and more often occurring in females (Young et al. 1987). The mechanism of the reaction is often unknown, and IgE-mediated reactions are rare. Questionnaire-based studies give a high 6.6-7.4% prevalence of self-reported adverse reactions to food additives in the general population. However, when food challenges are used to make the diagnosis, the prevalence falls to about 0.23%. One study shows the risk to be greatest in the atopic population, with no reactions observed in non-atopic individuals (Fuglsang et al. 1994). Virtually all reactions are minor and limited to the skin (worsening of eczema/urticaria) with serious systemic reactions rarely reported. Regarding the natural history, there are no good epidemiological data.
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