Tartrazine exclusion for allergic asthma

Risk assessment of azo dyes as food additives: Revision and discussion of data gaps toward their improvement

The food industry uses dyes mainly to overcome color loss during the processing and storage of products, with the azo dyes currently being the most employed. Studies on the safety of using these dyes in foods started in the 1950s and have indicated the potential for concern. This review discusses the risk assessment of food intake containing artificial azo dyes. There are case reports and, subsequently, double-blind placebo-controlled trials in some individuals who may experience adverse effects from the intake of azo dyes, but it is unclear whether these adverse effects are restricted to specific populations or more generalized. In view of this, different toxicological endpoints are evaluated to verify toxic effects in in vitro and in vivo models and to establish the no observed adverse effect level. Exposure estimation studies have shown that human exposure to azo dyes via oral intake is mainly below the acceptable daily intake established by advisory bodies. However, most countries do not have studies that estimate the oral intake of azo dyes. In this case, local food diversity and racial-ethnic specificities are not considered when stating the exposure estimate is below the acceptable daily intake for the human population and thus may not represent actual intake. Concerning the scenario established above, this review discusses the most critical gaps to be overcome to contribute to the direction of future studies and the development of more effective public policies concerning the safety of the intake of artificial azo dyes.

Protective effect of blackthorn fruits (Prunus spinosa) against tartrazine toxicity development in albino Wistar rats

Background

Tartrazine (Yellow 5 or E102) is a synthetic food dye able to modify perception and behavior, causing agitation, confusion, rhinitis and can produce hyperactivity syndrome in children when is combined with benzoates. Additionally, it can trigger oxidative stress which consequently generates metabolic disorders. Therefore, the study was designed to evaluate the harmful effects of the food additive tartrazine and to observe beneficial properties of blackthorn fruits (Prunus spinosa) on the blood and organs of albino Wistar rats.

Materials and methods

This study was carried out on 20 mature Wistar rats, randomly divided into four groups of five animals. Over the course of the experiment, the control group received only food and drinking water, group I received 75 mg of tartrazine dissolved in (250 ml) water group II was given 75 mg of tartrazine and 200 mg of dried blackthorn fruit powder 200 mg dissolved simultaneously in (250 ml) of tartrazine-water mixture (aiming to reduce the tartrazine toxicity) and group III received a higher dose of tartrazine (100 mg) in (250 ml) of water.

Results

At the end of the experiment, values regarding kidney and liver weight were significantly increased, while the weight of the spleen was slightly decreased compared with the weight of the control group. Biochemical and hematological assays, of the blood samples show that the addition of tartrazine in the diet of rats caused significant changes in all biochemical and hematological parameters of the blood. In the group II, which received (P. spinosa) powder combined with tartrazine, the biochemical and hematological parameters had average values similar to the control group.

Conclusions

Histopathological assay showed that the application of tartrazine in the group I, II and III produced lesions of the kidneys, spleen and the liver for all rodents. Tartrazine was able to generate histopathological changes, which caused significantly tissue lesions of the liver and significant changes in blood parameters. Blackthorn powder showed a promising protective role for the blood parameters but demonstrated no significant benefits for the organs.

Embryotoxic and Teratogenic Effects of Tartrazine in Rats

Tartrazine (TAZ) is one of the most commonly used artificial dyes for foods and drugs. We determined the effect of TAZ on fetal development by examining morphological, visceral, and skeletal malformations in rat fetuses following daily oral administration of TAZ to pregnant Wistar rats at the 6th-15th day of gestation. TAZ at 0.45 and 4.5 mg/kg induced 6.0 and 7.1% fetal resorptions, as well as 10.0 and 10.5% fetal mortality, respectively. Fetal body weight and length were significantly lower in the groups treated with TAZ at 0.45 (3.97 ± 0.21 g and 27.3 ± 0.54 mm, respectively) and 4.5 mg/kg (3.48 ± 0.15 g and 23.22 ± 1.02 mm, respectively) than in the control group (4.0 ± 0.15 g and 30.01 ± 0.42 mm, respectively). TAZ at 0.45 and 4.5 mg/kg induced hepatic damage (20 and 33.3%, respectively), dark brown pigmentation due to hemosiderin in the splenic parenchyma (16.7 and 21.7%, respectively), as well as destructed and necrotic renal tubules (16.7 and 26.7%, respectively) in the fetuses. Moreover, TAZ at 0.45 and 4.5 mg/kg caused one or more missing coccygeal vertebrae (20 and 40%, respectively), missing sternebrae (6 and 10%, respectively), missing hind limbs (24 and 4%, respectively), and irregular ribs (16 and 20, respectively) in the fetuses. We concluded that TAZ has embryotoxic and teratogenic potentials in rats.

Asthma and Food Allergy in Children: Is There a Connection or Interaction?

This review explores the relationship between food allergy and asthma. They can share the same risk factors, such as parental allergy, atopic eczema, and allergen sensitization, and they often coincide in the same child. Coexistence may negatively influence the severity of both conditions. However, it remains to be determined whether food allergy may directly affect asthma control. An early food sensitization in the first year of life can predict the onset of asthma. Furthermore, asthmatic symptoms could rarely be caused by ingestion or inhalation of the offending food. Asthma caused by food allergy is severe and may be associated with anaphylactic symptoms. Therefore, an accurate identification of the offending foods is necessary in order to avoid exposure. Patients should be instructed to treat asthmatic symptoms quickly and to use self-injectable epinephrine.

Allergic and immunologic reactions to food additives

For centuries, food additives have been used for flavouring, colouring and extension of the useful shelf life of food, as well as the promotion of food safety. During the last 20 years, the studies implicating the additives contained in foods and medicine as a causative factor of allergic reactions have been proliferated considerably. In this review, we aimed to overview all of the food additives which were approved to consume in EU and find out how common and serious allergic reactions come into existence following the consuming of food additives.

Overview of evidence in prevention and aetiology of food allergy: a review of systematic reviews

The worldwide prevalence of food allergy appears to be increasing. Early life environmental factors are implicated in the aetiology of this global epidemic. The largest burden of disease is in early childhood, where research efforts aimed at prevention have been focused. Evidence synthesis from good quality systematic reviews is needed. We performed an overview of systematic reviews concerning the prevention and aetiology of food allergy, retrieving 14 systematic reviews, which covered three broad topics: formula (hydrolysed or soy) for the prevention of food allergy or food sensitization; maternal and infant diet and dietary supplements for the prevention of food allergy or food sensitization and hygiene hypothesis-related interventions. Using the AMSTAR criteria for assessment of methodological quality, we found five reviews to be of high quality, seven of medium quality and two of low quality. Overall we found no compelling evidence that any of the interventions that had been systematically reviewed were related to the risk of food allergy. Updating of existing reviews, and production of new systematic reviews, are needed in areas where evidence is emerging for interventions and environmental associations. Furthermore, additional primary studies, with greater numbers of participants and objective food allergy definitions are urgently required.

An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses

BACKGROUND

Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation.

METHODS

Systematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms.

RESULTS

In total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication.

CONCLUSIONS

More research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions.

Safety of ingestion of yellow tartrazine by double-blind placebo controlled challenge in 26 atopic adults

BACKGROUND

Yellow dye tartrazine is a potential cause of exacerbations of asthma, allergic rhinitis and urticaria in atopic patients. The Brazilian Sanitary Surveillance Agency (ANVISA) published a consultation about the possibility of issuing a label warning addressing these potential effects of food and drugs containing tartrazine. The present study aims to evaluate tartrazine dye safety in atopic subjects suffering from allergic rhinitis, asthma, urticaria or sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs).

METHODS

Atopic patients with allergic rhinitis, asthma, urticaria or pseudo-allergic reactions to non-steroidal anti-inflammatory drugs were studied (n=26). The gold standard, double-blind placebo controlled, crossed-over challenge was used

RESULTS

There were no statistical differences between placebo and drug in cutaneous, respiratory or cardiovascular aspects.

CONCLUSIONS

In a group of atopic subjects with allergic rhinitis, asthma, urticaria or pseudo-allergic reactions to non-steroidal anti-inflammatory drugs, the administration of 35 mg of the tartrazine dye did not precipitate any kind of significant cutaneous, respiratory or cardiovascular reactions when compared to placebo.

Food allergy and asthma--what is the link?

Food allergy and asthma are both atopic diseases and therefore frequently co-exist. Food allergy is common in childhood, affecting approximately 8% of infants. The diagnosis is based on a suggestive history supported by skin-prick testing, serum specific IgE or food challenge. The role of diet in the aetiology of asthma and as a precipitant of exacerbations has been investigated extensively. Many people perceive diet as being an important precipitant of their asthma but objective testing suggests that it is only important in a minority. Meanwhile, there is considerable epidemiological evidence to suggest that there is a link between asthma and food allergy. Food can induce bronchospasm and food allergy has been implicated as a risk factor for life-threatening asthma. Additionally, asthma also seems to be a risk factor for life-threatening food allergy. The mechanism underlying this connection is unclear. The co-existence of food allergy should be considered in any child with asthma. Where food allergy is confirmed, steps should be taken to avoid these foods as this may considerably improve asthma control.

Crossreacting drugs and chemicals

Aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) exert their clinical effect through inhibition of prostaglandin H synthases 1 and 2, also known as cyclooxygenase. This shared effect of COX-inhibition is also the mechanism for shared adverse effects. Much of our understanding of cross-reacting drugs and chemicals with aspirin comes from studying asthmatics with aspirin-exacerbated respiratory disease (AERD). Aspirin exacerbated respiratory disease is characterized by recalcitrant sinusitis/polyposis, asthma and precipitation of asthma after ingestion of aspirin and most NSAIDs. Cross-reactions between ASA and NSAIDs occur with first exposure unlike IgE-mediated allergic drug reactions. Cross-reactions between aspirin and other drugs are dependent upon inhibition of the cyclooxygenase-1 isoenzyme. Desensitization to aspirin will result in cross-desensitization to all NSATDs that inhibit COX-1. Despite reports in the literature, there does not appear to he cross-reactions between food coloring, hydrocortisone succinate and monosodium glutamate in individuals with aspirin exacerbated respiratory disease. The new highly selective cyclooxygenase 2 inhibitors are well tolerated in AERD asthmatics who have not been desensitized to aspirin. Because low-dose ASA exerts a cardioprotective effect by irreversible inhibition of COX-1, AERD patients who are at risk for coronary artery disease should be considered for aspirin desensitization.