Adverse Reactions to Drug and Food Additives

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Chlorpromazine is authorised in the world under the following brand names: Chlorpromanyl (discontinued), Intensol, Largactil Liquid, Largactil Oral Drops, Novo-Chlorpromazine, Thorazine Spansule.

Glossary:

Urticaria: Commonly known as hives, this is a temporary skin condition marked by pale, patchy swelling and itching.

Angioedema: A flushing and swelling of the skin caused by the effusion of fluids into the tissue.

Anaphylaxis: A general, rather than local, allergic reaction characterized by difficulty breathing, wheezing, a shock-like state, or any combination of these symptoms.

Sulfites are used heavily in both foods and beverages for their ability to inhibit certain enzyme reactions. It’s the enzyme reaction that causes an apple or an artichoke to turn brown when it is cut, that blackens mushrooms and causes spots to form on fresh shrimp. Sulfite also prevents browning that is caused by non-enzymatic reactions in wine, dried fruits, vinegar and other products and is used in particularly large quantities for this task. Because sulfites are also antioxidants they are used by many pharmaceutical companies in drugs such as Novocaine, Demerol, thorazine and some brands of eyedrops.

Sulfur dioxide is a known irritant for asthmatics, but heat or acid — such as the gastric acid in the stomach — cause sulfites to release sulfur dioxide. For that reason, the U.S. Food and Drug Administration (FDA) requires the declaration of sulfites on food labels if they make up more than a certain proportion of the contents. The FDA also banned the use of sulfites on fresh vegetables, for example, in salad bars where it was once common.

Benzoates such as benzoic acid and sodium benzoate are widely used as preservatives in food and beverages for their antibacterial qualities. Parabens, similar preservatives, are used more in drugs and cosmetics. The worldwide consumption of benzoates, used since the early 1900s in food, is over 10 million pounds. Benzoates have low toxicity, and in fact occur naturally in prunes, cinnamon, cloves, tea, anise and many berries.

Monosodium glutamate is an amino acid commonly used as a flavouring. While it appears naturally in some foods like Camembert cheese, it’s used mainly as an additive, particularly in Chinese and Japanese food. A single bowl of Wonton soup can contain 2.5 grams of MSG. It’s also one of the “secret herbs and spices” in Kentucky Fried Chicken.

Aspartame (NutraSweet) is another additive that enhances flavour. Temporarily banned in the mid-1970s because of fears that it caused mental retardation and endocrine dysfunction, aspartame is now back as a common additive in foods and carbonated drinks. Nitrates and nitrites are preservatives that also add colour and flavour, and are common in preserved meats such as salami. Butylated hydroxanisole (BHA) and butylated hydroxytoluene (BHT) are antioxidants that appear in many grain and cereal products.

Dyes used in foods are either coal-tar derivatives called azo dyes, the best-known of which is tartrazine, or dyes derived from other sources known as non-azo dyes.

Allergic reactions: Urticaria, angioedema and anaphylaxis

Tartrazine and other dyes, benzoates and parabens may aggravate urticaria at times but none of them have been shown to cause it. Parabens have been shown to cause an anaphylactic reaction on a few rare occasions, but never when taken orally. Sulfites also have been known to cause anaphylaxis. MSG is responsible for an allergic reaction known as Chinese restaurant syndrome (CRS), characterized by headache, nausea, chest tightness, sweating and a burning sensation along the back of the neck. The symptoms affect only MSG-sensitive individuals who eat free MSG (usually added in the restaurant as a condiment) on an empty stomach. MSG has also been blamed in a case of angioedema. Aspartame, BHA and BHT are all known culprits in isolated cases of urticaria.

Allergic reactions: Asthma

The exact mechanism by which sulfites cause asthma attacks is controversial, but it has been suggested that inhalation while swallowing sulfite-bearing foods is the cause. This seems borne out by tests in which sulfite-sensitive people with asthma swallowed sulfite solutions with no reaction when they held their breath. Anyone can develop sulfite sensitivity, and many people’s first experience with asthma was a reaction to sulfites, which over the course of a few months became chronic asthma with dependence on corticosteroids. About three to five percent of asthmatics are sulfite-sensitive, and they tend also to be susceptible to other irritants such as exercise, upper respiratory infections, and particularly smog. Any food containing sulfites in sufficient concentration to cause a reaction must now be so labeled under FDA rules in the U.S.

MSG and benzalkonium chloride can cause bronchial constriction in asthmatics, but cases are rare and in the case of the second additive, concentrations are usually too low. Spearmint, peppermint and menthol, which appear in chewing gum and toothpaste, are also capable of triggering an attack. Dyes, parabens and benzoates are not believed to be dangerous for people with asthma.