Food additive blacklist: Which ingredients may trigger urticaria

Food additives that have been clinically proven to be clearly related to the onset of urticaria are mainly synthetic colors, preservatives, and artificial sweeteners. There are also a few antioxidants and flavor enhancers that have been observed to induce symptoms in susceptible people.

When I was doing food intolerance-related consulting work in an outpatient clinic, I met a 28-year-old Internet operator girl who had been suffering from chronic urticaria for almost 2 years. She checked dust mites, pollen, and common food allergens but couldn't find the cause. Finally, after keeping a food diary with me for 3 months, I discovered that 1-2 hours before each attack, she drank fruity sparkling water with sunset yellow and carmine red. After she stopped such drinks, her attack frequency dropped by more than 80%.

Some people may want to throw away all foods with additives after seeing this. It is completely unnecessary. The academic community has different opinions on this matter: some toxicology studies believe that only when the dosage of additives ingested far exceeds the amount allowed by the national standard, it will stimulate mast cells to release histamine and induce urticaria. As long as the food is marketed in compliance with regulations, ordinary people will have no problem eating it normally.； However, long-term clinical follow-up data shows that about 1% to 3% of patients with chronic urticaria are susceptible to additives. Even if they eat related foods with legal additive amounts, they may trigger symptoms. Individual differences are actually very large.

The most common triggers that everyone encounters are actually lemon yellow, sunset yellow, and carmine from synthetic pigments. These ingredients are often added to colorful candies, fruit-flavored sodas, candied fruits, and fancy decorated cakes. Half of the more than ten cases of urticaria induced by additives that I have encountered were caused by these ingredients. Then there are sulfites and benzoic acid in preservatives. The former is often used to protect the color of wine, dried fruits, and preserved fruits. Many people have small red spots on their bodies after drinking cheap red wine. They always think it is an alcohol allergy. In fact, it is most likely that sulfites are at fault. ； The latter is often added to pickles and sauces, and sensitive people may be susceptible to it if they eat it. There are also artificial sweeteners such as aspartame and acesulfame potassium added to sugar-free foods that have become popular in the past two years. Last year, I met a young man who drank sugar-free cola every day. He had recurring urticaria for half a year. After switching to sugar-free sparkling water with erythritol, the symptoms gradually disappeared.

Let’s talk about a common pitfall. Don’t think that products labeled as “natural additives” are absolutely safe. I have encountered patients who suffered from urticaria after eating energy bars with natural β-carotene. However, the probability of this kind of situation is much lower than that of synthetic additives. There is no need to overly demonize the synthetic ones, and there is no need to blindly believe in the natural ones.

If you have chronic urticaria, you may wish to keep a food diary for a month or two. Nowadays, you can scan the barcode on many food apps to see the full ingredients. Every time you have an attack, go back and review what you ate for 1-3 hours. You may be able to uncover the deeply hidden trigger. If you are really unsure, you can also go to the hospital to do a provocation test on food additives. There is no need to kill all the additives with a stick.