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Contact allergy and intolerance to sulphite compounds: clinical and occupational relevance

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  • 1 Citations



Sulphites are widely used as preservatives and antioxidants, e. g., in the food, cosmetic, and pharmaceutical industries. They are known to trigger epidermal sensitizations and associated eczematous contact allergic skin reactions; to identify these, patch testing is performed using sodium disulphite (= sodium metabisulphite; CAS 7681-57-4). In addition to this, inhalation or oral exposure to sulphite can cause the clinical picture of sulphite intolerance, including bronchoconstriction, urticaria, cardiovascular, intestinal, and/or life-threatening anaphylactic reactions, the identification of which requires challenge testing.


This review discusses the prevalence of sulphites, their chemical characteristics, statutory regulations and limit values; sulphite-related diseases and their diagnosis; the occupational significance of sulphites as contact allergens in the literature published between 1968 and 2015; and the current incidence of contact sensitizations in the patient collective at a dermatology practice. Individual cases of inhalative occupational sulphite intolerance were also analyzed.


A reaction incidence of 3.1% (++ or +++ reaction on day 4) to sodium metabisulphite (1% in Vaseline) was determined in a 10-year collective comprising 780 patients tested at a dermatology practice; in none of these cases was occupational relevance identified. In contrast, the rate of positive test reactions to sulphite was 1.1–4.5% in eight large patch test collectives. Although occupational relevance in the positive test results (depending on selection criteria) was between 0 and 100%, it was predominantly (in six of eight studies) between 5 and 14%. Approximately 50 cases involving occupational allergic contact dermatitis due to sulphite have been published in the literature over the last 45 years, as well as a small number of cases of occupational sulphite intolerance.


In summary, epidermal sensitizations to sulphite are rarely of occupational relevance. Despite the wide prevalence of sulphites in the form of preservatives and antioxidants, the low number of cases documented in an occupational dermatological context suggests that occupational sulphite exposure only rarely exists in disease-triggering form.

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Fig. 1



Acceptable daily intake


Everything added to food in the United States


Food and Drug Administration


Food Information Regulation


Immunoglobulin E


International Union of Pure and Applied Chemistry


Maximum workplace concentration


Parts per million


Positivity ratio


Reaction index

SO2 :

Sulphur dioxide


  1. 1.

    Petersen CS, Menné T. Consecutive patch testing with sodium sulfite in eczema patients. Contact Derm. 1992;27:344–5.

  2. 2.

    Vena GA, Foti C, Angelini G. Sulfite contact allergy. Contact Derm. 1994;31:172–5.

  3. 3.

    Kaaman AC, Boman A, Wrangsjö K, Matura M. Contact allergy to sodium metabisulfite: an occupational problem. Contact Derm. 2010;63:110–2.

  4. 4.

    Madan V, Walker SL, Beck MH. Sodium metabisulfite allergy is common but is it relevant? Contact Derm. 2007;57:173–6.

  5. 5.

    García-Gavín J, Parente J, Goossens A. Allergic contact dermatitis caused by sodium metabisulfite: a challenging allergen: a case series and literature review. Contact Derm. 2012;67:260–9.

  6. 6.

    Ralph N, Verma S, Merry S, et al. What is the relevance of contact allergy to sodium metabisulfite and which concentration of the allergen should we use? Dermatitis. 2015;26:162–5.

  7. 7.

    Febriana SA, Jungbauer F, Soebono H, Coenraads PJ. Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries. Contact Derm. 2012;67:277–83.

  8. 8.

    Häberle M, Geier J, Mahler V. Kontaktallergie auf Sulfite: klinische und berufliche Relevanz – Neue Daten aus DKG und IVDK. JDDG. (im Druck)

  9. 9.

    Anonymus. Sulfite. In: Greim H, editor. Gesundheitsschädliche Arbeitsstoffe: Toxikologisch-arbeitsmedizinische Begründungen von MAK-Werten, 26th edn. Weinheim: Wiley-VCH; 1998.

  10. 10.

    Fazio T, Warner CR. A review of sulphites in food: analytical methodology and reported findings. Food Addit Contam. 1990;7:433–54.

  11. 11.

    Taylor SL, Highley NA, Bush RK. Sulfites in foods: uses, analytical methods, residues, fate, exposure assessment, metabolism, toxicity, and hypersensitivity. Adv Food Res. 1986;30:1–76.

  12. 12.

    Green LF. Sulphur dioxide and food preservation – a review. Food Chem. 1976;1:103–24.

  13. 13.

    Le Coz CJ, Lepoittevin JP. Dictionary of contact allergens: Chemical structures, sources and references. In: Frosch PY, Menné T, Lepoittevin JP, editors. Contact Dermatitis, 4th edn. Berlin: Springer; 2006. pp. 1087–8.

  14. 14.

    Richtlinie 95/2/EG des Europäischen Parlaments und des Rates vom 20. Februar 1995 über andere Lebensmittelzusatzstoffe als Farbstoffe und Süßungsmittel. Amtsblatt der Europäischen Union L 61 vom 18.3.1995. p. 1–40

  15. 15.

    Verordnung EG Nr. 1223/2009 des Europäischen Parlaments und des Rates vom 30. November 2009 über kosmetische Mittel. Amtsblatt der Europäischen Union L 342 vom 22.12.2009. p. 59–209

  16. 16.

    Arzneibuch. Deutsches Arzneibuch 2012 (DAB 2012) und Europäisches Arzneibuch 8. Ausgabe, Grundwerk 2014 (Ph. Eur. 8.0). Stuttgart: Deutscher Apotheker Verlag 2014

  17. 17.

    Richtlinie 2003/89/EG des Europäischen Parlaments und des Rates vom 10. November 2003 zur Änderung der Richtlinie 2000/13/EG hinsichtlich der Angabe der in Lebensmitteln enthaltenen Zutaten. Amtsblatt der Europäischen Union L308 vom 25.11.2003. p. 15–8.

  18. 18.

    COMMISSION REGULATION (EC) No 753/2002 of 29 April 2002 laying down certain rules for applying Council Regulation (EC) No 1493/1999 as regards the description, designation, presentation and protection of certain wine sector products. Official Journal of the European Communities L 118 of 4.5.2002. p. 1–54

  19. 19.

    Verordnung (EU) Nr. 1169/2011 des Europäischen Parlaments und des Rates vom 25. Oktober 2011 betreffend die Information der Verbraucher über Lebensmittel und zur Änderung der Verordnungen (EG) Nr. 1924/2006 und (EG) Nr. 1925/2006 des Europäischen Parlaments und des Rates und zur Aufhebung der Richtlinie 87/250/EWG der Kommission, der Richtlinie 90/496/EWG des Rates, der Richtlinie 1999/10/EG der Kommission, der Richtlinie 2000/13/EG des Europäischen Parlaments und des Rates, der Richtlinien 2002/67/EG und 2008/5/EG der Kommission und der Verordnung (EG) Nr. 608/2004 der Kommission. Amtsblatt der Europäischen Union L304 vom 22.11.2011, p. 18–63.

  20. 20.

    Nair B, Elmore AR. Cosmetic Ingredient Review Expert Panel. Final report on the safety assessment of sodium sulfite, potassium sulfite, ammonium sulfite, sodium bisulfite, ammonium bisulfite, sodium metabisulfite and potassium metabisulfite. Int J Toxicol. 2003;22:63–88.

  21. 21.

    Vally H, Misso NL, Madan V. Clinical effects of sulphite additives. Clin Exp Allergy. 2009;39:1643–51.

  22. 22.

    U.S. Food and Drug Administration. Everything added to food in the United States (EAFUS-Liste) 2016. http://www.accessdata.fda.gov/scripts/fcn/fcnnavigation.cfm?rpt=eafuslisting&displayAll=true.

  23. 23.

    WHO. (editor) Safety evaluation of certain food additives. Sixty-ninth Report of the Joint FAO/WHO Expert Committee on Food Additives. World Health Organization Food additive series. vol 60. 2009, pp 221–59.

  24. 24.

    Anonymus. Schwefeldioxid (Nachtrag 2013). In: Hartwig A, editor. Gesundheitsschädliche Arbeitsstoffe: Toxikologisch-arbeitsmedizinische Begründungen von MAK-Werten, 55th edn. Weinheim: Wiley-VCH; 2013.

  25. 25.

    Lester MR. Sulfite sensitivity: significance in human health. J Am Coll Nutr. 1995;14:229–32.

  26. 26.

    Du Toit W, Pengilly M. The effect of molecular sulphur dioxide on the growth, acetic and gluconic acid production of selected South African acetic acid bacterial strains. In: Wynboer Technical Yearbook. Paarl: Wineland Publications; 2009. pp. 60–73.

  27. 27.

    Stingeni L, Bianchi L, Lisi P. Occupational airborne allergic contact dermatitis from potassium metabisulfite. Contact Derm. 2009;60:52–3.

  28. 28.

    Verordnung (EG) Nr. 1493/1999 des Rates vom 17. Mai 1999 über die gemeinsame Marktorganisation für Wein. Amtsblatt der Europäischen Union L 179 vom 14.7.1999. p. 1–109

  29. 29.

    Rangan C, Barceloux DG. Food additives and sensitivities. Dis Mon. 2009;55:292–311.

  30. 30.

    Fisher AA. Reactions to sulfites in foods: delayed eczematous and immediate urticarial, anaphylactoid, and asthmatic reactions. Part III. Cutis. 1989;44:187–90.

  31. 31.

    Simon RA. Update on sulfite sensitivity. Allergy. 1998;53:78–9.

  32. 32.

    Huang PY, Chu CY. Allergic contact dermatitis due to sodium metabisulfite in a bleaching cream. Contact Derm. 2007;56:123–4.

  33. 33.

    Pambor M. Contact Dermatitis due to ammonium bisulfite in a bleaching cream. Contact Derm. 1996;35:48–9.

  34. 34.

    Aerts O, Duchateau N, Lambert J, Bechtold T. Sodium metabisulfite in blue jeans: an unexpected cause of textile contact dermatitis. Contact Derm. 2014;70:190–2.

  35. 35.

    Bonneau JC. Contact allergy to sulfites: contact allergens, sources of exposure, and clinical profile. Allerg Immunol (Paris). 1994;26:324–6.

  36. 36.

    Dooms-Goossens A, de Alam AG, Degreef H, Kochuyt A. Local anesthetic intolerance due to metabisulfite. Contact Derm. 1989;20:124–6.

  37. 37.

    Langevin PB. Propofol containing sulfite-potential for injury. Chest. 1999;116:1140–1.

  38. 38.

    Phillips JF, Yates AB, Deshazo RD. Approach to patients with suspected hypersensitivity to local anaesthetics. Am J Med Sci. 2007;334:190–6.

  39. 39.

    Riemersma WA, Schuttelaar ML, Coenraads PJ. Type IV hypersensitivity to sodium metabisulfite in local anaesthetic. Contact Derm. 2004;51:148.

  40. 40.

    Lodi A, Chiarelli G, Mancini LL, Crosti C. Contact allergy to sodium sulfite contained in an antifungal preparation. Contact Derm. 1993;29:97.

  41. 41.

    Schwartz HJ, Gilbert IA, Lenner KA, et al. Metabisulfite sensitivity and local dental anesthesia. Ann Allergy. 1989;62:83–6.

  42. 42.

    Bekanntgaben der Bundesärztekammer. Die Arzneimittelkommission der deutschen Ärzteschaft informiert: Sulfit-haltige Parenteralia. Dtsch Ärztebl. 1989;86:A651–2.

  43. 43.

    Arzneimittelverzeichnis Deutschland. Rote Liste. Frankfurt/Main: Rote Liste Service GmbH; 2014.

  44. 44.

    Merget R, Korn M. Metabisulphite-induced occupational asthma in a radiographer. Eur Respir J. 2005;25:386–8.

  45. 45.

    Roberts DW, Basketter D, Kimber I, et al. Sodium metabisulfite as a contact allergen – an example of a rare chemical mechanism for protein modification. Contact Derm. 2012;66:123–7.

  46. 46.

    Ranguelova K, Chatterjee S, Ehrenshaft M, et al. Protein radical formation resulting from Eosinophil Peroxidase-catalyzed oxidation of sulfite. J Biol Chem. 2010;285:24195–205.

  47. 47.

    Ranguelova K, Rice AB, Khajo A, et al. Formation of reactive sulfite-derived free radicals by the activation of human neutrophils: an ESR study. Free Radic Biol Med. 2012;52:1264–71.

  48. 48.

    García-Bravo B, Mazuecos J, Rodriguez-Pichardo A, et al. Hypersensitivity to ketoconazole preparations: study of 4 cases. Contact Dermatitis. 1989;21:346–8.

  49. 49.

    Guidetti MS, Vincenzi C, Guerra L, Tosti A. Contact dermatitis due to imidazole antimycotics. Contact Derm. 1995;33:282.

  50. 50.

    Hills RJ, Ive FA. Contact sensitivity to nystatin in Timodine. Contact Derm. 1993;28:48.

  51. 51.

    Ikehata K, Kato J, Kuwano A, et al. Two cases of allergic contact dermatitis caused by sodium sulfite in the vehicle of antifungal cream. Skin Res. 1996;38:198–202.

  52. 52.

    Seitz CS, Bröcker EB, Trautmann A. Eyelid dermatitis due to sodium metabisulfite. Contact Derm. 2006;55:249–50.

  53. 53.

    Herbst RA, Maibach HI. Contact dermatitis caused by allergy to ophthalmic drugs and contact lens solutions. Contact Derm. 1991;25:305–12.

  54. 54.

    Nagayama H, Hatamochi A, Shinkai H. A case of contact dermatitis due to sodium bisulfite in an ophthalmic solution. J Dermatol. 1997;24:675–7.

  55. 55.

    Park HS, Nahm D. Localized periorbital edema as a clinical manifestation of sulfite sensitivity. J Korean Med Sci. 1996;11:356–7.

  56. 56.

    Heshmati S, Maibach HI. Active sensitization to sodium metabisulfite in hydrocortisone cream. Contact Derm. 1999;41:166–7.

  57. 57.

    Harrison DA, Smith AG. Concomitant sensitivity to sodium metabisulfite and clobetasone butyrate in Trimovate cream. Contact Derm. 2002;46:310.

  58. 58.

    Tucker SC, Yell JA, Beck MH. Allergic contact dermatitis from sodium metabisulfite in Trimovate cream. Contact Derm. 1999;40:164.

  59. 59.

    Sánchez-Pérez J, Abajo P, Córdoba S, García-Díez A. Allergic contact dermatitis from sodium metabisulfite in an antihemorrhoidal cream. Contact Derm. 2000;42:176–7.

  60. 60.

    Landeck L, John SM, Geier J. Periorbital dermatitis in 4779 patients – patch test results during a 10-year period. Contact Derm. 2014;70:205–12.

  61. 61.

    Nowak D. Wirkung von Schwefeldioxid auf die Lungenfunktion bei einer Stichprobe der Allgemeinbevölkerung. In: Nowak D, editor. Klinisch-experimentelle und epidemiologische Untersuchungen zur Wirkung irritativer Berufs- und Umweltnoxen auf den Atemtrakt Theorie und Forschung, vol 473. Regensburg: Roderer; 1997. pp. 41–128.

  62. 62.

    Oliveira A, Amaro C, Cardoso J. Allergic contact dermatitis caused by sodium metabisulphite in a cosmetic bleaching cream. Australas J Dermatol. 2015;56:144–5.

  63. 63.

    Malik MM, Hegarty MA, Bourke JF. Sodium metabisulfite – a marker for cosmetic allergy? Contact Derm. 2007;56:241–2.

  64. 64.

    Nassif A. Ammonium bisulfite contact dermatitis: face eczema due to a bleaching ointment used during hair-dying. Contact Derm. 2006;55:124.

  65. 65.

    Ban GY, Kim MA, Yoo HS, et al. Letter to the editor. Two major phenotypes of sulfite hypersensitivity: asthma and urticaria. Yonsei Med J. 2014;55:542–4.

  66. 66.

    Belchi-Hernandez J, Florido-Lopez JF, Estrada-Rodriguez JL, et al. Sulfite-induced urticaria. Ann Allergy. 1993;71:230–2.

  67. 67.

    Wüthrich B. Flush and dyspnea after alcohol drinking. Is it a “wine allergy”? MMW Fortschr Med. 2002;144:37–8.

  68. 68.

    Chou CH, Hsu JY, Fu LS, et al. The air pollutant sodium sulfite enhances mite crude extract-stimulated detachment of A549 airway epithelium cells. J Microbiol Immunol Infect. 2008;41:26–31.

  69. 69.

    Andersson E, Knutsson A, Hagberg S, et al. Incidence of asthma among workers exposed to sulphur dioxide and other irritant gases. Eur Respir J. 2006;27:720–5.

  70. 70.

    Hein H, Kirsten D, Jörres RA, Magnussen H. Oral testing for sulfite asthma. Pneumologie. 1996;50:394–8.

  71. 71.

    Steinacker A. A suggested mechanism of action for sulfite sensitivity. J Allergy Clin Immunol. 1986;77:116–7.

  72. 72.

    Anonymus. Schwefeldioxid (Nachtrag 1998). In: Greim H, editor. Gesundheitsschädliche Arbeitsstoffe: Toxikologisch-arbeitsmedizinische Begründungen von MAK-Werten, 26th edn. Weinheim: Wiley-VCH; 1998.

  73. 73.

    Kleinhans D. Sensitivity of asthma patients to sulphur compounds in food, wine and injection solutions. Dtsch Med Wochenschr. 1982;107:1409–11.

  74. 74.

    Stevenson DD, Simon RA. Sulfites and asthma. J Allergy Clin Immunol. 1984;74:469–72.

  75. 75.

    Przybilla B, Ring J. Sulfit-Überempfindlichkeit. Hautarzt. 1987;38:445–8.

  76. 76.

    Jacobsen DW, Simon RA, Singh M. Sulfite oxidase deficiency and cobalamin protection in sulfite-sensitive asthmatics (SSA). J Allergy Clin Immunol. 1984;73:135.

  77. 77.

    Misso NL, Aggarwal S, Thompson PJ, Vally H. Increases in urinary 9alpha, 11beta-prostaglandin f2 indicate mast cell activation in wine-induced asthma. Int Arch Allergy Immunol. 2009;149:127–32.

  78. 78.

    Mansour E, Ahmed A, Cortes A, et al. Mechanisms of metabisulfite-induced bronchoconstriction: evidence for bradykinin B2-receptor stimulation. J Appl Physiol. 1992;72:1831–7.

  79. 79.

    Boxer MB, Bush RK, Harris KE, et al. The laboratory evaluation of IgE antibody to metabisulfites in patients skin test positive to metabisulfites. J Allergy Clin Immunol. 1988;82:622–6.

  80. 80.

    Sainte-Laudy J, Vallon C, Guérin JC. Demonstration of sulfite-group-specific IgE in patients with tolerance to preservatives. Allerg Immunol (Paris). 1994;26:132–134, 137–138.

  81. 81.

    Simon RA, Green L, Stevenson DD. The incidence of ingested metabisulfite sensitivity in an asthmatic population. J Allergy Clin Immunol. 1982;69:118.

  82. 82.

    Soulat JM, Bouju P, Oxeda C, Amiot JF. Anaphylactoid shock due to metabisulfites during cesarean section under peridural anesthesia. Cah Anaesthesiol. 1991;39:257–9.

  83. 83.

    Prenner BM, Stevens JJ. Anaphylaxis after ingestion of sodium bisulfite. Ann Allergy. 1976;37:180–2.

  84. 84.

    Jamieson DM, Guill MF, Wray BB, May JR. Metabisulfite sensitivity: case report and literature review. Ann Allergy. 1985;54:115–21.

  85. 85.

    Witek TJ Jr, Schachter EN. Detection of sulphur dioxide in bronchodilator aerosols. Chest. 1984;86:592–4.

  86. 86.

    Vissers-Croughs KJ, van der Kley AM, Vulto AG, Hulsmans RF. Allergic contact dermatitis from sodium sulfite. Contact Derm. 1988;18:252–3.

  87. 87.

    Levanti C, Ricciardi L, Isola S, et al. Burning mouth syndrome: hypersensitivity to sodium metabisulfite. Acta Derm Venereol. 1996;76:158–9.

  88. 88.

    Reese I, Zuberbier T, Bunselmeyer B, et al. Diagnostisches Vorgehen bei Verdacht auf eine pseudoallergische Reaktion durch Nahrungsmittelinhaltsstoffe. Allergo J. 2008;17:540–9.

  89. 89.

    Yang WH, Purchase EC, Rivington RN. Positive skin tests and Prausnitz-Küstner reactions in metabisulfite-sensitive subjects. J Allergy Clin Immunol. 1986;78:443–9.

  90. 90.

    Frick WE, Lemanske RF Jr.. Oral sulfite sensitivity and provocative challenge in a 2 year old. J Asthma. 1991;28:221–4.

  91. 91.

    Howland WC 3rd, Simon RA. Sulfite-treated lettuce challenges in sulfite-sensitive subjects with asthma. J Allergy Clin Immunol. 1989;83:1079–82.

  92. 92.

    Jäger L, Wüthrich B Nahrungsmittelzusatzstoffe. In: Jäger L, Wüthrich B, editors. Nahrungsmittelallergien und -intoleranzen, 2nd edn. München: Urban & Fischer; 2002. pp. 177–92.

  93. 93.

    Vally H, Thompson PJ, Misso NL. Changes in bronchial hyperresponsiveness following high- and low-sulphite wine challenges in wine-sensitive asthmatic patients. Clin Exp Allergy. 2007;37:1062–6.

  94. 94.

    Nowak D, Jörres R, Berger J, et al. Airway responsiveness to sulphur dioxide in an adult population sample. Am J Respir Crit Care Med. 1997;156:1151–6.

  95. 95.

    Koenig JQ, Pierson WE, Horike M, Frank R. Effects of inhaled sulphur dioxide (SO2) on pulmonary function in healthy adolescents: exposure of SO2 alone or SO2 + sodium chloride droplet aerosol during rest and exercise. Arch Environ Health. 1982;37:5–9.

  96. 96.

    Mahler V, Geier J, Schnuch A. Current trends in patch testing – new data from the German Contact Dermatitis Research Group (DKG) and the Information Network of Departments of Dermatology (IVDK). J Dtsch Dermatol Ges. 2014;12:583–92.

  97. 97.

    Schnuch A, Aberer W, Agathos M, et al. Durchführung des Epikutantests mit Kontaktallergenen, Leitlinien der Deutschen Dermatologischen Gesellschaft (DDG), Deutschen Gesellschaft für Allergie und klinische Immunologie (DGAKI). J Dtsch Dermatol Ges. 2008;6:770–5.

  98. 98.

    Uter W, Mackiewicz M, Schnuch A, Geier J. Interne Qualitätssicherung von Epikutantest-Daten des multizentrischen Projektes „Informationsverbund Dermatologischer Kliniken“ (IVDK). Dermatol Beruf Umw. 2005;53:107–14.

  99. 99.

    Apetato M, Marques MS. Contact dermatitis caused by sodium metabisulphite. Contact Derm. 1986;14:194.

  100. 100.

    Jacobs MC, Rycroft RJ. Contact dermatitis and asthma from sodium metabisulfite in a photographic technician. Contact Derm. 1995;33:65–6.

  101. 101.

    Aalto-Korte K, Suuronen K, Alanko K. Sodium metabisulfite – a contact allergen? Contact Derm. 2009;60:115–7.

  102. 102.

    Sasseville D, El-Helou T. Occupational allergic contact dermatitis from sodium metabisulfite. Contact Derm. 2009;61:244–5.

  103. 103.

    Mahler V. Chefs and Food handlers. In: Kanerva L, Elsner P, Wahlberg JE, Maibach HI, editors. Handbook of Occupational Dermatology. Berlin: Springer; 2000.

  104. 104.

    Bauer A, Geier J, Elsner P. Type IV allergy in the food processing industry: sensitization profiles in bakers, cooks and butchers. Contact Derm. 2002;46:228–35.

  105. 105.

    Steiner M, Scaife A, Semple S, et al. Sodium metabisulphite induced airways disease in the fishing and fish-processing industry. Occup Med (Lond). 2008;58:545–50.

  106. 106.

    Madan V, Beck MH. Sodium metabisulfite – a contact allergen? Contact Derm. 2009;61:58.

  107. 107.

    Maibach HI. Sodium metabisulfite: an allergen or a patch test irritant. 6th International Symposium on Contact Dermatitis, Erfurt. 1982.

  108. 108.

    De Groot AC, Weyland JW, Nater JP. (editors) Unwanted effects of cosmetics and drugs used in dermatology, 3rd ed. Amsterdam: Elsevier; 1994, p 64.

  109. 109.

    Oliphant T, Mitra A, Wilkinson M. Contact allergy to sodium sulfite and its relationship to sodium metabisulfite. Contact Derm. 2012;66:128–30.

  110. 110.

    Brasch J, Henseler T. The reaction index: a parameter to assess the quality of patch test preparations. Contact Derm. 1992;27:203–4.

  111. 111.

    Geier J, Uter W, Lessmann H, Schnuch A. The positivity ratio – another parameter to assess the diagnostic quality of a patch test preparation. Contact Derm. 2003;48:280–2.

  112. 112.

    Brasch J, Geier J. How to use the reaction index and positivity ratio. Contact Derm. 2008;59:63–5.

  113. 113.

    Brockow K, Garvey LH, Aberer W, et al. Skin test concentrations for systemically administered drugs – an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013;68:702–12.

  114. 114.

    Nater JP. Allergic contact dermatitis caused by potassium metabisulfite. Dermatologica. 1968;136:477–8.

  115. 115.

    Epstein E. Sodium bisulfite. Contact Dermat Newsl. 1970;7:155.

  116. 116.

    Lee A, Nixon R. Contact dermatitis from sodium metabisulfite in a baker. Contact Derm. 2001;44:127–8.

  117. 117.

    Acciai MC, Brusi C, Francalanci Giorgini S, Sertoli A. Allergic contact dermatitis in caterers. Contact Derm. 1993;29:48.

  118. 118.

    García Ortiz JC, Vega Gutiérrez JM, Pérez Velesar MJ, Medina AA. Occupational allergic contact dermatitis from potassium metabisulfite. Dermatitis. 2014;25:150–1.

  119. 119.

    Valero AL, Bescos M, Amat P, Malet A. Bronchial asthma caused by occupational sulfite exposure. Allergol Immunopathol (Madr). 1993;21:221–4.

  120. 120.

    Malo JL, Cartier A, Desjardins A. Occupational asthma caused by dry metabisulphite. Thorax. 1995;50:585–9.

  121. 121.

    Agard C, Nicolet-Akhavan F, Bouillard J, Sandron D. Occupational asthma to metabisulfites. Three cases. Rev Mal Respir. 1998;15:537–40.

  122. 122.

    Pougnet R, Loddé B, Lucas D, et al. A case of occupational asthma from metabisulphite in a fisherman. Int Marit Health. 2010;62:180–4.

  123. 123.

    Uriarte SA, Fernández-Nieto M, Arochena L, Sastre J. Occupational asthma in seafood manufacturing and food allergy to seafood. J Investig Allergol Clin Immunol. 2015;25:59–60.

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Correspondence to Prof. Dr. Vera Mahler.

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M. Häberle, J. Geier and V. Mahler declare that they have no competing interests.

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Häberle, M., Geier, J. & Mahler, V. Contact allergy and intolerance to sulphite compounds: clinical and occupational relevance. Allergo J Int 26, 53–66 (2017). https://doi.org/10.1007/s40629-016-0003-x

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  • Sulphite
  • Allergic contact dermatitis
  • Sulphite intolerance
  • Exposure
  • Occupation
  • Case series