Tartrazine


Tartrazine is an azo dye used in many foods an drugs including antibiotics, antihistamines, steroids, bronchodilators and antidepressants (imipramine, desipramine, amitriptyline).
 
Incidence
0.1 to 6 subjects /1 000.
 
Clinical manifestations
General: anaphylactic shock.
 
Respiratory: bronchospasm.
 
Cutaneous: urticaria (acute and chronic), angioedema, fixed drug eruption, contact dermatitis, allergic vasculitis.
E.N.T.: rhinitis.
 
Diagnostic methods
The oral challenge with tartrazine is a only reliable method of accurate diagnosis:
 
Urticaria: tartrazine 1,5,25 and 50 mg at 30 minute intervals.
 
Asthma: tartrazine 0,1 mg to 50 mg at 30 minute intervals.
 
Mechanisms
Direct histamine release?
 
Management
Tartrazine free diet and avoidance of all drugs containing tartrazine. If symptoms improve, re-challenge with tartrazine. Reappearance of symptoms is sufficient proof of tartrazine hypersensitivity.
 
In obscure cases, perform oral challenge.
 
No cross reaction has been demonstrated between tartrazine and aspirin with regard to respiratory symptoms. Consequently, no avoidance of tartrazine in aspirin-allergic patients unless an adverse reaction has been observed in challenge tests.

References

  1. Orchard D.C, Varigos G.A, "Fixed drug eruption to tartrazine", Austral. J. Dermatol., 1997; 38 (4): 212-4
  2. Dipalma J.R, "Tartrazine sensitivity", Am. Fam. Physician., 1990; 42 (5): 1347-50 
  3. Stevenson D.D, Simon R.A, Lumry W.R, Mathison D.A, "Adverse reactions to tartrazine", J. Allergy Clin. Immunol., 1986; 78: 182-91. 
  4. Collins-Williams C, "Clinical spectrum of adverse reactions to tartrazine", J. Asthma, 1985; 22 (3): 139-43.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.