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Sulphite hypersensitivity
Understand reactions, identify sulphites and confirm the diagnosis
In this sheet
Four essential points
Asthma is the most typical context
Reactions are mainly reported in people with asthma, with bronchospasm as a typical manifestation.
Symptoms may vary
A reaction may be respiratory, skin-related, digestive and, exceptionally, systemic.
There is no simple blood test to diagnose intolerance
There is no validated sulphite-specific IgE test for routine clinical practice.
An oral challenge is the reference test if confirmation is needed
It must be performed in a service experienced in challenges, never at home.
What symptoms may occur?
Breathing
Cough, tightness, wheezing, bronchospasm, asthma attack.
Nose and throat
A blocked or runny nose, nasal discomfort.
Skin
Redness, hives, itching, angioedema.
Digestive system
Abdominal pain, nausea, diarrhoea.
Severe reaction
Low blood pressure, systemic reaction or anaphylaxis: rare.
Where are sulphites found?
On a label, look especially for: sulphites · sulphur dioxide · metabisulphite · E220 to E228.
How can I identify them on a label?
Which foods are often involved?
Alcoholic drinks
Wine, some ciders and certain fermented or wine-based drinks.
Dried fruit
Dried apricots, raisins, figs, peaches, plums and dried bananas, depending on the product and treatment.
Processed potatoes and vegetables
Some prepared or dehydrated potatoes, white vegetables and dried mushrooms.
Crustaceans
Some fresh, frozen or cooked crustaceans may be treated with sulphites to limit darkening.
Condiments, sauces and preparations
Some sauces, industrial citrus juices, molasses, syrups and preparations using sulphited ingredients.
Medicines and care: what you need to know
Sulphites may be used as antioxidants or preservatives in some formulations. Their presence and amount vary by product, so the exact medicine must be checked.
Some adrenaline preparations
Some injectable adrenaline solutions and some auto-injectors contain sodium metabisulphite.
Adrenaline and emergencies
Sulphite sensitivity must never delay or prevent the use of adrenaline for anaphylaxis. When life is at risk, adrenaline remains indicated.
Dental anaesthesia
Some local anaesthetics containing adrenaline also contain sulphite or metabisulphite. Tell your dentist, but do not cancel anaesthesia yourself: an alternative can be chosen if necessary.
How is it diagnosed?
The history
This covers the product consumed, amount, delay, symptoms, reproducibility, presence of asthma, its level of control and associated medicines.
Skin tests?
For typical food intolerance, there is no standardised routine skin prick test that confirms or excludes non-IgE-mediated sulphite hypersensitivity.
Sulphite oral challenge
When the history is suggestive but the diagnosis uncertain, an oral sulphite challenge may be offered at a specialist centre, with increasing doses according to the service protocol. In someone with asthma, the team may monitor symptoms, chest examination, oxygen saturation and respiratory function.
Rare IgE-mediated allergy
Very rare cases have demonstrated an IgE-mediated mechanism with a positive skin test to metabisulphite and a reproducible reaction. This exists, but remains exceptional and is not the usual mechanism.
What about patch tests?
Sodium metabisulphite can cause true allergic contact dermatitis. A patch test may be relevant in this context.
A positive patch test does not mean food intolerance to sulphites. Contact allergy and food hypersensitivity are two different problems.
Never reproduce a ‘sulphite test’ at home
A challenge must be performed in a medical setting, with stopping criteria and treatments immediately available.
What should I do if I have asthma?
The most important point is to keep asthma properly controlled. If a respiratory reaction occurs after a product containing sulphites: write down the product, photograph the label, note the timing and medicines used, then report the episode to your doctor. Do not change your maintenance treatment on your own.
What should I avoid?
Avoidance must be targeted. If hypersensitivity is confirmed, the priority is to identify sources that have actually caused reactions, read labels and adapt avoidance to the individual threshold.
Practical priorities
Check first
Wine or sulphited drinks, dried fruit and sulphite-rich products that have already caused symptoms.
Look for on the label
E220-E228, sauces, condiments, processed potatoes, crustaceans and relevant industrial products.
Depending on your history
Medicines containing metabisulphite, particularly some injectable forms or dental anaesthetics containing adrenaline.
Do not remove unnecessarily
Foods without sulphites, sulphates, foods naturally containing sulphur and sulphonamide medicines.
Common misconceptions
‘Sulphites mean sulphur allergy.’
False.
‘I must avoid sulphates.’
No.
‘I must avoid every sulphonamide antibiotic.’
No: there is no automatic link.
‘A negative skin test excludes sulphite intolerance.’
No. There is no sufficiently validated routine skin prick test.
‘If I react to wine, it must be the sulphites.’
No. Wine contains other substances that may cause symptoms.
‘Every food containing a little sulphite will cause a reaction.’
No. The individual threshold and dose matter.
‘If I am sensitive to sulphites, I cannot receive adrenaline.’
False and potentially dangerous: adrenaline remains the priority in anaphylaxis.
‘A positive metabisulphite patch test means food intolerance.’
No. Contact allergy is a different problem.
Key takeaways
- Reactions to sulphites are most often non-IgE-mediated hypersensitivity, particularly in some patients with asthma.
- Bronchospasm, hives, digestive symptoms or systemic reactions are possible, but not every reaction after sulphited food is caused by sulphites.
- Look for ‘sulphites’ and E220-E228 on labels.
- In Europe, they must be declared above 10 mg/kg or 10 mg/L.
- Diagnosis is based mainly on the history and, if necessary, a medically supervised oral challenge.
- A true IgE-mediated sulphite allergy exists, but is rare.
- Do not remove medicines or foods excessively without diagnostic confirmation.
You may also want to read
Main references
- AAAAI-EAACI PRACTALL. Standardizing oral food challenges - 2024 Update.
- Babbel J, et al. Adverse reactions to food additives. J Food Allergy. 2021.
- Vally H, Misso NLA. Adverse reactions to the sulphite additives. Review.
- Simon RA, Stevenson DD. Travaux de référence sur la provocation orale aux sulfites et l’asthme.
- Sokol WN, Hydick IB. Réaction IgE-médiée au métabisulfite. Ann Allergy. 1990.
- American Contact Dermatitis Society. Sulfites: Allergen of the Year 2024.
- Règlements UE 1169/2011 et 1333/2008 : étiquetage et usages alimentaires des sulfites.
General information: Information for patients and carers. This sheet does not replace a medical consultation or personalised advice from your healthcare professional.
Scientific review: September 2026 · sosallergo.fr