Aspirin and concomitant idiosyncrasies in adult asthmatic patients. Aspirin and tartrazine oral challenge: incidence of adverse response in chronic childhood asthma. Oral tartrazine challenge in childhood asthma: effect on bronchial reactivity. Tartrazine and benzoate challenge and dietary avoidance in chronic asthma. Intolerance to tartrazine in aspirin-induced asthma: results of a multicenter study.
The nasal and respiratory symptoms observed after oral challenge to aspirin (ASA), tartrazine, and other nonsteroidal anti-inflammatory substances are best described as idiosyncratic reactions. A positive response to oral challenge, defined as a 20% fall in forced expiratory volume in 1 sec (FEV1) from baseline for up to 4 hr, occurred in 44 of 230 patients with ASA, 11 of 277 with tartrazine, 2 of 93 with sodium salicylate, and 2 of 69 with acetaminophen. No one had a positive response to tartrazine, sodium salicylate, or acetaminophen who was not also positive to ASA. The dose of ASA causing a positive response was less than 5 grains in 95% of the patients. Of 50 patients with a suspicious history studied in detail, 96% of those with ASA idiosyncrasy had sinusitis and 71% had nasal polyps. Methacholine challenges and random circulating and sputum eosinophils did not differentiate patients with a negative challenge from those with a positive challenge. However, patients with a positive history and positive challenge had significantly more random nasal eosinophils than those with negative aspirin challenges. The term "aspirin triad" has outlived its usefulness since ASA idiosyncrasy can exist in patients lacking certain components of the triad. ASA idiosyncrasy is unsuspected in many patients and possibly overdiagnosed in others. nan Ten asthmatic children who gave a history of cough or wheeze after orange drinks, were tested for tartrazine sensitivity. On separate days, either oral tartrazine (1 mg) or a placebo capsule were administered double blind. Bronchial reactivity was measured before, 30 and 60 min after ingestion by means of a histamine-inhalation challenge test. There was no change in baseline lung function after tartrazine, but histamine sensitivity (PC20) increased significantly in four of the children. No response was obtained to a larger dose of tartrazine (10 mg) in four of the non-responders. Alteration in the bronchial reactivity after an oral challenge, appears to be a sensitive means of detecting tartrazine sensitivity. This study undertook to determine the usefulness of tartrazine and benzoate challenge and dietary avoidance in the management of patients with chronic asthma. Double-blind ingestion-challenge tests were performed on separate days with lactose, tartrazine, benzoate and acetylsalicyclic acid (ASA). Of the twenty-eight subjects challenged, one responded to tartrazine and one to benzoate. Two additional subjects responded to ASA and a further eight were not tested with this material because of a definite history of sensitivity. Twenty-four subjects completed 1 month periods of observation while first on a normal diet and then while on a tartrazine-benzoate avoidance diet. No improvement occurred during the modified diet in anyone with positive challenge-tests or in all, but one, of those with a history of ASA idiosyncrasy; paradoxically, several of these subjects worsened during this period. We conclude that tartrazine-benzoate dietary avoidance was not of value in the management of the chronic asthmatic in this study, even among patients who respond to challenge with these substances or have ASA idiosyncrasy. One hundred and fifty-six German, Italian and Polish patients with confirmed aspirin-induced asthma underwent open oral challenges with increasing doses of tartrazine up to 25 mg. All positive challenges were repeated under double-blind conditions. Only 4 of 156 patients (all Polish) had positive reactions in a double-blind test, as evidenced by a fall in FEV1 greater than 25% from baseline and corresponding clinical symptoms. Sixty-five patients who tolerated 25 mg tartrazine well received 50-3,000 mg tartrazine and none showed adverse reactions. Thus, intolerance to tartrazine appears to be rare among Central-European and South-European patients with aspirin-induced asthma, its frequency amounting to about 2.6%.