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Beware- Even sparkling water may cause life threatening allergy

Beware- Even sparkling water may cause life threatening allergy

Beware- Even sparkling water may cause life-threatening allergy. It is a festive season and sparkling water is often mixed with alcohol to attain the desired dilution. But better be careful, even an innocuous drink like sparkling water may be dangerous.

Although in medical science it is a common and established dictum that Anything below Sun including Sun can cause allergy. But in a day to day life it is difficult to comprehend that sparkling water could be hazardous.

Dr Ryan K. Dean, at Department of Medicine, SUNY Upstate Medical University, East Adams Street,  reported a case in which sparkling water almost took away the life of a patient. This rare case of Anaphylactic reaction to sparkling water appeared in The American Journal of Emergency Medicine.

According to history a  25-year-old female presented with a facial rash, generalized pruritus, swelling of the tongue, difficulty swallowing and shortness of breath shortly after drinking sparkling water. She had a past medical history of asthma and anaphylactic reactions to multiple medications, including sulfa antibiotics. She was panting for breath and this condition for sure developed after consumption of sparkling water drink. 

She was immediately given diphenhydramine, ranitidine and methylprednisolone at an urgent care centre and was transferred to the emergency department (ED) for incomplete resolution of her symptoms. 

There she was given epinephrine and intravenous fluids and was admitted to the ICU. She was also given intravenous methylprednisolone, famotidine, diphenhydramine and albuterol nebulizers with subsequent symptomatic improvement. At one point during hospitalization, she was re-challenged with the same sparkling water, which precipitated an additional anaphylactic reaction. It is presumed that sulfites in sparkling water were the offending agents.

These reactions could not be explained by any new medications. Given her significant allergy history as well as familial allergy history, a C1 esterase inhibitor and complement levels were tested and were ultimately found to be normal.

Learning points

  • Sulfiting agents (sulfur dioxide and the sodium and potassium salts of bisulfites, sulfite, and metabisulfites) are widely used, mainly for its inherent cleaning and disinfecting properties. It also has use as a preservative in food, alcoholic beverages such as beer and wine, and medications. In the food industry, sulfites are used to prevent the growth of bacteria, maintain the colour of the food, and allow for a longer shelf life.
  • Allergies to sulfur are common, but mainly appear when the patient takes certain medications that contain sulfur. However, “sulfa allergies” are a response to sulfonamides, which is a different molecule than the sulfites. While the allergies to sulfa-containing drugs are usually easy to diagnose, determining other sensitivities are often not. Patients can develop sensitivities to seemingly anything. 
  • Reports of sulfite intolerance or hypersensitivity have been increasing in frequency. In addition, those patients with asthma may be at a greater risk for developing sulfite related reactions. It is important for clinicians to be aware of these reactions in order to educate patients to avoid such precipitants, including sparkling waters.
  • This makes it easy to see how it can be challenging to determine the specific culprit for a reaction from the patient. Actually making a diagnosis of sensitivity to a specific entity requires a provocative challenge.
  • Something as small and minor as sulfite can be easily overlooked in the search for the cause of an adverse reaction

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Source: With inputs from American Journal of Emergency Medicine

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