Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2001;2001(4):CD000460.
doi: 10.1002/14651858.CD000460.

Tartrazine exclusion for allergic asthma

K D Ardern  1 , F S Ram
Affiliations

Tartrazine exclusion for allergic asthma

K D Ardern et al. Cochrane Database Syst Rev. 2001.

Abstract

Background: Tartrazine is the best known and one of the most commonly used food additives. Food colorants are also used in many medications as well as foods. There has been conflicting evidence as to whether tartrazine causes exacerbations of asthma with some studies finding a positive association especially in individuals with cross-sensitivity to aspirin.

Objectives: To assess the overall effect of tartrazine (exclusion or challenge) in the management of asthma.

Search strategy: A search was carried out using the Cochrane Airways Group specialised register. Bibliographies of each RCT was searched for additional papers. Authors of identified RCTs were contacted for further information for their trials and details of other studies.

Selection criteria: RCTs of oral administration of tartrazine (as a challenge) versus placebo or dietary avoidance of tartrazine versus normal diet were considered. Studies which focused upon allergic asthma, were also included. Studies of tartrazine exclusion for other allergic conditions such as hay fever, allergic rhinitis and eczema were only considered if the results for subjects with asthma were separately identified. Trials could be in either adults or children with asthma or allergic asthma (e.g. sensitivity to aspirin or food items known to contain tartrazine).

Data collection and analysis: Study quality was assessed and data abstracted by two reviewers independently. Outcomes were analysed using RevMan 4.1.1.

Main results: Ninety abstracts were found, of which 18 were potentially relevant. Six met the inclusion criteria, but only three presented results in a format that permitted analysis and none could be combined in a meta-analysis. In none of the studies did tartrazine challenge or avoidance in diet significantly alter asthma outcomes.

Reviewer's conclusions: Due to the paucity of available evidence, it is not possible to provide firm conclusions as to the effects of tartrazine on asthma control. However, the six RCTs that could be included in this review all arrived at the same conclusion. Routine tartrazine exclusion may not benefit most patients, except those very few individuals with proven sensitivity.

PubMed Disclaimer

Conflict of interest statement

There are no known conflicts of interest

Figures

1.1
1.1. Analysis
Comparison 1 Tartrazine challenge versus Placebo, Outcome 1 PC20 ‐ Histamine (mg/ml).
1.2
1.2. Analysis
Comparison 1 Tartrazine challenge versus Placebo, Outcome 2 PEFR (litres/min).
1.4
1.4. Analysis
Comparison 1 Tartrazine challenge versus Placebo, Outcome 4 Adverse Events.
2.1
2.1. Analysis
Comparison 2 Tartrazine avoidance diet versus Normal diet, Outcome 1 PEFR (litres/min).
2.2
2.2. Analysis
Comparison 2 Tartrazine avoidance diet versus Normal diet, Outcome 2 Asthma symptom score (higher score worse).
2.3
2.3. Analysis
Comparison 2 Tartrazine avoidance diet versus Normal diet, Outcome 3 Inhaled asthma medication requirements.
See this image and copyright information in PMC

References

References to studies included in this review

Hariparsad 1984 {published data only}
    1. Hariparsad D, Wilson N, Dixon C, Silverman M. Oral tartrazine challenge in childhood asthma: effect on bronchial reactivity. Clinical Allergy 1984;4:81‐5. - PubMed
Spector 1979 {published data only}
    1. Spector SL, Wangaard C, Farr RS. Aspirin and concomitant idiosyncrasies in adult asthmatic patients. Journal of Allergy & Clinical Immunology 1979;64(6):500‐6. - PubMed
Tarlo 1982 {published data only}
    1. Tarlo SM, Broder I. Tartrazine and benzoate challenge and dietary avoidance in chronic asthma. Clinical Allergy 1982;12:303‐12. - PubMed
Vedanthan 1977 {published data only}
    1. Vedanthan PK, Menon MM, Bell TD, Bergin D. Aspirin and tartrazine oral challenge: incidence of adverse response in chronic childhood asthma. Journal of Allergy & Clinical Immunology 1977;60(1):8‐13. - PubMed
Virchow 1988 {published data only}
    1. Virchow C, Szczeklik A, Bianco S, Schmitz‐Schumann M, Juhl E, Robuschi M, et al. Intolerance to tartrazine in aspirin‐induced asthma: results of a multicenter study. Respiration 1988;53(1):20‐3. - PubMed
Weber 1979 {published data only}
    1. Weber RW, Hoffman M, Raine DA, Nelson HS. Incidence of bronchoconstriction due to aspirin, azo dyes, non‐azo dyes, and preservatives in a population of perennial asthmatics. Journal of Allergy & Clinical Immunology 1979;64(1):32‐7. - PubMed

References to studies excluded from this review

Adler 1991 {published data only}
    1. Adler BR, Assadullahi T, Warner JA, Warner JO. Evaluation of a multiple food specific IgE antibody test compared to parental perception, allergy skin tests and RAST. Clinical and Experimental Allergy 1991;21:683‐8. - PubMed
Collins‐W 1985 {published data only}
    1. Collins‐Williams C. Clinical spectrum of adverse reactions to tartrazine. Journal of Asthma 1985;22(3):139‐43. - PubMed
Delaney 1976 {published data only}
    1. Delaney JC. Response of patients with asthma and aspirin idosyncrasy to tartrazine (a drug commonly used in the food and drug industries). The Practitioner 1976;217:285‐7. - PubMed
Freedman 1977 {published data only}
    1. Freedman BJ. Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. Clinical Allergy 1977;7:407‐15. [PMID: 412611] - PubMed
Fuglsang 1994 {published data only}
    1. Fulgsang GM, Halken C, Jorgensen M, Ostergaard PA, Osterballe O. Adverse reactions to food additives in children with atopic symptoms. Allergy 1994;49:31‐7. - PubMed
Grzelewska‐R 1986 {published data only}
    1. Grzelewska‐Rzymowska I, Szmidt M, Kowalski ML, Rozniecki J. Sensitivity and tolerance to tartrazine in aspirin‐sensitive asthmatics. Allergologia et Immunopathologia 1986;14(1):31‐6. [PMID: 3962814] - PubMed
    1. Grzelewska‐Rzymowska I, Szmidt M, Kowalski ML, Rozniecki J. Tartrazine hypersensitivity in patients with asthma and aspirin hypersensitivity [Nadwrazliwosc na tartrazine u chorych na astme z nadwrazliwoscia na aspiryne]. Polskie Archiwum Medycyny Wewnetrznej 1984;72(5):237‐42. - PubMed
Morales 1985 {published data only}
    1. Morales MC, Basomba A, Pelaez A, Garcia Villalmanzo I, Campos A. Challenge tests with tartrazine in patients with asthma associated intolerance to analgesics (ASA‐Triad). A comparative study with placebo. Clinical Allergy 1985;15(1):55‐9. - PubMed
Schneider 1996 {published data only}
    1. Schneider LC, Lester MR. Atopic disease, rhinitis and conjunctivitis and upper respiratory infections. Current Opinion in Pediatrics 1996;8:531‐40. - PubMed
Settipane 1975 {published data only}
    1. Settipane GA, Pudupakkam RK. Aspirin intolerance. iii. Subtypes, familial occurrence and cross‐reactivity with tartrazine. Journal of Allergy & Clinical Immunology 1975;56(3):215‐21. - PubMed
Stenius 1976 {published data only}
    1. Stenius BSM, Lemola M. Hypersensitivity to acetylsalicylic acid (ASA) and tartrazine in patients with asthma. Clinical Allergy 1976;6:119‐29. - PubMed
Timberlake 1992 {published data only}
    1. Timberlake CM, Toun AK, Hudson BJ. Precipitation of asthma attacks in Melanesian adults by sodium metabisulphite. Papua New Guinea Medical Journal 1992;35:186‐90. - PubMed
Wilson 1989 {published data only}
    1. Wilson N, Scott A. A double‐blind assessment of additive intolerance in children using a 12 day challenge period at home. Clinical and Experimental Allergy 1989;19:267‐72. - PubMed

References to studies awaiting assessment

Park 2008 {published data only}
    1. Park HW, Park CH, Park SH, Park JY, Park HS, Yang HJ, et al. Dermatologic adverse reactions to 7 common food additives in patients with allergic diseases: A double‐blind, placebo‐controlled study. Journal of Allergy and Clinical Immunology 2008;121(4):1059‐61. - PubMed
Pestana 2010 {published data only}
    1. Pestana S, Moreira M, Olej B. Safety of ingestion of yellow tartrazine by double‐blind placebo controlled challenge in 26 atopic adults. Allergologia Et Immunopathologia 2010;38(3):142‐6. - PubMed

Additional references

Genton 1985
    1. Genton C, Frei PC, Pecoud A. Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria. Journal of Allergy & Clinical Immunology 1985;76(1):40‐5. - PubMed
Lockey 1977
    1. Lockey SD Sr. Hypersensitivity to tartrazine (FD&C Yellow No. 5) and other dyes and additives present in foods and pharmaceutical products. Annals of Allergy 1977;38(3):206‐10. - PubMed
MacCara 1982
    1. MacCara ME. Tartrazine: a potentially hazardous dye in Canadian drugs. Canadian Medical Association Journal 1982;126(8):910‐4. - PMC - PubMed
Pollock 1989
    1. Pollock I, Young E, Stoneham M, Slater N, Wilkinson JD, Warner JO. Survey of colourings and preservatives in drugs. BMJ 1989;299(6700):649‐51. - PMC - PubMed
Simon 1986
    1. Simon RA. Adverse reactions to food additives. New England & Regional Allergy Proceedings 1986;7(6):533‐42. - PubMed
Smith 1976
    1. Smith LJ, Slavin RG. Drugs containing tartrazine dye. Journal of Allergy & Clinical Immunology 1976;58(4):456‐70. - PubMed

Publication types

MeSH terms