Asthma, Rhinorrhea, and Nasal Polyps

Aspirin is known to cause serious reactions in certain patients with asthma (Cooke 1919). The patients can also have rhinorrhea and nasal polyps that may precede the bronchoconstrictor type of intolerance to aspirin for months or years. This triad of symptoms is common in middle-aged women. The aspirin-sensitive patients often show intolerance to other analgesics (Smith 1971). Speer (1958) reported that color additives can precipitate asthma. Aspirin-sensitive patients with asthma also cross-react to tartrazine in 8%-15% of the cases (Chafee and Setti-PANE 1967 Samter and Beers 1967 Hosen 1972 Settipane and Pudupakkam 1975 Delaney 1976) and to various benzoates (Juhlin et al. 1972 Rosenhall and Zetterstrom 1973). Hypersensitivity to food colorants, preservatives, and analgesics was studied in 504 patients with asthma and rhinitis by Rosenhall (1977). Hypersensitivity to at least one of the substances was found in 106 patients. In 33 patients sensitive to tartrazine 42% were intolerant to aspirin and 39% to sodium benzoate. Rosenhall also tested his patients with other azo dyes such as Sunset Yellow and New Coccine as well as the non-azo dyes carmine and patent blue. The method of examination and reproducibility of the results were studied in detail. Dietary treatment was found to be effective in some patients in preventing exacerbations of the disease but on the whole had no influence on the course of the disease or the need for medication. 

Stenius and Lemola (1976) tested 140 asthmatics for sensitivity to aspirin and tartrazine. Most of the patients sensitive to tartrazine also reacted to aspirin. In one-third of the tartrazine-sensitive patients a history of reaction to colored additives in food and drinks was obtained. They recommended that tests for sensitiv- 

Reactions to tartrazine have also been described in children (Speer 1958). Vedanthan et al. (1977) found no adverse response after tartrazine provocation in 56 asthmatic children. Syvanen and Backman (1978) reported 32 children with asthma where intolerance to aspirin was seen in 33%, to sodium benzoate in 18%, and to tartrazine in 20%. 0sterballe et al. (1979) in a primary screening found that 11 of 46 children with asthma had positive reactions to aspirin benzoates or dyes. In a double-blind retesting with placebo, however, only 3 of 46 children reacted. Similar results were reported by Weber et al. (1979) in 45 patients with moderately severe asthma. 

Gum acacia and tragacanth are used in tablets, suppositories, vaginal jellies, and diabetic foods as excipients. A few cases of asthma have been reported to such vegetable gums (Gelfand 1943). Brown and Crepea (1947) reported a patient who was sensitive to tablets containing 0.005 mg tragacanth. 

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