Drug additives intolerance

L. Juhlin, Intolerance to food and drug additives , in A. L. Week and H. Bundgaard (eds.). Allergic Reactions to Drugs, Berlin, Springer Verlag, 1983. 

It seems clear that all patients with urticaria should avoid taking aspirin in any form (Kaplan 1978). Care should be taken also to exclude from the diet food and drug additives and colorants (e. g., benzoates, or tartrazine) to which some patients are intolerant (Juhlin et al. 1972). Recent surveys report intolerance to tartrazine (a yellow dye widely used with foods, drinks, and drugs) as amounting to 8% (Set-tipane et al. 1976) and 13% (Dry et al. 1979) among patients with chronic urticaria. A simple diet free of aspirin and food and drug additives leads to rapid improvement in a substantial number of patients with chronic urticaria (Rudzki 1977). 

The miscellaneous drugp are used to treat a variety of musculoskeletal disorders. Ffenicillamine, methotrexate (MTX), and hydroxychloroquine are used to treat rheumatoid arthritis in patients who have had an insufficient therapeutic response to or are intolerant of other antirheumatic drugp such as the sailcylates and NSAIDs. The Summary Drug Table Drug s Used to Tream Musculoskeletal Disorders provides additional information about these and other drug s. One compound, hylan G-F 20, listed in the Summary Drug Table is not used for rheumatoid arthritis, but rather, for osteoarthritis knee pain. It is a viscous, elastic... 

Failure of initial therapy should result in addition of another class of drug. Substitution of a drug from another class should be reserved for drug intolerance. Metformin and an insulin secretagogue are often first- and second-line therapy. 

In addition to the somatic side-effects of neuroleptics, there are a number of important psychiatric side-effects, such as demotivation or indifference (a direct effect of most drugs, actually part of the definition of the neuroleptic effect). This may mimic the negative features of the illness and may lead to prescriptions of an antidepressant when a reduction in dose or change of antipsychotic may be more appropriate. A second key problem is anxious activation or akathisia. This dose-dependent dysphoric state may lead to an apparent worsening in the clinical picture and accordingly an increase in antipsychotic dose rather than decrease and may be so intolerable as to lead on to suicide. 

Trace analysis by IR spectroscopy, involving pre-concentration, separation, and computer techniques has been reported by Hannah et al. (1978). The term trace analysis is used to refer to concentrations in the ppm range up to 1%. In instances where interference is at its minimum, analysis may be performed in a straightforward manner by using difference techniques. However, there are many cases in which analysis may be complicated by the fact that the trace material is structurally similar to the matrix material. Moreover, the presence of other trace compounds is intolerable if their spectra interfere with that of the compound under investigation. In this case it is often necessary to use pre-concentration or separation techniques. This method is illustrated by analyses of aromatic isomers, gasoline additives, drugs, and polymer additives. The different aspects of trace analyses by infrared spectroscopy are discussed by Smith (1986). 

As noted above, ascorbic acid can sometimes cause immune reactions. Ascorbic acid and citric acid are used as food additives, ascorbic acid (E300) as an acidifier, an antioxidant, and an additive in wheat, and citric acid as an acidifying complex-binding agent. Because additives are widely used in foods, beverages, and drugs, people with allergies or intolerance have to be carefully instructed. Caution must also be taken when scratch tests are performed with these substances (34). 

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