More Than a Drink: A Rare Anaphylactic Reaction to Sparkling Water

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Allergy and Airway SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Anaphylaxis is a severe, potentially life threatening, type I hypersensitivity reaction which can occur within seconds to minutes after exposure to an allergen. Sulfites have been implicated in causing symptoms ranging from mild wheezing to a potentially life threatening anaphylactic reaction. Here we present a patient who had an anaphylactic reaction secondary to exposure to sulfites present in sparkling water. CASE PRESENTATION: A 25 year old female with a past medical history of asthma and anaphylactic reactions to multiple medications, including sulfa antibiotics, presented with a facial rash, pruritus, swelling of the tongue, difficulty swallowing and shortness of breath shortly after drinking sparkling water. She was initially given diphenhydramine, ranitidine and methylprednisone at an urgent care center and was transferred to the emergency department (ED) for incomplete resolution of her symptoms. She was given epinephrine and intravenous fluid in ED. She was admitted to the ICU and given intravenous methylprednisone, famotidine, diphenhydramine and albuterol inhalation with subsequent symptomatic improvement. At one point during hospitalization, she drank the same water which precipitated an additional anaphylactic reaction, that could not be explained by any new medications. Given her significant allergy history as well as familial allergy history, C1 esterase inhibitor and complement levels were tested which was found to be normal. DISCUSSION: Sulfites are widely used as a preservatives in food, beverages (beers/wines), medications and are also known to be present in mineral water. Some mineral waters have over 410mg/L of sulfate. Allergies to sulfur are common, including well known reactions to certain antibiotics, and other medications. Sulfite sensitivity occurs most often in asthmatic adults, with reactions being extremely rare in non-asthmatics. Asthmatics who have a higher degree of airway hyper-reactivity may be at greater risk. Our patient had asthma and a known allergy to sulfa medications, and presented with an anaphylactic reaction after consuming sparkling water, which contained sulfites. Therefore asthmatics, who also have a severe sulfa allergy should take care while consuming food or beverages containing sulfites in addition to avoiding sulfa medications. CONCLUSIONS: The purpose of this case report is to bring light to the fact that people who have sulfur intolerance can suffer reactions to even small amounts of sulfur compounds, such as those contained in mineral water. In addition, those patients with asthma may be at a greater risk for developing sulfur related reactions. Reference #1: Lester MR. Sulfite sensitivity: significance in human health. J Am Coll Nutr. 1995;14(3):229-32. Reference #2: Marenco arellano V, Reaño martos M, Rodriguez cabreros M, Bueso fernández A, Garcia loria J, Rodríguez mosquera M. Sulfite sensitivity in a patient with allergic asthma. Allergol Immunopathol (Madr). 2011;39(5):306-7. DISCLOSURE: The following authors have nothing to disclose: Rogin Subedi, Ryan Dean, Anil Ghimire No Product/Research Disclosure Information