Dose-Dependent Bronchospasm From Sulfites in Isoetharine

• Published in: JAMA : the journal of the American Medical Association Vol. 251; no. 22; pp. 2982 - 2983
• Main Authors: Koepke, Jerald W, Christopher, Kent L, Chai, Hyman, Selner, John C
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 08-06-1984
• Subjects: Adult; Amino Alcohols - adverse effects; Asthma - chemically induced; Biological and medical sciences; Bronchial Spasm - chemically induced; Bronchial Spasm - physiopathology; case studies; Dose-Response Relationship, Drug; Drug Hypersensitivity - etiology; drug therapy; Drug toxicity and drugs side effects treatment; Female; food sensitivity; Forced Expiratory Volume; hazards; Humans; hypersensitivity; Isoetharine - adverse effects; Medical sciences; Pharmaceutic Aids - adverse effects; Pharmacology. Drug treatments; Preservatives, Pharmaceutical - adverse effects; Respiratory Hypersensitivity - chemically induced; respiratory tract diseases; risk; sulfites; Sulfites - adverse effects; sulfur; Toxicity: respiratory system, ent, stomatology; Bronchospasm; Sulfites; Impurity; Toxicity; Bronchodilator; Dose activity relation
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.1984.03340460060024

ADVERSE reactions to sulfiting agents used as preservatives in foods and medications are being reported with increasing frequency.1 Many bronchodilator solutions contain sulfites as antioxidants. We have previously called attention to the fact that sulfite-preserved bronchodilator solutions will liberate sulfur dioxide when nebulized.2 Since the asthmatic airway has a heightened reactivity to sulfur dioxide, such exposure could place the asthmatic patient at risk.3 This article describes an asthmatic patient who experienced a paradoxical response to isoetharine containing sodium bisulfite as preservative.Report of a CaseThe patient was a 31-year-old aspirin-sensitive asthmatic woman whose condition was first diagnosed when she was 9 years of age. In addition to bronchodilators, she had been taking daily steroids since the age of 10 years. Between 1972 and 1975, the patient experienced four episodes of severe wheezing following the ingestion of dried apricots, wine, a restaurant salad, and guacamole dip. The