From Patch to Plate: Evaluation of Systemic Symptoms in Patients With Positive Patch Test Reactions to Sodium Disulfite

<u><b><i></i></b></u> <u><b><i>Background:</i></b></u> Sodium disulfite is a well-established contact allergen. Whether individuals with this contact allergy also experience systemic symptoms after ingesting sulfites remains unclear.<u><b><i>Objective:</i></b></u> To evaluate whether patients with positive patch test reactions to sodium disulfite report systemic symptoms after consuming high-sulfite-containing foods and beverages compared with patch test-negative controls.<u><b><i>Methods:</i></b></u> In this retrospective cross-sectional study, 41 patients with positive and 41 patients with negative patch tests to sodium disulfite completed a standardized survey assessing symptoms (eg, headache, coughing, gastrointestinal distress) following consumption of high-sulfite foods and beverages. Symptom frequency, severity, and triggers were analyzed and compared between groups.<u><b><i>Results:</i></b></u> Systemic symptoms were significantly more common among patch test-positive individuals (57.9%) compared with controls (26.8%, <i>P</i> = 0.005), particularly with wine (58.1% vs 25.6%, <i>P</i> = 0.006). Stronger patch test reactions correlated with greater symptom frequency and severity.<u><b><i>Conclusions:</i></b></u> Patients with sodium disulfite contact allergy more frequently report systemic symptoms after ingesting high-sulfite foods and beverages. These findings suggest a possible overlap between contact allergy and systemic intolerance, supporting a potential role for dietary counseling in select patch test-positive patients.