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Diet & Asthma
Research Menu Page ||| Last update 11/18/2013

Listed in reverse date order:
Fasmer 2010 Comorbidity of Asthma With ADHD.
Strassburger 2010 Nutritional errors in the first months of life and their association with asthma and atopy in preschool children.
Healy 2008   Control of salicylate intolerance with fish oils.
Devereux 2006 The increase in the prevalence of asthma and allergy: food for thought.
Andrews 2004 Impact of racemic albuterol compared to levalbuterol on objective measures of hyperactivity and inattentiveness in children with asthma.
Yusoff 2004 The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study.
Vally 2002 The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients.
Asmus 2001 Pulmonary function response to EDTA, an additive in nebulized bronchodilators.
Yoneyama 2000 The effect of DPT and BCG vaccinations on atopic disorders.
Nagakura 2000 Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma.
Niles 2000 Sulfur-induced polioencephalomalacia in stocker calves.
Vally 2000 Alcoholic drinks: important triggers for asthma.
Asmus 1999 Bronchoconstrictor additives in bronchodilator solutions.
Smit 1999 Dietary influences on chronic obstructive lung disease and asthma: a review of the epidemiological evidence.
Yoshida 1999 Amalgam allergy associated with exacerbation of aspirin-intolerant asthma.
Arai 1998 Food and food additives hypersensitivity in adult asthmatics. I. Skin scratch test with food allergens and food challenge in adult asthmatics.
Arai 1998 Food and food additives hypersensitivity in adult asthmatics. III. Adverse reaction to sulfites in adult asthmatics.
Barnes 1998 Difficult asthma.
Nekam 1998 Nutritional triggers in asthma.
Petrus 1997 Clinico-immunological study of 16 cases of benzoate intolerance in children.
Kurek 1996 Pseudoallergic reactions. Intolerance to natural and synthetic food constituents masquerading as food allergy.
Hodge 1996 Consumption of oily fish and childhood asthma risk.
Hodge 1996 Assessment of food chemical intolerance in adult asthmatic subjects.
Petrus 1996 Asthma and intolerance to benzoates.
Lester 1995 Sulfite sensitivity: significance in human health.
Businco 1995 Food allergy and asthma.
Corder 1995 Aspirin, salicylate, sulfite and tartrazine induced bronchoconstriction. Safe doses and case definition in epidemiological studies.
Sakakibara 1995 Aspirin-induced asthma as an important type of bronchial asthma.
Schapowal 1995 Phenomenology, pathogenesis, diagnosis and treatment of aspirin-sensitive rhinosinusitis.
Simon 1994 Oral challenges to detect aspirin and sulfite sensitivity in asthma.
Timberlake 1992 Precipitation of asthma attacks in Melanesian adults by sodium metabisulphite.
Park 1991 Sodium salicylate sensitivity in an asthmatic patient with aspirin sensitivity.
Hong 1989 Oral provocation tests with aspirin and food additives in asthmatic patients.
Van Bever 1989 Food and food additives in severe atopic dermatitis. (Respiratory symptoms also)
Longo 1987 Food Allergy in Asthma. Diagnostic Significance of Peripheral Eosinophils.
Chudwin 1986 Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis.
Warrington 1986 Cell-mediated immune responses to artificial food additives in chronic urticaria. (asthma too)
Genton 1985 Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria.
Mathison 1985 Precipitating Factors in Asthma: Aspirin, Sulfites, and Other Drugs and Chemicals
Towns 1984 Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma.
Egger 1983 Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. (asthma too)
Ratner 1983 Milk protein-free diet for nonseasonal asthma and migraine in lactase-deficient patients.
Miller 1982 Sensitivity to tartrazine.
Grzelewska Rzymowska 1981    Asthma with aspirin intolerance. Clinical entity or coincidence of nonspecific bronchial hyperreactivity and aspirin intolerance.
Illig 1981 Urticaria and "aspirin intolerance"--part of an interdisciplinary pathogenetic principle?
Wuthrich 1981 Acetylsalicylic acid and food additive intolerance in urticaria, bronchial asthma and rhinopathy.
Ishihara 1979 Experimental investigation on the pathogenesis of tartrazine-induced asthma.
Spector 1979 Aspirin and concomitant idiosyncrasies in adult asthmatic patients.
Ceserani 1978 Tartrazine and prostaglandin-system.
Lockey 1977 Hypersensitivity to tartrazine (FD&C Yellow No. 5) and other dyes and additives present in foods and pharmaceutical products.
Abrishami 1977 Aspirin intolerance--a review.
Stenius 1976 Hypersensivity to acetylsalicylic acid (ASA) and tartrazine in patients with asthma
Settipane 1975 Aspirin intolerance. III. Subtypes, familial occurence, and cross-reactivity with tartarazine.


The following excerpts are in alphabetical order by first author.

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  1. Aspirin intolerance--a review. Abrishami MA, Thomas J, Ann Allergy 1977 Jul;39(1):28-37
    " 1. Association of bronchial asthma, nasal pathology and intolerance to aspirin is a unique syndrome. Aspirin-induced prolongation of bleeding time, and a tendency for diabetes, may exist with it. ... Progression of asthma and nasal polyposis is not prevented by avoidance of aspirin. 4. Salicylates other than aspirin are well tolerated but cross-reactivity with other analgesics, and with tartrazine, may occur. ..."

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  2. Chronic Obstructive Pulmonary Disease and Long-Term Exposure to Traffic-Related Air Pollution: A Cohort Study. Andersen ZJ, Hvidberg M, Jensen SS, Ketzel M, Loft S, Sørensen M, Tjønneland A, Overvad K, Raaschou-Nielsen O, American Journal of Respiratory and Critical Care Medicine, 2010 Sep 24. [Epub ahead of print]
    "Short-term exposure to air pollution has been associated with exacerbation of chronic obstructive respiratory disease (COPD) whereas the role of long-term exposures on the development of COPD is not yet fully understood. ... We followed 57 053 participants in the Danish Diet, Cancer and Health cohort in the Hospital Discharge Register for their first hospital admission for COPD between 1993 and 2006. We estimated the annual mean levels of nitrogen dioxide (NO2) and nitrogen oxides (NOx) at all residential addresses of the cohort participants since 1971 ... CONCLUSIONS: Long-term exposure to traffic related air pollution may contribute to the development of COPD with possibly enhanced susceptibility in people with diabetes and asthma."
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  3. Impact of racemic albuterol compared to levalbuterol on objective measures of hyperactivity and inattentiveness in children with asthma. W. Andrews, M.H. Teicher, A. Polcari, M. Pankratrz The Journal of Allergy & Clinical Immunology, 113(2), Suppl, S32 (Feb 2004)
    "Levalbuterol (LEV) 0.63 mg produces clinically comparable bronchodilation compared with racemic albuterol (RAC) 2.5 mg, but with fewer beta-mediated side effects. Parents complain of increases in hyperactivity and restlessness following treatment with racemic albuterol ... Attention and activity were measured using an FDA-approved test (McLean Motion and Attention Test) focused on two of the primary symptoms of ADHD, namely hyperactivity ... RAC, but not LEV, resulted in a significant increase in heart rate ... In this study, treatment with RAC 2.5 mg significantly increased objective measures of hyperactivity and inattentiveness in asthmatic children compared with LEV 0.63 mg."

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  4. Food and food additives hypersensitivity in adult asthmatics. I. Skin scratch test with food allergens and food challenge in adult asthmatics. Arai Y, Sano Y, Ito K, Iwasaki E, Mukouyama T, Baba M, Arerugi 1998 Jul;47(7):658-66
    "...Six hundred and twenty five of 3102 subjects (20.1%) had a positive test to one or more food allergens. The commonest food allergens were shrimp (27.7%), crab (27.7%), yeast (23.8%) and buckwheat (15.8%)... Positive food challenge responses occurred in 30/60 subjects (50%)..."

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  5. Food and food additives hypersensitivity in adult asthmatics. III. Adverse reaction to sulfites in adult asthmatics, Arai Y, Muto H, Sano Y, Ito K, Arerugi 1998 Nov;47(11):1163-7
    "...Twenty adult asthmatic patients, who were non-steroid-dependent and without a suggestive history of sulfite sensitivity, underwent challenge with oral solution of metabisulfite. ... 12 patients reacted to metabisulfite. They demonstrated airway obstruction 5 (41.7%), urticaria 4 (36.7%), skin manifestation 2 (16.7%) and nasal congestion 1 (8.3%). All patients who demonstrated airway obstruction, were sensitive to aspirin..."

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  6. Pulmonary function response to EDTA, an additive in nebulized bronchodilators. Asmus MJ, Barros MD, Liang J, Chesrown SE, Hendeles L. J Allergy Clin Immunol. 2001 Jan;107(1):68-72.
    " Some nebulized bronchodilator solutions contain additives, such as EDTA, benzalkonium chloride (BAC), or both. OBJECTIVE: Although BAC-induced bronchoconstriction has been well documented in patients with asthma, there is no information on the effects of EDTA on FEV(1) when inhaled in the amounts that would be administered during emergency department treatment of asthma. ... CONCLUSION: The amount of EDTA contained in maximum recommended doses of nebulized bronchodilators does not induce bronchospasm. In contrast, BAC induces clinically important bronchospasm, which could decrease the efficacy of a bronchodilator during an emergency."

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  7. Bronchoconstrictor additives in bronchodilator solutions. Asmus MJ, Sherman J, Hendeles L, J Allergy Clin Immunol 1999 Aug;104(2 Pt 2):S53-60
    " Nebulized bronchodilator solutions are available in the United States as both nonsterile and sterile-filled products. Sulfites, benzalkonium chloride (BAC), or chlorobutanol are added to nonsterile products to prevent bacterial growth... Ethylenediamine tetraacetic acid (EDTA) is added to some products to prevent discoloration of the solution. With the exception of chlorobutanol, all of these additives are capable of inducing bronchospasm in a concentration-dependent manner. However, it is rarely apparent to the patient or health care provider that the additive diminishes the bronchodilator effects. Older products (eg, isoproterenol and isoetharine) contain enough sulfites to produce bronchospasm in most patients with asthma, even in those without a prior history of sulfite sensitivity. Bronchoconstriction from inhaled BAC is cumulative, prolonged, and correlates directly with basal airway responsiveness... If the screwcap product is used in the emergency department, a patient could receive as much as 1800 microg of BAC in the first hour. ...Only additive-free sterile solutions should be used for hourly or continuous nebulization of albuterol. ..."

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  8. Asthma management: Part 1: An overview of the problem and current trends. Baker VO, Friedman J, Schmitt R. J of the School of Nursing 2002 Jun;18(3):128-37.
    "Death rates from asthma have increased or remained stable over the past decade despite increased knowledge about the pathophysiology and improved treatment of the disease, a fact that is both puzzling and disconcerting. ... School nurses implement and monitor the child's response to the plan. Therefore, the school nurse needs current information about asthma management. Part I of this two-part series describes the pathophysiology of asthma and the types, risk factors, and current trends in management of the disease. The role of the school nurse in asthma management is outlined, including how he or she can influence environmental factors that precipitate asthma symptoms or exacerbations. Part II will discuss the role of the school nurse in pharmacologic management of asthma. Complementary alternative medicine for asthma management will be described, as well as health teaching for the child with asthma and their family."

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  9. Asthma management: Part II: APharmacologic Management Baker VO, Friedman J, Schmitt R. J of the School of Nursing 2002 Oct;18(5):257-69.
    "... Part II reviews specific school nursing responsibilities associated with current pharmacologic therapy for the child with asthma. Issues related to nutritional supplements as well as complementary and alternative treatments used in asthma management are covered. Other topics discussed include issues related to access of asthma medication in the school setting by the student, involvement of the school team in the care of the child with asthma, and health education strategies for children with asthma and their families."

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  10. Difficult asthma. Barnes PJ, Woolcock AJ, Eur Respir J 1998 Nov;12(5):1209-18
    "Asthma is usually easy to manage, but approximately 5% of patients are not controlled even on high doses of inhaled corticosteroids. ... There may be unidentified exacerbating factors, including unrecognized allergens, occupational sensitizers, dietary additives, drugs, gastro-oesophageal reflux, upper airway disease, or other systemic diseases, that need to be identified and avoided or treated. ..."

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  11. Food allergy and asthma, Businco L, Falconieri P, Giampietro P, Bellioni B, Pediatric Pulmonology Supplement 1995;11:59-60
    "... The prevalence and incidence of subjects with food-induced wheezing have not been well studied. ... Food allergy may trigger allergic respiratory symptoms through two main routes: ingestion or inhalation. ... We have shown that a significant proportion of children with IgE-mediated cow's milk allergy experienced asthma following DBPCOFC [double-blind, placebo-controlled oral food challenge] with cow's milk."

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  12. Tartrazine and prostaglandin-system. Ceserani R, Colombo M, Robuschi M, Bianco S., Prostaglandins Med 1978 Dec;1(6):499-505
    " Tartrazine, a dye largely employed for colouring foods, drinks, drugs and cosmetics, induces in some aspirin-sensitive subjects a bronchoconstriction similar to that caused by aspirin and other nonsteroidal anti-inflammatory drugs. . . . Preliminary experiments on aspirin asthmatic patients treated or not with tartrazine are discussed. "

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  13. Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis. Chudwin DS, Strub M, Golden HE, Frey C, Richmond GW, Luskin AT, Ann Allergy 1986 Aug;57(2):133-4
    " A woman experienced exacerbations of bronchial asthma after taking aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. On oral challenges, she developed an urticarial reaction after tartrazine; urticarial and bronchospastic reactions after salicylsalicylic acid; and urticarial and bronchospastic reactions after choline magnesium trisalicylate. . . . The results of sensitivity studies of our patient indicates that such patients may also be sensitive to non-acetylated salicylates."

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  14. Aspirin, salicylate, sulfite and tartrazine induced bronchoconstriction. Safe doses and case definition in epidemiological studies. Corder EH, Buckley CE 3rd, J Clin Epidemiol 1995 Oct;48(10):1269-75
    "Allergic-like reactions to chemical components of foods and medicines may be common. ... A 15% decrease in the amount of air expired in one second was defined a positive response. ... Doses to which the most sensitive (5%) and practically all (95%) susceptible persons might respectively respond are: metabisulfite 4.6 mg, 255.8 mg; tartrazine 3.4 mg, 885.6 mg; aspirin 0.8 mg, 332.3 mg; and salicylate 2.6 mg, 89.9 mg. Doses within these ranges can be used in epidemiological studies."

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  15. The increase in the prevalence of asthma and allergy: food for thought. Devereux G., Nature Reviews, Immunology, 2006 Nov;6(11):869-74.
    " Since about 1960, the prevalence of asthma and allergic disease has increased sufficiently to become a major public-health concern. Concurrently, there have been marked changes in our diet, and it has been proposed that these changes have contributed to the increase in the prevalence of asthma and allergy. In this article, these hypotheses about diet are described, together with the postulated mechanisms and the evidence for and against, leading to the most recent evidence indicating that maternal diet during pregnancy might be particularly important in the development of childhood asthma. "

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  16. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment., Egger J et al., Lancet 1983 Oct 15;2(8355):865-9
    "93% of 88 children with severe frequent migraine recovered on oligoantigenic diets; ... the role of the foods provoking migraine was established by a double-blind controlled trial in 40 of the children. ... Associated symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. In most of the patients in whom migraine was provoked by non-specific factors, such as blows to the head, exercise, and flashing lights, this provocation no longer occurred while they were on the diet."

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  17. Comorbidity of Asthma With ADHD. Fasmer OB, Riise T, Eagan TM, Lund A, Dilsaver SC, Hundal O, Oedegaard KJ, Journal of Attention Disorders. 2010 Jun 23. [Epub ahead of print]
    "Objective: To assess how frequently drugs used to treat asthma and ADHD are prescribed to the same patients. ... There was a 65% increased overall risk (OR = 1.65) of being prescribed one of the drugs given a prescription of the other. Women had a markedly higher risk than men. When data for each age group (10 years interval) and each gender were analyzed separately, the strongest associations were found for women between 20 and 49 years of age and men between 30 and 49 years of age. Conclusion: These prescription patterns suggested a marked comorbidity between asthma and ADHD."

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  18. Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria. Genton C, Frei PC, Pecoud A, Journal of Allergy and Clinical Immunology 1985 Jul;76(1):40-5
    "...Twenty-four of the 34 patients (nine with asthma and 15 with urticaria) were intolerant to at least one compound. However, no serious reaction was observed. In 20 of these 24 patients [83%](six with asthma and 14 with urticaria), a diet free of additives and nonsteroidal anti-inflammatory drugs resulted, within 5 days, in a marked improvement of symptoms, which persisted 8 to 14 mo after starting the diet..."

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  19. Zn-limited diet modifies the expression of the rate-regulatory enzymes involved in phosphatidylcholine and cholesterol synthesis. Gomez NN, Biaggio VS, Rozzen EJ, Alvarez SM, Gimenez MS., The British Journal of Nutrition, 2006 Dec;96(6):1038-46.
    " Suboptimal intake of Zn (Zinc) is one of the most common nutritional worldwide problems ... After 2 months of treatment with a ZL (Zinc-limited) diet we found important variations in the lipid content of Wistar male rats ... These results suggest that ZL alters the expression of enzymes involved in phosphatidylcholine and cholesterol synthesis, which could lead to increased phospholipids and cholesterol, and decreased triacylglycerol. This study suggests that major changes in the lipid composition of lung are induced by a ZL condition. Therefore, Zn deficiency must be taken into account in order to design therapies and public health interventions, such as Zn supplementation for high-risk subjects or certain diseases, such as asthma. "

    Note: Studies by Ward and Brenner indicated that Zinc deficiency is also a problem in ADHD, and that furthermore exposure to synthetic colorings cause children with ADHD to lose zinc. What about children with asthma?

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  20. Dietary intake of antioxidant (pro)-vitamins, respiratory symptoms and pulmonary function: the MORGEN study. Grievink L, Smit HA, Ocke MC, van 't Veer P, Kromhout D, Thorax 1998 Mar;53(3):166-71
    FEV1=Forced expiratory volume in 1 s measurement
    FVC=Forced vital capacity measurement

    "... Complete data were collected in a cross sectional study in a random sample of the Dutch population on 6555 adults during 1994 and 1995. ... The results of this study suggest that a high intake of vitamin C or beta-carotene is protective for FEV1 and FVC compared with a low intake, but not for respiratory symptoms."
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  21. Plasma concentrations of the antioxidants beta-carotene and alpha-tocopherol in relation to lung function. Grievink L, Smit HA, Veer P, Brunekreef B, Kromhout D, Eur J Clin Nutr 1999 Oct;53(10):813-7
    FEV1=Forced expiratory volume in 1 s measurement
    FVC=Forced vital capacity measurement

    "...subjects with a high plasma beta-carotene tended to have a higher FVC than subjects with a low plasma beta-carotene concentration which was borderline statistically significant. The difference for FEV1 between high and low levels of plasma beta-carotene tended to be in the same positive direction as that of FVC but did not reach the pre-set statistical significance level. There is no relation between plasma alpha-tocopherol and lung function. ..."

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  22. Asthma with aspirin intolerance. Clinical entity or coincidence of nonspecific bronchial hyperreactivity and aspirin intolerance. Grzelewska-Rzymowska I, Rozniecki J, Szmidt M, Kowalski ML, Allergol Immunopathol (Madr) 1981 Nov-Dec;9(6):533-8
    "... Nasal and paranasal polyps were found in 77% of the group examined. The sequence of asthma, polyps and aspirin sensitivity has been analyzed. The authors conclude that aspirin - induced bronchoconstriction is the effect of the coincidence of two different phenomena in one subject, i. e. bronchial hyperreactivity and ASA - intolerance."

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  23. Reexamining the familial association between asthma and ADHD in girls. Hammerness P, Monuteaux MC, Faraone SV, Gallo L, Murphy H, Biederman J. Journal of Attention Disorders. 2005 Feb;8(3):136-43.
    "The objective of this study is to further evaluate the association between asthma and ADHD, addressing issues of familiality in female probands. ... The results extend to female probands' previously reported findings that asthma and ADHD are independently transmitted in families. These findings further support the conclusion that ADHD symptoms should not be dismissed as part of asthma symptomatology or a consequence of its treatment."

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  24. Control of salicylate intolerance with fish oils. Healy E, Newell L, Howarth P, Friedmann PS., British Journal of Dermatology 2008 Dec;159(6):1368-9. Epub 2008 Sep 15.
    "We report three patients with disabling salicylate-induced intolerance who experienced abrogation of symptoms following dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs). All three patients experienced severe urticaria, asthma requiring systemic steroid therapy and anaphylactic reactions. After dietary supplementation with 10 g daily of fish oils rich in omega-3 PUFAs for 6-8 weeks all three experienced complete or virtually complete resolution of symptoms allowing discontinuation of systemic corticosteroid therapy. Symptoms relapsed after dose reduction. Fish oil appears a safe and effective treatment for this difficult and often serious condition."

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  25. Consumption of oily fish and childhood asthma risk. Hodge L, Salome CM, Peat JK, Haby MM, Xuan W, Woolcock AJ. Med J Aust. 1996 Feb 5;164(3):137-40.
    " . . . Response rate to the questionnaire was 81.5% (n=468.) After adjusting for confounders such as sex, ethnicity, country of birth, atopy, respiratory infection in the first two years of life and a parental history of asthma or smoking, children who ate fresh, oily fish (>2% fat) had a significantly reduced risk of current asthma (odds ratio, 0.26; 95% confidence interval, 0.09-0.72; P<0.01). . . CONCLUSION: These data suggest that consumption of oily fish may protect against asthma in childhood. "

    Quote from full text: "Fish oil contains the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have anti-inflammatory effects"

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  26. Assessment of food chemical intolerance in adult asthmatic subjects. Hodge L, Yan KY, Loblay RL., Thorax. 1996 Aug;51(8):805-9.
    " . . . A study was undertaken to determine whether changes in bronchial responsiveness to histamine following food chemical challenge without an elimination diet might be a faster, more convenient method. METHODS: Eleven adult asthmatic subjects were challenged twice with metabisulphite, aspirin, monosodium glutamate, artificial food colours, sodium nitrite/ nitrate, 0.5% citric acid solution (placebo), and sucrose (placebo) on separate days. . . . CONCLUSIONS: Strict dietary elimination and measurement of FEV1 after double blind food chemical challenge remains the most reliable method for the detection of food chemical intolerance in asthmatic subjects."

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  27. Oral provocation tests with aspirin and food additives in asthmatic patients. Hong SP, Park HS, Lee MK, Hong CS, Yonsei Med J 1989 Dec;30(4):339-45
    "Aspirin and food additives are known to induce bronchoconstriction, angioedema or urticaria in susceptible patients. ... Significant bronchoconstrictions were found in 15 (41.7%) of the 36 subjects tested. Eight of the 15 subjects showed positive asthmatic responses to the aspirin, two showed asthmatic responses to the food additives, and five responded to both aspirin and the food additives. ..."

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  28. Urticaria and "aspirin intolerance"--part of an interdisciplinary pathogenetic principle? Illig L, Z Hautkr 1981 Mar 15;56(6):347-67
    "Like the so-called "aspirin asthma", the aspirin-induced provocation of chronic urticaria is a symptom of the intolerance syndrome. This may also be induced by various other drugs, particularly by indomethacin and food additives. ... An exact differentiation is only possible in patients without any clinical symptoms after additive-free diet ..."

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  29. Experimental investigation on the pathogenesis of tartrazine-induced asthma. Ishihara Y, Kitamura S, Tohoku Journal of Experimental Medicine, 1979 Nov;129(3):303-9.
    ". . . The contractile responses of guinea pig tracheal tissues induced by various bronchoconstrictors were potentiated in the presence of tartrazine. These results may suggest that tartrazine-induced asthma is not induced by inhibition of PGLS [prostaglandin-like substances] synthesis, but induced by potentiation of bronchoconstrictor responses."

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  30. Pseudoallergic reactions. Intolerance to natural and synthetic food constituents masquerading as food allergy. Kurek M, Pediatr Pol 1996 Sep;71(9):743-52
    " Adverse hypersensitivity reactions to natural foods and certain drugs and food additives are mediated by immunological (allergy) or non-immunological mechanisms. ...This observation has led to the concept of "pseudoallergic reactions-PAR". PAR can be triggered in various ways such as: interactions with the central or peripherical nervous system, non-specific release of mediators, enzyme inhibition due to hereditary or pharmacologically induced enzyme deficiencies and pharmacological properties of some natural food constituents such as biogenic amines... PAR to food additives occurs frequently in patients suffering from urticaria, asthma ... The same additives (azo dyes, sulphites, benzoates) are used in various drug formulations and may be responsible for eliciting PAR... Skin tests and "in vitro" tests are only sporadically informative. ... Individually performed exclusion regimes are the principal methods of prevention." The Feingold diet is one way to do this.

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  31. Sulfite sensitivity: significance in human health. Lester MR , J Am Coll Nutr 1995 Jun;14(3):229-32
    "... As food additives, sulfiting agents were first used in 1664 and approved in the United States as long ago as the 1800s...They are currently used for a variety of preservative properties, including controlling microbial growth, preventing browning and spoilage, and bleaching some foods. ... Adverse reactions to sulfites in nonasthmatics are extremely rare. Asthmatics who are steroid-dependent or who have a higher degree of airway hyperreactivity may be at greater risk of experiencing a reaction to sulfite-containing foods... The majority of reactions are mild. These manifestations may include dermatologic, respiratory, or gastrointestinal signs and symptoms. ... Broncho-constriction is the most common sensitivity response in asthmatics... Inhalation of sulfur dioxide (SO2) generated in the stomach following ingestion of sulfite-containing foods or beverages, a deficiency in a mitochondrial enzyme, and an IgE-mediated immune response have all been implicated."

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  32. Hypersensitivity to tartrazine (FD&C Yellow No. 5) and other dyes and additives present in foods and pharmaceutical products. Lockey SD Sr, Annals of Allergy 1977 Mar;38(3):206-10
    "Tartrazine (FD&C Yellow No. 5) and other allowed certified color additives may have an exacerbating effect in chronic urticaria and asthma sufferers. . ."

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  33. Food Allergy in Asthma. Diagnostic Significance of Peripheral Eosinophils, Longo G, Scornavacca G, Strinati R, Poli F, Pedoatroa Medica e Chirurgica , 1987 Nov-Dec;9(6):663-8
    A total of 82 patients with asthma were put on an additive-free "oligoantigenic" diet. Their eosinophil count went down significantly, and improvement of symptoms followed, with significant improvement of lung capacity. Only 10 patients had no improvement.

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  34. Precipitating Factors in Asthma: Aspirin, Sulfites, and Other Drugs and Chemicals, Mathison DA, Stevenson DD, Simon RA. Chest. 1985 Jan;87(1 Suppl):50S-54S.
    "... Approximately 40 percent of patients with rhinosinusitis, nasal polyps, and asthma and 5 to 10 percent of all asthmatic patients are sensitive to aspirin and aspirin-like nonsteroidal anti-inflammatory drugs ... When aspirin/aspirin-like drug is essential for treatment of cardiovascular or musculoskeletal disorder, desensitization by cautious oral challenges with graded doses of aspirin can be accomplished. ... Sulfur dioxide and sulfites, commonly used as sanitizers and preservatives of foods and pharmaceuticals, may precipitate acute asthma in 5 percent or more of asthmatic patients. ..."

    Also mentioned: drugs such as propranolol (Toprol) can cause bronchospasm, "unmasking" asthma.

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  35. Sensitivity to tartrazine. Miller K., British Medical Journal (Clin Res Ed). 1982 Dec 4;285(6355):1597-8.
    " ...Intolerance to tartrazine was first reported in 1959, and its part in the induction of intractable urticaria has been recognized since 1975. Non-thrombocytopenic purpura is also reported to be due to hypersensitivity to tartrazine - which suggests the possibility that tartrazine may act as a hapten bound to the endothelial cells of small blood vessels. ...People sensitive to acetylsalicylic acid [aspirin] who are allergic to foods should avoid tartrazine as a food dye..."

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  36. Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma., Nagakura T et al., Eur Respir J 2000 Nov;16(5):861-5
    " ... The effects of dietary supplementation with fish oil for 10 months in 29 children with bronchial asthma was investigated in a randomized controlled fashion. ... Subjects received fish oil capsules containing 84 mg eicosapentaenoic acid (EPA) and 36 mg docosahexaenoic acid (DHA) or control capsules containing 300 mg olive oil. . . Asthma symptom scores decreased and responsiveness to acetylcholine decreased in the fish oil group but not in the control group. In addition, plasma EPA levels increased significantly only in the fish oil group . . .The present results suggest that dietary supplementation with fish oil rich in the omega-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid is beneficial for children with bronchial asthma . . ."

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  37. Nutritional triggers in asthma. Nekam KL, Acta Microbiol Immunol Hung 1998;45(1):113-7
    " ... Exact epidemiological data are lacking, partly because the etiological link is not always obvious, the diagnosis of food hypersensitivity is often complicated and ambiguous, food triggers usually act in concert with other trigger(s),...The participation of airway symptoms in food allergy goes up to 40%... In the therapy avoidance measures are of great importance besides usual asthma therapy, and probably in combination with the reduction of gut permeability."

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  38. Sulfur-induced polioencephalomalacia in stocker calves.
    Niles GA, Morgan SE, Edwards WC, Vet Hum Toxicol 2000 Oct;42(5):290-1
    "Calves from 3 farms exhibited blindness, head pressing, and circling before death. Brain lesions confirmed polioencephalomalacia. Excess sulfur was found in the diets on all 3 farms . . . Corn gluten feed and corn steep liquor, . . . corn syrup, corn gluten, corn oil, and corn starch have gained popularity as livestock feeds due to their low prices. With this increased usage as livestock feed, increasing number of cases of polioencephalomalacia have been seen. "

    NOTE: What about the meat of those cows who don't die? What about people with sulfite sensitivity (especially asthma) who eat it?

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  39. Allergy to house dust mite and snails: a model of cross-reaction between food and inhalant allergens with a clinical impact. Pajno GB, Morabito L, Barberio G., Pediatric Pulmonology Suppl., 1999;18:163-4.
    " A knowledge of cross-reactions between different allergens can facilitate the diagnosis of allergy. IgE cross-reactivity has been identified between house dust mite and snails. While most patients have mild symptoms, asthma and/or anaphylaxis may occur with these and other cross-reacting foods. It may be worthwhile to include measurement of IgE to some edible invertebrate animals in asthmatics, e.g. in mite allergic asthmatic patients who eat snails."

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  40. Sodium salicylate sensitivity in an asthmatic patient with aspirin sensitivity. Park HS et al., J Korean Med Sci 1991 Jun;6(2):113-7
    " ...The result of this study suggests that sodium salicylate may cross-react with aspirin in aspirin-and tartrazine-sensitive patients."

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  41. Asthma and intolerance to benzoates. Petrus M, Bonaz S, Causse E, Rhabbour M, Moulie N, Netter JC, Bildstein G, Arch Pediatr 1996 Oct;3(10):984-7
    " ...A girl with a family history of asthma ... was successfully given continuous bronchodilator therapy until the age of 7 years. At that time, she had more frequent and severe exacerbations ... Oral challenges with bisulfite and sodium benzoate... revealed heightened sensitivity to administration of sodium benzoate. Avoidance of this additive was followed by complete and prolonged disappearance of episodes of coughing and wheezing. ... Adverse reactions to benzoate in this patient required avoidance of some drugs ... prescribed under the form of syrups in asthma. "

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  42. Clinico-immunological study of 16 cases of benzoate intolerance in children, Petrus M, Bonaz S, Causse E, Micheau P, Rhabbour M, Netter JC, Bildstein G, Allerg Immunol (Paris) 1997 Feb;29(2):36-8
    " ...Sixteen children (9 boys and 7 girls) were directed to the Hospital of Tarbes from June 1995 to July 1995, for recurring urticaria (7/16) combined with asthma (1/16), atopic eczema (2/16), dermorespiratory syndrome (2/16) and asthma (1/16). All were subject to an immunological examination ... whose confirmation is certified by the benefit of the food eviction. ... besides food such as grey shrimps, sodas and antibiotic syrups, one finds benzoates in the antiallergic syrups initially prescribed as a preventive measure. "

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  43. Asthma/allergic airways disease: does postnatal exposure to environmental toxicants promote airway pathobiology?, Plopper CG, Smiley-Jewell SM, Miller LA, Fanucchi MV, Evans MJ, Buckpitt AR, Avdalovic M, Gershwin LJ, Joad JP, Kajekar R, Larson S, Pinkerton KE, Van Winkle LS, Schelegle ES, Pieczarka EM, Wu R, Hyde DM. Toxicologic Pathology. 2007;35(1):97-110.
    " The recent, dramatic increase in the incidence of childhood asthma suggests a role for environmental contaminants in the promotion of interactions between allergens and the respiratory system of young children. To establish whether exposure to an environmental stressor, ozone (O3), and an allergen, house dust mite (HDMA), during early childhood promotes remodeling of the epithelial-mesenchymal trophic unit (EMTU) of the tracheobronchial airway wall by altering postnatal development, infant rhesus monkeys were exposed to cyclic episodes of filtered air (FA), HDMA, O3, or HDMA plus O3. The following alterations in the EMTU were found after exposure to HDMA, O3, or HDMA plus O3: (1) reduced airway number; (2) hyperplasia of bronchial epithelium; (3) increased mucous cells; (4) shifts in distal airway smooth muscle bundle orientation and abundance to favor hyperreactivity; (5) interrupted postnatal basement membrane zone differentiation; (6) modified epithelial nerve fiber distribution; and (7) reorganization of the airway vascular and immune system.

    Conclusions: cyclic challenge of infants to toxic stress during postnatal lung development modifies the EMTU. This exacerbates the allergen response to favor development of intermittent airway obstruction associated with wheeze. And, exposure of infants during early postnatal lung development initiates compromises in airway growth and development that persist or worsen as growth continues, even with cessation of exposure. "

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  44. Milk protein-free diet for nonseasonal asthma and migraine in lactase-deficient patients, Ratner D, Shoshani E, Dubnov B, Israel Journal of Medical Sciences 1983 Sep;19(9):806-9
    "In a series of 48 patients suffering from either nonseasonal asthma or classic migraine, a marked clinical alleviation was obtained in 33 patients [69%] by removing all cows milk protein from their diet. All patients who responded to the diet had laboratory evidence of lactase deficiency. Lactase deficiency may be a useful indicator of milk allergy in asthmatic or migrainous patients."

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  45. Aspirin-induced asthma as an important type of bronchial asthma Sakakibara H, Suetsugu S, Nihon Kyobu Shikkan Gakkai Zasshi 1995 Dec;33 Suppl:106-15
    " Aspirin-induced asthma (AIA) should be recognized as an important types of bronchial asthma ... Some patients with AIA are hypersensitive to some agents in addition to NSAID, e.g., tartrazine (15.1%), sodium benzoate (14.3%), and parabens (12.0%). (6) Patients with latent AIA are in danger of having fatal or near-fatal asthma attacks if they take NSAID. We should educate patients to eliminate the risk posed by NSAID and other agents that may induce asthma attacks, and should enlighten doctors and pharmacists, who are not specialists in allergy or respiratory disease, about AIA. (7) Asthma in these patients will be less severe if their condition is correctly diagnosed and they receive appropriate medical treatment."

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  46. Phenomenology, pathogenesis, diagnosis and treatment of aspirin-sensitive rhinosinusitis. Schapowal AG, Simon HU, Schmitz-Schumann M, Acta Otorhinolaryngol Belg 1995;49(3):235-50
    "Aspirin-sensitive rhinosinusitis is a non-allergic, non-infectious perennial eosinophilic rhinitis starting in middle age and rarely seen in children. ... There is an intolerance to aspirin and most other NSAID. An intolerance to tartrazine (Yellow 5), food additives, alcohol, narcotics and local anaesthetics can follow. Most aspirin-sensitive patients develop nasal polyps. Untreated, it can lead to asthma. The frequency of aspirin intolerance is 6.18% in patients with perennial rhinitis and 14.68% in patients with nasal polyps. ... "

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  47. Aspirin intolerance. III. Subtypes, familial occurence, and cross-reactivity with tartarazine. Settipane GA, Pudupakkam RK, J Allergy Clin Immunol 1975 Sep;56(3):215-21
    "Evidence has been presented supporting the hypothesis that at least 2 different types of mechanisms may be involved in aspirin intolerance, one resulting in bronchospasm [asthmatic-type difficulty breathing] and the other producing urticaria/angioedema [hives]. Bronchospasm is the predominant symptom of aspirin intolerance in patients who have asthma. In contrast, the predominant symptom of aspirin intolerance in patients who have rhinitis is urticaria/angioedema. . ."

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  48. Oral challenges to detect aspirin and sulfite sensitivity in asthma. Simon RA, Allerg Immunol (Paris) 1994 Jun;26(6):216-8
    "Oral challenge with aspirin or potential cross-reacting substances ... is an effective method for establishing the presence of sensitivity to these substances in asthmatic subjects. Sulfite challenges can be performed in a similar manner. However, many of these subjects have concomitant active irritable airways that could make testing both inaccurate and potentially dangerous. ..."

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  49. Dietary influences on chronic obstructive lung disease and asthma: a review of the epidemiological evidence. Smit HA, Grievink L, Tabak C, Proc Nutr Soc 1999 May;58(2):309-19
    "... In conclusion, the epidemiological evidence for a beneficial effect on indicators of asthma and COPD of eating fish, fruit and vegetables is increasing... Several unresolved questions are raised, which should be addressed in future studies on the relationship between diet and respiratory disease."

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  50. Aspirin and concomitant idiosyncrasies in adult asthmatic patients. Spector SL, Wangaard CH, Farr RS, J Allergy Clin Immunol 1979 Dec;64(6 Pt 1):500-6
    " . . . A positive response to oral challenge, defined as a 20% fall in forced expiratory volume in 1 sec(FEV1) from baseline for up to 4 hr, occurred in 44 of 230 patients with ASA, 11 of 277 with tartrazine, 2 of 93 with sodium salicylate, and 2 of 69 with acetaminophen. No one had a positive response to tartrazine, sodium salicylate, or acetaminophen who was not also positive to ASA. The dose of ASA causing a positive response was less than 5 grains in 95% of the patients. ... 96% of those with ASA idiosyncrasy had sinusitis and 71% had nasal polyps. . . "

    Note: each challenge was given separately. Williams 1989 later showed that there could be a possible additive effect when used together.

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  51. Hypersensitivity to acetylsalicylic acid (ASA) and tartrazine in patients with asthma. Stenius BS, Lemola M., Clinical Allergy. 1976 Mar;6(2):119-29.
    " One-hundred and forty asthmatics were tested perorally with acetylsalicylic acid (ASA), and/or with the azo-colour tartrazine; a fall in PEF of more than 20% was accepted as a positive result. About one quarter of the patients displayed a positive reaction to one of the two tested agents. ... The frequency of cross-reactivity between the two tested agents was statistically significant; patients reacting to tartrazine were for the most part, also sensitive to ASA. Tests for sensitivity to analgesics and food additives should be conducted as a routine measure in asthmatics, and sensitive patients should be given information on suitable medication and dietary control."

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  52. Nutritional errors in the first months of life and their association with asthma and atopy in preschool children. Strassburger SZ, Vitolo MR, Bortolini GA, Pitrez PM, Jones MH, Stein RT, J Pediatr (Rio J). 2010 Sep-Oct;86(5):391-9.
    " OBJECTIVE: To evaluate the impact of exclusive breastfeeding and introduction of cow's milk in the first year of life on the diagnosis of asthma, wheezing, and atopy in children aged 3 to 4 years. ... RESULTS: Of the 397 children followed during the first year of life, 354 were reassessed between 3 and 4 years of age. Prevalence of wheezing, evaluated for the 12 months prior to questionnaires, was 21.3%, while prevalence of asthma and atopy was 5.5 and 28.7%, respectively. Children fed cow's milk previous to being four months of life were significantly more likely to have asthma between three and four years of age... CONCLUSIONS: The early introduction of cow's milk was an important risk factor for triggering asthma/wheeze symptoms at the age of 4 years. Exclusive breastfeeding for longer than six months was also potentially associated with protection against the development of atopy. The results of this study suggest that dietary interventions during the first year of life have the potential to reduce the impact of asthma, and possibly, atopy."

    Full Text of Study - Get Password

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  53. Precipitation of asthma attacks in Melanesian adults by sodium metabisulphite. Timberlake CM, Toun AK, Hudson BJ, P N G Med J 1992 Sep;35(3):186-90
    " Seven Melanesian asthmatic patients were challenged with substances that have been shown to precipitate asthma attacks in asthma patients in developed countries. Patients were challenged in a double-blind fashion using placebo and active substances. ... All 7 patients were challenged with tartrazine [amount not noted]and sodium metabisulphite; 5 were challenged with aspirin also, but only 2 were challenged with betel nut. Asthma attacks were precipitated by sodium metabisulphite in 3 patients. No other substances precipitated asthma. As sodium metabisulphite is a common food additive, these results suggest that processed foods introduced into developing countries may have an important role in precipitating asthma attacks in susceptible persons."

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  54. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Towns SJ, Mellis CM, Pediatrics 1984 May;73(5):631-7
    "...There was a 66% (19/29) incidence of positive challenge (greater than 20% decrease in forced expiratory volume in one second) with MBS [sodium metabisulfite] and a 21% (6/29) incidence of positive challenge with ASA [aspirin]. . . After 3 months ... four of 19 children on the MBS-free diet and one of six on the salicylate-free diet had objective signs of improvement, namely, reduction in asthma medications and/or improvement in lung function. Unfortunately, compliance with the restrictive diet during this 3-month period was poor ..."

    They had to figure out their own diet -- the Feingold diet would have made it easier for them. Even with poor compliance, 20% of the children improved! Remember, "if you have 5 nails in your shoe, and you remove one of them, don't be surprised that you still limp."

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  55. Alcoholic drinks: important triggers for asthma. Vally H, de Klerk N, Thompson PJ, J Allergy Clin Immunol 2000 Mar;105(3):462-7
    " ... RESULTS: Thirty-three percent of respondents indicated that alcoholic drinks had been associated with the triggering of asthma on at least 2 occasions. Wines were the most frequent triggers, with responses being rapid in onset (<1 hour) ... CONCLUSION: Alcoholic drinks, and particularly wines, appear to be important triggers for asthmatic responses. Sensitivity to the sulfite additives in wines seems likely to play an important role in many of these reactions. Sensitivities of individuals to salicylates present in wines may also play a role."

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  56. The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Vally H, Taylor ML, Thompson PJ. Thorax, 2002 Jul;57(7):569-74.
    " Aspirin intolerant asthma (AIA) is a clinically distinct syndrome characterised by the precipitation of asthma attacks following the ingestion of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). The prevalence of AIA among Australian asthmatic patients has not previously been reported. ... CONCLUSION: The prevalence of respiratory symptoms triggered by aspirin/NSAID use was found to be 10-11% in patients with asthma and 2.5% in non-asthmatics. Aspirin sensitivity appears to be a significant problem in the community and further investigations of the mechanisms of these responses and the possible link between this syndrome and other food and chemical sensitivities are required."

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  57. Food and food additives in severe atopic dermatitis. Van Bever HP, Docx M, Stevens WJ, Allergy 1989 Nov;44(8):588-94
    "In this study the role of food additives, tyramine and acetylsalicylic acid, was investigated by double-blind placebo-controlled challenges (DBPCC) in 25 children with severe atopic dermatitis (AD). All children challenged with foods (n = 24), except one, showed one or more positive reactions to the DBPCC with foods. Positive reactions presented as different combinations of flares of skin symptoms, intestinal symptoms and respiratory symptoms... Six children underwent DBPCC with food additives, tyramine and acetylsalicylic acid. All were found to demonstrate positive skin and/or intestinal reactions to at least one of the food additives. Two children reacted to tartrazine, three to sodium benzoate, two to sodium glutamate, two to sodium metabisulfite, four to acetylsalicylic acid and one to tyramine. It is concluded that some foods, food additives, tyramine and acetylsalicylic acid, can cause positive DBPCC in children with severe AD."

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  58. The burden of childhood asthma. von Mutius E, Archive of Diseases of Childhood 2000 Jun;82 Suppl 2:II2-5
    "...The prevalence of asthma varies worldwide, possibly because of different exposure to respiratory infection, indoor and outdoor pollution, and diet... This paper discusses the burden, prevalence, and risk factors associated with paediatric asthma."

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  59. Cell-mediated immune responses to artificial food additives in chronic urticaria. Warrington RJ, Sauder PJ, McPhillips S, Clin Allergy 1986 Nov;16(6):527-33
    "In some cases of chronic urticaria it is suspected that food additives such as tartrazine and sodium benzoate or salicylates may play a role in the pathogenesis of the condition. ... It was found that significant production of LIF [T cell-derived lymphokine leucocyte inhibitory factor] occurred in response to tartrazine and sodium benzoate in those individuals with chronic additive induced urticaria. In addition, tartrazine caused LIF release from mononuclear cells of ASA-sensitive asthmatics. These results may indicate a possible role for additive-induced cell-mediated immune responses in the pathogenesis of some cases of chronic urticaria and suggest a potential diagnostic test for this condition."

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  60. Acetylsalicylic acid and food additive intolerance in urticaria, bronchial asthma and rhinopathy, Wuthrich B, Fabro L, Schweiz Med Wochenschr 1981 Sep 26;111(39):1445-50
    "Adverse reactions (urticaria, angio-edema, bronchoconstriction, purpura) to Aspirin (ASS) and food-and-drug additives such as the yellow dye tartrazine and the preservative benzoate are observed all over the world... it is described as intolerance or pseudo-allergy and has been related to an imbalance of prostaglandin synthesis. ... More than two thirds of the intolerant patients were improved by an elimination diet and by the avoidance of "aspirin-like" drugs. More than one third of chronic urticaria patients became symptomfree. ... Moreover, azo-dyes must no longer be used for colouring of drugs."

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  61. The effect of DPT and BCG vaccinations on atopic disorders. Yoneyama H, Suzuki M, Fujii K, Odajima Y, Arerugi 2000 Jul;49(7):585-92
    " ...Among the 82 children aged 0-3, out of the 39 who received DPT vaccination, 10 (25.6%) suffered from bronchial asthma and this ratio was significantly higher than among the children who have not received DPT vaccination (1 in 43, 2.3%), ... This was also the case concerning atopic dermatitis (... 18.0% vs ... 2.3%) . ... if ... (bronchial asthma, allergic rhinitis and atopic dermatitis) were combined (... 56.4% vs ... 9.3%) ... From these results, we conclude that DPT vaccination has some effect in the promotion of atopic disorders, ..."

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  62. Amalgam allergy associated with exacerbation of aspirin-intolerant asthma. Yoshida S, Mikami H, Nakagawa H, Hasegawa H, Onuma K, Ishizaki Y, Shoji T, Amayasu H, Clin Exp Allergy 1999 Oct;29(10):1412-4
    "... Sensitivity to amalgam may cause exacerbation of aspirin-intolerant asthma in some patients. ..."

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  63. The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study. Yusoff NA, Hampton SM, Dickerson JW, Morgan JB., Journal of the Royal Society of Health 2004 Mar;124(2):74-80
    " ... The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinically diagnosed as having mild to moderate disease. The investigation was single blind and prospective, and parents were given the option of volunteering to join the 'experiment' group, avoiding eggs, milk and their products for eight weeks, or the 'control' group, who consumed their customary food. ... results suggest that even over the short time period of eight weeks, an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children. "

    Note: removing eggs and milk also removes most processed foods, commercially baked goods, etc. Again, is it the eggs and milk or the reduction in additives that these children inadvertently experienced? Or both?

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  64. Control of asthma. Zervas E, Oikonomidou E, Kainis E, Kokkala M, Petroheilou K, Gaga M. Therapeutic Advances in Respiratory Disease. 2008 Jun;2(3):141-8.
    " ... in the latest guidelines, a clearer definition of control is given and new tools for the assessment and monitoring of control are instituted. In order to achieve asthma control, not only relevant pharmacological treatment but, the establishment of a good patient-doctor relationship, proper education of the asthmatic patient, reduction of exposure to triggers and treatment of co-morbidities are pivotal issues and must be ensured. "

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