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Recognition of sulfite sensitivity by the practicing dermatologist has become increasingly important. A wide spectrum of anaphylactoid reactions can occur after ingestion of sulfite additives in foods and medications. We report the case of a 47-year-old man with severe acute intermittent urticaria. A placebo-controlled oral challenge test with 50 mg sodium disulfite resulted in an acute urticaria attack. A biopsy taken 5 h after the appearance of the urticaria demonstrated a leukocytoclastic vasculitis with eosinophilia. Avoiding foods and drugs containing sulfites is often difficult due to its widespread use. Therefore, the patient should be equipped with a medical emergency kit.

A 33-year-old woman with documented hypersensitivity to acetylsalicylic acid (ASA) and preservatives, causing bronchial asthma and rhinitis when ingested, was investigated because of 'allergy to nose drops'. It was found that she had a serious local reaction caused by the preservative used in the nose drops prescribed. This reaction might occur more commonly than realized, since sensitivity towards ASA is fairly common in the general population.