Clustered outbreak of adverse reactions to a salsa containing high levels of sulfites

Six patients came to our attention in the Sacramento, CA area who developed cough or asthma after the ingestion of one brand (Brand 1) of refrigerated Mexican-style salsa, labelled "fresh". These patients had consumed other brands previously, not necessarily sulfited, but noted cough or asthma only in relation to consumption of this brand. Patients 1 and 2 developed reproducible severe cough and throat tightness after ingestion. Patients 3 and 4 developed status asthmaticus within minutes of ingesting salsa, requiring intubation and mechanical ventilation. Patients 5 and 6 experienced mild flares of their asthma after eating the salsa. The mean sulfite concentration of 6 containers of Brand 1 salsa was 1,803 ppm (range 1,630 to 1,920 ppm). Two other brands of salsa averaged 766 and 373 ppm sulfite, respectively. The manufacturer of Brand 1 salsa eliminated sulfites from their product after learning of the adverse reactions. These cases suggest that the amount of sulfite used was unnecessarily and dangerously high, and for one known sulfite-sensitive asthmatic, the use of the term "fresh" was misleading, resulting in near-fatal bronchospasm. Manufacturers should be careful to use only the minimum amount of sulfiting agent necessary