Common food colorants and allergic reactions in children: Myth or reality?

•Adverse reactions to food colorants are both IgE and non-IgE-mediated.•Rare in the general population but higher in atopic individuals.•Discrepancy between parents' perceptions and reported prevalence.•Testing is of limited value, except for some natural colorants.•Clinical manifestations are usually mild; rarely anaphylaxis.

Various additives, including food colorants (FCs), are used in the food industry to make food appealing to consumers and to add variety. Despite the widespread usage of FCs, adverse reactions related to their consumption, including reactions triggered by immune (immediate and delayed-type hypersensitivity) and non-immune (intolerance) mechanisms, are considered rare. There is a discrepancy between the perception of patients and parents (7.4%) and the reported prevalence of adverse reactions to additives (0.01-0.23%), which is higher in atopic individuals (2-7%). Documented reactions are mild, involving mainly the skin, and, rarely, anaphylaxis. A major problem in diagnosing reactions to FCs is identification of the offending agent(s), which is based on careful dietary history taking. Allergy testing is usually unrevealing, except for reaction to some natural colorants. Treatment consists of avoidance of the offending colorant as no successful desensitization procedures have been reported.