By Joe Gorelick, MSN, FNP-C

How many patients do you see with contact dermatitis? Negative patch testing results can be so frustrating and perhaps this year’s  Allergen of the Year—sulfites–could be the culprit.

Sulfites, commonly used preservatives in consumer items, including foods, beverages, pharmaceuticals, and personal care products, have been named the 2024 Contact Allergen of the Year by the American Contact Dermatitis Society (ACDS). Of clinical significance, most screening patch test series currently do not include sulfites.

Based on analysis of existing evidence, ACDS experts suggest that sulfites should be added to the next update of the American Contact Dermatitis Core Series.

Sulfites are distinct from sulfates. They occur naturally in water, minerals, soil, rocks, plants, and many foods, especially fermented foods. “Sulfiting agents”—including sodium disulfite (SD), commonly referred to as sodium metabisulfite or sodium pyrosulfite (CAS 7681-57-4)–contain the sulfite ion SO32−.

Although there are numerous documented cases and case series of ACD associated with sulfites in the literature, experts predict that ACD associated with sulfites is under-recognized and under-reported.

Side effects, such as headache, may be associated with ingestion of sulfites in foods and beverages, like wine. However, susceptibility to such side effects is not correlated with positive patch test reactions.