As part of a multicentre study of food additive intolerance commissioned by the UK Ministry of Agriculture, Fisheries and Food, the prevalence of reactions to food additives was studied in a survey population by the Depts of Dermatology and Community medicine, Wycombe General Hospital, High Wycombe, Bucks, and St. Thomas’ Campus, London University. Of 18,582 respondents to questionnaires, 7.4% had reactions to food additives, 15.6% had problems with foods, and 10% had symptoms related to aspirin. The incidence of a personal history of atopy reported in 28% of all respondents was significantly higher in those reacting to additives, food, and aspirin (50%, 47.5%, and 36% respectively). A preponderance of reactions occurred in children, boys more than girls. Older patients were affected less often and with a female preponderance.
Abnormal behavior and mood changes were mainly related to additives whereas headache was associated with foods more frequently than additives. Of 44 individuals (7% of 649 interviewed) who reported monosodium glutamate sensitivity, 13 (30%) suffered headache, and 8 (18%) had behavioral or mood changes. Headache was related to food intolerance in 14% of those interviewed but had not previously been regarded as migrainous in nature. Of 81 reactive subjects who completed an additive challenge with annatto or azo dye, only 3 showed consistent reactions. The authors estimated the prevalence of food additive intolerance in the study population at 0.01-0.23%. 
COMMENT. The debate in the UK on food additives and behavior waxes while in the USA interest wanes, with more attention being given to sugar and the effectiveness of stimulants in therapy (see Ped Neur Briefs 1987;1:5,22,38). In the same issue of the JRCP London, Pollock 1 and Warner JO at the Brompton Hospital report a follow-up of children with food additive intolerance showing that symptoms were mainly transient, 76% showing no reaction on rechallenge studies, and Lessof MH at Guy’s Hospital reviews the literature and concludes that more reliable diagnostic tests and toxicological screening methods are needed. A food intolerance databank has been compiled at the Leatherhead Food Research Association, UK, that will provide constantly updated information on food product composition and brands free from ingredients most commonly associated with food intolerance (milk, egg, wheat, soya bean, cocoa, BHA and BHT, sulfur dioxide, benzoate, glutamate and azo colours).