Acute Sulfite-Induced Hypersensitivity Reaction Following Balsamic Vinegar Consumption: A Case Report.

Sulfite sensitivity is an underrecognized cause of acute adverse reactions to preserved foods and beverages. Although sulfites are widely used as antimicrobial and antioxidant agents, hypersensitivity reactions may occur even in individuals without a prior allergy history. We report the case of a 68-year-old otherwise healthy male who developed an acute systemic reaction shortly after ingesting balsamic vinegar containing sulfites. The episode was characterized by severe epigastric burning pain, flushing, diaphoresis, and intense autonomic discomfort associated with a subjective sensation of heat requiring removal of clothing for relief. Symptoms resolved spontaneously within approximately one hour without medical intervention. The patient had long tolerated balsamic vinegar of Modena from another manufacturer without labeled sulfites and without adverse effects. This presentation suggests a sulfite-induced hypersensitivity reaction with predominant gastrointestinal and autonomic manifestations rather than classic respiratory findings typically associated with immunoglobulin E (IgE)-mediated reactions. Recognition of such reactions is important to prevent misdiagnosis and unnecessary diagnostic testing.