Food additives and their impact on human health
Main Article Content
Keywords
allergy, food additives, health
Abstract
Increasing evidence suggests that high consumption of ultra-processed foods (UPF) is associated with an increase in noncommunicable diseases, overweight, and obesity. This review aimed to verify the association of UPF with inflammatory diseases, especially allergic diseases. To identify relevant articles, an extensive literature search was conducted using the two most important search sites – PubMed and Google Scholar. Specific Medical Subject Headings (MeSHes) such as “food additives and health,” “food additives and immune system,” and “food additives and diseases” were used to conduct an advanced search. Emulsifiers have been, particularly, implicated in disrupting intestinal barrier function, modifying gut microbiota, and promoting inflammation, which may contribute to the development of food allergies and inflammatory diseases. While food additives serve various functions in the food industry, concerns regarding their impact on health, particularly in systemic autoimmune and metabolic conditions, have been raised. Common additives have been associated with allergic reactions, intolerances, and sensitivities.
References
1 Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: A systematic review and meta-analysis. Br J Nutr. 2021;125(3):308–18. 10.1017/S0007114520002688
2 Vitale M, Costabile G, Testa R, D’Abbronzo G, Nettore IC, Macchia PE, et al. Ultra-processed foods and human health: A systematic review and meta-analysis of prospective cohort studies. Adv Nutr. 2024;15(1):100121. 10.1016/j.advnut.2023.09.009
3 Marino M, Puppo F, Del Bo’ C, Vinelli V, Riso P, Porrini M, et al. A systematic review of worldwide consumption of ultra-processed foods: Findings and criticisms. Nutrients. 2021;13(8):2778. 10.3390/nu13082778
4 Chang K, Gunter MJ, Rauber F, Levy RB, Huybrechts I, Kliemann N, et al. Ultra-processed food consumption, cancer risk, and cancer mortality: A large-scale prospective analysis within the UK Biobank. EClinicalMedicine. 2023;56:101840. 10.1016/j.eclinm.2023.101840
5 Bonaccio M, Di Castelnuovo A, Costanzo S, Ruggiero E, Esposito S, Persichillo M, et al. Ultra-processed food consumption is associated with all-cause and cardiovascular mortality in participants with type 2 diabetes independent of diet quality: A prospective observational cohort study. Am J Clin Nutr. 2023;118(3):627–36. 10.1016/j.ajcnut.2023.07.004
6 Muthukumar J, Selvasekaran P, Lokanadham M, Chidambaram R. Food and food products associated with food allergy and food intolerance—An overview. Food Res Int. 2020;138(Pt B):109780. 10.1016/j.foodres.2020.109780
7 Whelan K, Bancil AS, Lindsay JO, Chassaing B. Ultra-processed foods and food additives in gut health and disease. Nat Rev Gastroenterol Hepatol. 2024;21(6):406–27. 10.1038/s41575-024-00893-5
8 Montera VSP, Martins AP, Mais LA, Canrella DS. Informação sobre aditivos alimentares nos rótulos de alimentos no Brasil: Análise crítica. Rev. Saúde Pública 2023;57:2. 10.11606/s1518-8787.2023057004371
9 Richey Levine A, Picoraro JA, Dorfzaun S, LeLeiko NS. Emulsifiers and intestinal health: An introduction. J Pediatr Gastroenterol Nutr. 2022;1;74(3):314–9. 10.1097/MPG.0000000000003361
10 Naimi S, Viennois E, Gewirtz AT, Chassaing B. Direct impact of commonly used dietary emulsifiers on human gut microbiota. Microbiome. 2021;9(1):66. 10.1186/s40168-020-00996-6
11 Velázquez-Sámano G, Collado-Chagoya R, Cruz-Pantoja RA, Velasco-Medina AA, Rosales-Guevara J. (2019). Hypersensitivity reactions to food additives. Rev Alergia Mex. 1993;66(3):329–39. 10.29262/ram.v66i3.613
12 Raposa B, Pónusz R, Gerencsér G, Budán F, Gyöngyi Z, Tibold A, et al. Food additives: Sodium benzoate, potassium sorbate, azorubine, and tartrazine modify the expression of NFκB, GADD45α, and MAPK8 genes. Physiol Int. 2016);103(3):334–43. 10.1556/2060.103.2016.3.6
13 Halmos EP, Mack A, Gibson PR. Review article: Emulsifiers in the food supply and implications for gastrointestinal disease. Aliment Pharmacol Ther. 2019;49(1):41–50. 10.1111/apt.15045
14 Chassaing B, Koren O, Goodrich JK, Poole AC, Srinivasan S, Ley RE, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015;519(7541):92–6. 10.1038/nature14232
15 Borsani B, De Santis R, Perico V, Penagini F, Pendezza E, Dilillo D, et al. The role of carrageenan in inflammatory bowel diseases and allergic reactions: Where do we stand? Nutrients. 2021;13(10):3402. 10.3390/nu13103402
16 Cox S, Sandall A, Smith L, Rossi M, Whelan K. Food additive emulsifiers: A review of their role in foods, legislation, and classifications, presence in the food supply, dietary exposure, and safety assessment. Nutr Rev. 2021;12;79(6):726–41. 10.1093/nutrit/nuaa038
17 Sweis IE, Cressey BC. Potential role of the common food additive manufactured citric acid in eliciting significant inflammatory reactions contributing to serious disease states: A series of four case reports. Toxicol Rep. 2018;5:808–12. 10.1016/j.toxrep.2018.08.002
18 Zinöcker MK, Lindseth IA. The western diet–microbiome–host Interaction and its role in metabolic disease. Nutrients. 2018;10(3):365. 10.3390/nu10030365
19 Loayza JJJ, Kang S, Schooth L, Teh JJ, de Klerk A, Noon EK, et al. Effect of food additives on key bacterial taxa and the mucosa-associated microbiota in Crohn’s disease. The ENIGMA study. Gut Micr. 2023;15(1):2172670. 10.1080/19490976.2023.2172670
20 Witkowski M, Grajeta H, Gomułka K. Hypersensitivity reactions to food additives–preservatives, antioxidants, flavor enhancers. Int J Environ Res Pub Health. 2022;19(18):11493. 10.3390/ijerph191811493
21 Camilleri M. What is the leaky gut? Clinical considerations in humans. Curr Opin Clin Nutr Metab Care. 2021; 1;24(5):473–82. 10.1097/MCO.0000000000000778
22 Losol P, Sokolowska M, Hwang YK, Ogulur I, Mitamura Y, Yazici D, et al. Epithelial barrier theory: The role of exposome, microbiome, and barrier function in allergic diseases. Allergy Asthma Immunol Res. 2023;15(6):705–24. 10.4168/aair.2023.15.6.705
23 Celebi Sozener Z, Özbey Yücel Ü, Altiner S, Ozdel Oztürk B, Cerci P, Türk M, et al. The external exposome and allergies: From the perspective of the epithelial barrier hypothesis. Front Allergy. 2022;3:887672. 10.3389/falgy.2022.887672
24 Ogulur I, Yazici D, Pat Y, Naz Bingöl E, Babayev H, Ardicli S, et al. Mechanisms of gut epithelial barrier impairment caused by food emulsifiers polysorbate 20 and polysorbate 80. Allergy. 2023;78(9):2441–55. 10.1111/all.15825
25 Dufrusine B, Di Lisio C, Maurizio A, Sallese M, De Laurenzi V, Dainese E. Influence of food emulsifiers on cellular function and inflammation, a preliminary study. Front Nutr. 2023;10:1197686. 10.3389/fnut.2023.1197686
26 Khuda SE, Nguyen AV, Sharma GM, Alam MS, Balan KV, Williams KM. Effects of emulsifiers on an in vitro model of intestinal epithelial tight junctions and the transport of food a. Mol Nutr Food Res. 2022;66(4):e2100576. 10.1002/mnfr.202100576
27 Liu Y, Wu Q, Zhang J, Yan W, Mao X. Food emulsions stabilized by proteins and emulsifiers: A review of the mechanistic explorations. Int J Biol Macromol. 2024;261(Pt 1):129795. 10.1016/j.ijbiomac.2024.129795
28 Street ME, Shulhai AM, Rotondo R, Giannì G, Caffarelli C. Current knowledge on the effects of environmental contaminants in early life nutrition. Front Nutr. 2023;10:1120293. 10.3389/fnut.2023.1120293
29 Paparo L, Coppola S, Nocerino R, Pisapia L, Picariello G, Cortese M, et al. How dietary advanced glycation end products could facilitate the occurrence of food allergy. J Allergy Clin Immunol. 2024;153:742–58. 10.1016/j.jaci.2023.11.023
30 Kotchetkoff ECA, Suano-Souza FI, Almeida DNG, Barreto TLN, Mendonça RB, Sarni ROS. Ultra-processed food intake and food intake and food allergy in children and adolescents. Int J Food Sci Nutr. 2024;30:1–8. 10.1080/09637486.2024.2306296
31 Bancil AS, Sandall AM, Rossi M, Chassaing B, Lindsay JO, Whelan K.J. Food additive emulsifiers and their impact on gut microbiome, permeability, and inflammation: Mechanistic insights in inflammatory bowel disease. Crohn’s Colitis. 2021;15(6):1068–79. 10.1093/ecco-jcc/jjaa254
32 Raoul P, Cintoni M, Palombaro M, Basso L, Rinninella E, Gasbarrini A, et al. Food additives, a key environmental factor in the development of IBD through gut dysbiosis. Microorganisms. 2022;10(1):167. 10.3390/microorganisms10010167
33 Chassaing B, Compher C, Bonhomme B, Liu Q, Tian Y, Walters W, et al. Randomized controlled-feeding study of dietary emulsifier carboxymethylcellulose reveals detrimental impacts on the gut microbiota and metabolome. Gastroenterology. 2022;162(3):743–56. 10.1053/j.gastro.2021.11.006
34 Tang Q, Wang C, Jin G, Li Y, Hou H, Wang X, et al. Early-life dietary emulsifier exposure predisposes the offspring to obesity through gut microbiota-FXR axis. Food Res Int. 2022;162(Pt A):111921. 10.1016/j.foodres.2022.111921
35 Lane MM, Davis JA, Beattie S, Gómez-Donoso C, Loughman A, O’Neil A, et al. Ultra-processed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obes Rev. 2021;22:e13146. 10.1111/obr.13146
36 De Siena M, Raoul P, Costantini L, Scarpellini E, Cintoni M, Gasbarrini A, et al. Food emulsifiers and metabolic syndrome: The role of the gut microbiota. Foods. 2022;11(15):2205. 10.3390/foods11152205
37 Carucci L, Votto M, Licari A, Marseglia GL, Berni Canani R. Food allergy: Cause or consequence of pediatric eosinophilic esophagitis? Potential implications of ultraprocessed foods in prevention and management. Front Allergy. 2023;4:1138400. 10.3389/falgy.2023.1138400
38 Smith PK, Masilamani M, Li XM, Sampson HA. The false alarm hypothesis: Food allergy is associated with high dietary advanced glycation end-products and proglycating dietary sugars that mimic alarmins. J Allergy Clin Immunol 2017;139(2):429–37. 10.1016/j.jaci.2016.05.040
39 Chang JW, Jensen ET, Dellon ES. Nature with nurture: The role of intrinsic genetic and extrinsic environmental factors on eosinophilic esophagitis. Curr Allergy Asthma Rep. 2022;22(12):163–70. 10.1007/s11882-022-01042-1
40 Zhu YT, Yuan YZ, Feng QP, Hu MY, Li WJ, Wu X, et al. Food emulsifier polysorbate 80 promotes the intestinal absorption of mono-2-ethylhexyl phthalate by disturbing intestinal barrier. Toxicol Appl Pharmacol. 2021;414:115411. 10.1016/j.taap.2021.115411
2 Vitale M, Costabile G, Testa R, D’Abbronzo G, Nettore IC, Macchia PE, et al. Ultra-processed foods and human health: A systematic review and meta-analysis of prospective cohort studies. Adv Nutr. 2024;15(1):100121. 10.1016/j.advnut.2023.09.009
3 Marino M, Puppo F, Del Bo’ C, Vinelli V, Riso P, Porrini M, et al. A systematic review of worldwide consumption of ultra-processed foods: Findings and criticisms. Nutrients. 2021;13(8):2778. 10.3390/nu13082778
4 Chang K, Gunter MJ, Rauber F, Levy RB, Huybrechts I, Kliemann N, et al. Ultra-processed food consumption, cancer risk, and cancer mortality: A large-scale prospective analysis within the UK Biobank. EClinicalMedicine. 2023;56:101840. 10.1016/j.eclinm.2023.101840
5 Bonaccio M, Di Castelnuovo A, Costanzo S, Ruggiero E, Esposito S, Persichillo M, et al. Ultra-processed food consumption is associated with all-cause and cardiovascular mortality in participants with type 2 diabetes independent of diet quality: A prospective observational cohort study. Am J Clin Nutr. 2023;118(3):627–36. 10.1016/j.ajcnut.2023.07.004
6 Muthukumar J, Selvasekaran P, Lokanadham M, Chidambaram R. Food and food products associated with food allergy and food intolerance—An overview. Food Res Int. 2020;138(Pt B):109780. 10.1016/j.foodres.2020.109780
7 Whelan K, Bancil AS, Lindsay JO, Chassaing B. Ultra-processed foods and food additives in gut health and disease. Nat Rev Gastroenterol Hepatol. 2024;21(6):406–27. 10.1038/s41575-024-00893-5
8 Montera VSP, Martins AP, Mais LA, Canrella DS. Informação sobre aditivos alimentares nos rótulos de alimentos no Brasil: Análise crítica. Rev. Saúde Pública 2023;57:2. 10.11606/s1518-8787.2023057004371
9 Richey Levine A, Picoraro JA, Dorfzaun S, LeLeiko NS. Emulsifiers and intestinal health: An introduction. J Pediatr Gastroenterol Nutr. 2022;1;74(3):314–9. 10.1097/MPG.0000000000003361
10 Naimi S, Viennois E, Gewirtz AT, Chassaing B. Direct impact of commonly used dietary emulsifiers on human gut microbiota. Microbiome. 2021;9(1):66. 10.1186/s40168-020-00996-6
11 Velázquez-Sámano G, Collado-Chagoya R, Cruz-Pantoja RA, Velasco-Medina AA, Rosales-Guevara J. (2019). Hypersensitivity reactions to food additives. Rev Alergia Mex. 1993;66(3):329–39. 10.29262/ram.v66i3.613
12 Raposa B, Pónusz R, Gerencsér G, Budán F, Gyöngyi Z, Tibold A, et al. Food additives: Sodium benzoate, potassium sorbate, azorubine, and tartrazine modify the expression of NFκB, GADD45α, and MAPK8 genes. Physiol Int. 2016);103(3):334–43. 10.1556/2060.103.2016.3.6
13 Halmos EP, Mack A, Gibson PR. Review article: Emulsifiers in the food supply and implications for gastrointestinal disease. Aliment Pharmacol Ther. 2019;49(1):41–50. 10.1111/apt.15045
14 Chassaing B, Koren O, Goodrich JK, Poole AC, Srinivasan S, Ley RE, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015;519(7541):92–6. 10.1038/nature14232
15 Borsani B, De Santis R, Perico V, Penagini F, Pendezza E, Dilillo D, et al. The role of carrageenan in inflammatory bowel diseases and allergic reactions: Where do we stand? Nutrients. 2021;13(10):3402. 10.3390/nu13103402
16 Cox S, Sandall A, Smith L, Rossi M, Whelan K. Food additive emulsifiers: A review of their role in foods, legislation, and classifications, presence in the food supply, dietary exposure, and safety assessment. Nutr Rev. 2021;12;79(6):726–41. 10.1093/nutrit/nuaa038
17 Sweis IE, Cressey BC. Potential role of the common food additive manufactured citric acid in eliciting significant inflammatory reactions contributing to serious disease states: A series of four case reports. Toxicol Rep. 2018;5:808–12. 10.1016/j.toxrep.2018.08.002
18 Zinöcker MK, Lindseth IA. The western diet–microbiome–host Interaction and its role in metabolic disease. Nutrients. 2018;10(3):365. 10.3390/nu10030365
19 Loayza JJJ, Kang S, Schooth L, Teh JJ, de Klerk A, Noon EK, et al. Effect of food additives on key bacterial taxa and the mucosa-associated microbiota in Crohn’s disease. The ENIGMA study. Gut Micr. 2023;15(1):2172670. 10.1080/19490976.2023.2172670
20 Witkowski M, Grajeta H, Gomułka K. Hypersensitivity reactions to food additives–preservatives, antioxidants, flavor enhancers. Int J Environ Res Pub Health. 2022;19(18):11493. 10.3390/ijerph191811493
21 Camilleri M. What is the leaky gut? Clinical considerations in humans. Curr Opin Clin Nutr Metab Care. 2021; 1;24(5):473–82. 10.1097/MCO.0000000000000778
22 Losol P, Sokolowska M, Hwang YK, Ogulur I, Mitamura Y, Yazici D, et al. Epithelial barrier theory: The role of exposome, microbiome, and barrier function in allergic diseases. Allergy Asthma Immunol Res. 2023;15(6):705–24. 10.4168/aair.2023.15.6.705
23 Celebi Sozener Z, Özbey Yücel Ü, Altiner S, Ozdel Oztürk B, Cerci P, Türk M, et al. The external exposome and allergies: From the perspective of the epithelial barrier hypothesis. Front Allergy. 2022;3:887672. 10.3389/falgy.2022.887672
24 Ogulur I, Yazici D, Pat Y, Naz Bingöl E, Babayev H, Ardicli S, et al. Mechanisms of gut epithelial barrier impairment caused by food emulsifiers polysorbate 20 and polysorbate 80. Allergy. 2023;78(9):2441–55. 10.1111/all.15825
25 Dufrusine B, Di Lisio C, Maurizio A, Sallese M, De Laurenzi V, Dainese E. Influence of food emulsifiers on cellular function and inflammation, a preliminary study. Front Nutr. 2023;10:1197686. 10.3389/fnut.2023.1197686
26 Khuda SE, Nguyen AV, Sharma GM, Alam MS, Balan KV, Williams KM. Effects of emulsifiers on an in vitro model of intestinal epithelial tight junctions and the transport of food a. Mol Nutr Food Res. 2022;66(4):e2100576. 10.1002/mnfr.202100576
27 Liu Y, Wu Q, Zhang J, Yan W, Mao X. Food emulsions stabilized by proteins and emulsifiers: A review of the mechanistic explorations. Int J Biol Macromol. 2024;261(Pt 1):129795. 10.1016/j.ijbiomac.2024.129795
28 Street ME, Shulhai AM, Rotondo R, Giannì G, Caffarelli C. Current knowledge on the effects of environmental contaminants in early life nutrition. Front Nutr. 2023;10:1120293. 10.3389/fnut.2023.1120293
29 Paparo L, Coppola S, Nocerino R, Pisapia L, Picariello G, Cortese M, et al. How dietary advanced glycation end products could facilitate the occurrence of food allergy. J Allergy Clin Immunol. 2024;153:742–58. 10.1016/j.jaci.2023.11.023
30 Kotchetkoff ECA, Suano-Souza FI, Almeida DNG, Barreto TLN, Mendonça RB, Sarni ROS. Ultra-processed food intake and food intake and food allergy in children and adolescents. Int J Food Sci Nutr. 2024;30:1–8. 10.1080/09637486.2024.2306296
31 Bancil AS, Sandall AM, Rossi M, Chassaing B, Lindsay JO, Whelan K.J. Food additive emulsifiers and their impact on gut microbiome, permeability, and inflammation: Mechanistic insights in inflammatory bowel disease. Crohn’s Colitis. 2021;15(6):1068–79. 10.1093/ecco-jcc/jjaa254
32 Raoul P, Cintoni M, Palombaro M, Basso L, Rinninella E, Gasbarrini A, et al. Food additives, a key environmental factor in the development of IBD through gut dysbiosis. Microorganisms. 2022;10(1):167. 10.3390/microorganisms10010167
33 Chassaing B, Compher C, Bonhomme B, Liu Q, Tian Y, Walters W, et al. Randomized controlled-feeding study of dietary emulsifier carboxymethylcellulose reveals detrimental impacts on the gut microbiota and metabolome. Gastroenterology. 2022;162(3):743–56. 10.1053/j.gastro.2021.11.006
34 Tang Q, Wang C, Jin G, Li Y, Hou H, Wang X, et al. Early-life dietary emulsifier exposure predisposes the offspring to obesity through gut microbiota-FXR axis. Food Res Int. 2022;162(Pt A):111921. 10.1016/j.foodres.2022.111921
35 Lane MM, Davis JA, Beattie S, Gómez-Donoso C, Loughman A, O’Neil A, et al. Ultra-processed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obes Rev. 2021;22:e13146. 10.1111/obr.13146
36 De Siena M, Raoul P, Costantini L, Scarpellini E, Cintoni M, Gasbarrini A, et al. Food emulsifiers and metabolic syndrome: The role of the gut microbiota. Foods. 2022;11(15):2205. 10.3390/foods11152205
37 Carucci L, Votto M, Licari A, Marseglia GL, Berni Canani R. Food allergy: Cause or consequence of pediatric eosinophilic esophagitis? Potential implications of ultraprocessed foods in prevention and management. Front Allergy. 2023;4:1138400. 10.3389/falgy.2023.1138400
38 Smith PK, Masilamani M, Li XM, Sampson HA. The false alarm hypothesis: Food allergy is associated with high dietary advanced glycation end-products and proglycating dietary sugars that mimic alarmins. J Allergy Clin Immunol 2017;139(2):429–37. 10.1016/j.jaci.2016.05.040
39 Chang JW, Jensen ET, Dellon ES. Nature with nurture: The role of intrinsic genetic and extrinsic environmental factors on eosinophilic esophagitis. Curr Allergy Asthma Rep. 2022;22(12):163–70. 10.1007/s11882-022-01042-1
40 Zhu YT, Yuan YZ, Feng QP, Hu MY, Li WJ, Wu X, et al. Food emulsifier polysorbate 80 promotes the intestinal absorption of mono-2-ethylhexyl phthalate by disturbing intestinal barrier. Toxicol Appl Pharmacol. 2021;414:115411. 10.1016/j.taap.2021.115411
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Mar 1, 2025
Article Details
How to Cite
Urrutia-Pereira, M., Guidos Fogelbach, G., Chong-Neto, H. J., & Solé, D. (2025). Food additives and their impact on human health. Allergologia Et Immunopathologia, 53(2), 26-31. https://doi.org/10.15586/aei.v53i2.1149
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Review Article
How to Cite
Urrutia-Pereira, M., Guidos Fogelbach, G., Chong-Neto, H. J., & Solé, D. (2025). Food additives and their impact on human health. Allergologia Et Immunopathologia, 53(2), 26-31. https://doi.org/10.15586/aei.v53i2.1149