Challenge with sulfite solution for patients reporting asthmatic reactions

Step 1 (placebo dose)	10 mL vehicle solution.* Have patient swish for several seconds and swallow.	Measure FEV₁ prior to dose and if patient develops symptoms. If no reaction after 30 minutes, proceed to step 2.
Steps 2 through 4 (active doses)	Give 10 mL vehicle* containing: 10, 50, and then 100 mg potassium metabisulfite.	Measure FEV₁ prior to each dose and if patient develops symptoms. Allow 30 minutes between doses. If no reaction after last dose, proceed to step 5.
Step 5 (placebo dose)	Give one 10 mL dose of vehicle solution.* Have patient swish and swallow.	Measure FEV₁ prior to each dose and if patient develops symptoms. If no reaction, observe for 30 minutes after last dose.

Asthmatic reactions to sulfite solutions occur quickly. A 30-minute interval is adequate for observation after each dose. Each dose should be swished in the mouth for several seconds and then swallowed. If the patient reacts to an active dose, then the challenge is stopped and deemed positive. Protocol courtesy of Ronald A Simon, MD.

FEV₁: forced expiratory volume in one second.
* Vehicle solution is lemonade made on day of challenge from sulfite-free commercial crystalized lemonade mix or from fresh lemons.

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Challenge with sulfite solution for patients reporting asthmatic reactions