FOOD INTOLERANCE NETWORK FACTSHEET
Food additives and asthma
Sulphites and asthma
Why don't asthmatics notice the connection between their asthma and foods?
The effect is related to the size of the dose
Sources of sulphites
Other food chemicals that can be associated with asthma
Preservatives
MSG
Salicylates
Allergies and food sensitivities
Reader stories
What you can do
Conclusion
Scientific references
More information
Keywords: sulphites, sulfites, asthma, preservatives, MSG, salicylates
A month after Jamie Oliver introduced additive free meals at Wingfield Primary School in London in 2003, teachers noticed that asthmatic children no longer needed their asthma medication at school. 'Unbelievable,' Jamie commented. 'I'm totally dumbfounded. That primary school, with little kids? ... you just change their food and then you don't have to be ramming all those chemicals and drugs down them.'
It's the same at the Food Intolerance Network. Over many years, we have seen that when families go on an elimination diet to help a child with behaviour problems, any asthmatics in the family are likely to improve as well.
This is because the food chemicals that can be associated with asthma are the same as those that can cause behaviour problems in susceptible children.
Sulphites and asthma
Sulphites are the additives most associated with asthma. In 1999 the World Health Organisation decided that:
- many more asthmatic children are affected by sulphite preservatives (up to 20-30 per cent) than previously thought (4 per cent). This is still a conservative estimate considering Australian research showed that over 65 per cent of asthmatic children were affected by sulphites.
- alternative preservatives other than sulphites should be used where possible
- appropriate labeling can help consumers who are sensitive to sulphites
Why don't asthmatics notice the connection between their asthma and foods?
People usually only make a connection between foods and symptoms if the reaction occurs within 30 minutes.
A few asthmatics will react to sulphites with an immediate asthma attack but for most asthmatics, sulphites will cause irritable airways with no obvious symptoms.
When the child or adult with irritable airways is exposed to an asthma trigger such as:
- a cold or flu (or other virus)
- running around outside (or other exercise), or
- cold air
they will have asthma. If you avoid the sulphites - and other irritating food chemicals - that person can be exposed to asthma triggers without developing asthma.
The effect is related to the size of the dose
Sulphites are used in varying levels. The ADI (Acceptable Daily Intake) for sulphites can be exceeded by a two year old who eats more than half a dried apricot in a day or a ten year old who eats more than one and a half dried apricots in a day, although the ADI is no guarantee of safety for asthmatics. A seven-year-old with no known asthma who reported 'it was a bit hard to breathe' after eating ten dried apricots in a day could be an asthmatic on daily medication if he ate that level of sulphites every day, as some do. High consumers of highly sulphited foods are particularly at risk or asthma or chronic cough.
Sources of sulphites
Major sources of sulphites in the diet include:
- dried fruit and dried fruit in fruit bars, muesli bars, fruit rolls and other processed foods
- sausages
- cordials, some fruit juice drinks, flavoured water, some soft drinks
Children in the 2-5 year old age range are the highest consumers of sulphites by far with high-consuming boys eating nearly three times the ADI. This age group also has the highest asthma rates
Adults can be affected by sulphites too. A Dutch woman who developed adult onset asthma within three months of starting a weight loss program had been snacking on dried fruit and nut trail mix. After her doctor advised her to drop the dried fruit, her asthma disappeared. For adults, sulphites in wine and beer can be a major source of sulphites. There are preservative-free wines and beer available.
Other food chemicals that can be associated with asthma
Preservatives
Benzoates (210-218 but especially sodium benzoate 211) are another asthmagenic preservative. They are commonly found in drinks, icecream toppings, milkshake syrups and syrup medications sometimes consumed in very high amounts by young children. A case history reported in a French medical journal describes a child diagnosed with asthma by her first birthday and treated with continuous medication for almost six years. At that time her condition worsened, requiring hospitalisation about once a month. Challenges showed that the girl was sensitive to benzoate preservatives (211) in her asthma medication. After 12 months of avoiding benzoates in foods, drinks and medications, she remained asthma-free. In Australia, there are benzoates in asthma medication and other medications given to asthmatics, despite objections by doctors.
Benzoates can affect adults too. One woman noticed that her diagnosis of adult-onset asthma coincided with a switch to diet cola. After three months, she needed daily asthma preventers and relievers. The diet cola is preserved with benzoates, regular cola is not. When she reverted to regular cola, her asthma disappeared.
MSG
During a series of talks to school students last year, several primary students talked about parents or siblings who get asthma after eating Chinese food. See our MSG factsheet for more on the link between asthma and MSG.
Salicylates
Salicylates are natural chemicals in many ‘healthy’ foods including most fruit (some of the highest are citrus fruits, avocado, pineapple, plums, grapes and sultanas); some vegetables (highest are tomatoes/sauce/paste, broccoli), mint flavouring, licorice, herbs and spices, perfumes and many medications. Aspirin contains salicylate but many salicylate-sensitive asthmatics have never realized their sensitivity because reactions can be delayed or build up slowly. About 20 per cent of asthmatics are thought to be sensitive to salicylates. Nasal polyps can be associated with salicylate-sensitive asthma.
Allergies and food sensitivities
Any or all of the above food chemicals can be associated with asthma as well as dairy products and possibly wheat in some cases. Some asthmatics are extremely sensitive, some only mildly so. Allergy testing by a hospital allergy clinic can reveal true allergies to both foods and environmental factors such as dust mites. For food intolerance, you need to do an elimination diet. Unlike IgE-mediated allergies, there are no scientifically proven laboratory tests for food intolerance.
See all success stories about asthma and food
[1080] Additive-induced asthma – from 20 puffs of Ventolin a day to none (December 2011)
I wrote you 4 years back (story 524), and I just thought I should write in with an update. If you'll recall I had suffered from additive-induced asthma from the age of 10 (I'm now 37). It took a couple of decades to finally realise that artificial food additives were THE cause of my condition. Over 23 years, not a single doctor ever once asked if my condition might be due to food.
As a heads-up for those still "lost" and wondering if there is a cure, I strongly urge you to give up what I call the "trifecta" (i.e. artificial colours, flavours and preservatives). This covers most of the main culprits which cause most peoples' asthmatic conditions (in my opinion).
After this, I also discovered I was highly sensitive to "vegetable gums" (that friendly sounding additive in many bread products: This includes Gum Arabic and the so-called 'safe' one, Xanthan Gum). The symptoms these two nasty additives create in sensitive people is a tight chest, light-headedness and a general feeling of not being able to breathe. (I literally almost died one night a while back, when I woke up gasping for air at 3am, after having consumed bread with Xanthan Gum in it over a period of four days straight...)
Well, there it is guys. Thanks mainly to your wonderful website I have gone from 20 puffs a day to not touching Ventolin or any medication for over a year now. Not a single time! I honestly never thought I would reach this stage. It's so sad to think that if we - as a society - just stuck to "whole" foods, leaving out ALL artificial additives, many, MANY health issues would be non-existent. Things are getting better, thanks to websites like yours, Sue, but it's still too slow. Thank you so much for all the valuable things you do and God Bless you all! - Mark, by email
[1365] Asthma related to preservatives (sulphites, benzoates, nitrates) and colours including natural colour annatto 160b (November 2015)
Our son's breathing problems and wheezing started at four months, when a GP put him on antibiotics. He was on the nebuliser at least twice a day with corticosteroids, ipratropium and salbutamol and oral steroids thrown in when he got really bad. He had all the tests for causes - dust mites etc - which proved negative. Then he started solids at 5 months and got worse.
When he was two and a half we started on the elimination diet. His asthma disappeared in the second week.
Challenges showed that Joe reacted to sulphites, benzoates, nitrates and colours, both artificial and natural. One musk stick (artificial colours azorubine and erythrosine 127) started him coughing within three minutes. Annatto natural colour 160b took a little longer. Artificial yellow colour tartrazine 102 turned out to be the worst of all. Through experience, we learned that Joe gets asthma from colours in antibiotics and toothpaste. Additives can also be absorbed through the skin, so he also gets asthma from coloured shampoo and liquid soap. - from Fed Up with Asthma
[524] Open neglect by medical establishment (January 2007)
Criminal. It's the only word that comes to mind when I realise that, from the age of 10, I have suffered terribly from asthma; and yet, over the next 23 years, not a single - I repeat NOT A SINGLE - so-called "doctor" ever once asked if my condition might be due to environmental factors", or that it might be caused by the food that I eat... All they ever did was pop a stethoscope on my back, and fill out a prescription for ventolin... "See ya next time, Mark!"
I am so angry and frustrated at the modern medical establishment for their open neglect. For years, almost every morning I would wake with an awful wheeze and a fit of coughing... And it only got worse as my 20's progressed!
When I think back to those days (although I never made the precise connection myself at the time), it got to the point where I would need my puffer after almost every meal! Macca's.. Pizza... Pies... even good 'ole home cooked meals like curries, stews & roasts! As you can imagine, I became very depressed.
I will also confess that I was indeed a smoker as well (I know, I know), but I gave them up around 3 years ago thinking that IT was the main *cause* of my asthma... Oddly enough, I was wrong ... the daily ritual wheezing-fest continued unabated. I was, by then, needing up to 20 puffs a day and my depression worsened. I remember thinking: "I've given up the damn ciggies, so why aren't I any better?! What's wrong with me?" I began to accept that I would NEVER recover from this ailment.
Then I discovered your website, "Fedup!" ... And oh what a life changer!
I bought the video a few months back and have read much of the material on the website, and with what I now know about salicylates, amines, preservatives and additives of all kinds, it finally all makes sense!
So far, my family and I have managed to stop the intake of preservatives and additives (That's the EASY part!) with noticeable improvements too, I might add, especially for my asthma! However, I have not completely recovered yet, and my eldest son - although improved - still has temper problems; so, over the last two days we have finally started tackling the salicylate/amine issue... It's harder I'll admit, BUT, I can already see definite positive-changes from my first-born son, and in my own well-being as well.
It's been around 6 months now since we actively started amending our diet, and overall, my asthma is now highly manageable... (I now use the ventolin only rarely, and the morning-wheeze is completely gone!) But, it's not just that: I finally feel "in control" for the first time ever; I feel that there is now real hope that it could perhaps, go altogether! I really do.
Thank God for you, Sue. Thank you for caring enough about human beings in general, to do what you do. Alright, I'm falling to tears now... so I best go - Mark & family, Vic
[526] Diet has been a lifesaver (January 2007)
We have had excellent results with diet for our five-year-old daughter who had severe asthma attacks with daily singulair, ventolin, atrovent and also 3 lots of prednisilone within the space of about 3 or 4 months at the beginning of 2006. Since going failsafe in August, not even a cough. I attribute a big part of this success to eliminating both sulphites and artificial colours in particular.
I always felt that there was something more we could do, but just didn't know where to start. My children had what I thought to be such a healthy diet, no cordials, lollies and lots of fruit and dried fruit for snacks. Now I know better.
If telling our story assists in being a catalyst for positive change for other families in situations like ours, that will be wonderful - Monica, NSW
[525] “a second lease on life” (January 2007)
Without sounding corny, it is like my daughter has been given a second lease on life.
Our youngest daughter was diagnosed with asthma at 3 years of age and we then spent many times in and out hospital, with still no improvement. She missed so many days of Preschool, could not run without puffing and requiring her asthma puffer all the time, she also had permanent grey colour under her eyes. We really did not think we would be able to send her to school.....it was that bad.
Then a friend of mine from work went to a Sue Dengate talk … and the light went on. I contacted my husband immediately and told him about it, cause we had been so worried and that night I cleaned out all my food cupboard and fridge and made it additive-free.
Our daughter is now 6 and is going into Year 1 and has not been in hospital since the month we stopped the additives. We have a liitle girl who runs, jumps for ages on the trampoline, has lost the grey under her eyes and very happy parents.
Abbey knows that she can't have food with additives and has had to make a lot of sacrifices, but when she said to me a few months after stopping all of that, that she feels better then I know it is all worth it - Kathy, NSW
[373] No significant asthma in 10 months
I bought a copy of "Fed Up With Asthma" about 10 months ago. Since then I have been avoiding the food additives highlighted on your card and have had no significant asthma. You argument seems to fit in perfectly with my history. I grew up in England and developed mild asthma as an adult. This was generally triggered by cats, house dust or overexertion. I moved to New Zealand, where my asthma got much worse. My doctor told me that this was due to the cold, damp Wellington climate.
I moved to Belgium in 2000. Despite living in a colder and damper climate I had no asthma in Belgium. During this time I drank very little wine, preferring the traditional local beers. I also consumed far fewer food additives just by being there. For example bread lasts less than a day as the bakers are fiercely traditional in their methods. The same is true of most other food providers.
On returning to New Zealand in 2004, the asthma started to return. This was despite living in sunny Nelson. I knew that it must have been caused by something regional. Your book helped me to identify the problem as bad food additives.
This afternoon I was shocked to hear an expert on asthma and allergies on Radio New Zealand re-iterating the old message about kids not eating enough dirt. I must have eaten loads as a kid. When I called in he insisted that there was no link to food additives, except perhaps sulphite in wine as a trigger. There is obviously still some way to go. Please keep up the good work! - by email from NZ
[310] Asthma due to salicylates
Since we discovered salicylates, my daughter doesn't need preventative medication anymore although I have made a few slip ups with her diet. Every time she has a reaction I look at what she has eaten and it is always salicylates. For example, she had a reaction to rissoles in the early stages of the diet before I had your books to help me. My dietitian said, 'Did you put pepper in the rissoles?" I hadn't realised pepper was high in salicylates and used it automatically. Last year I bought some "Kids Bananas" from Coles because my daughter never ate more than half of the usual big Cavendish bananas. Two days later her eczema had flared up and then she got asthma. By this time she had eaten three of these bananas. They must have been sugar bananas which are high in salicylates but I didn't know that at the time. During that attack she had to go back on her preventer medication as well as Ventolin but she hasn't needed it since. - failsafer, Qld
[370] Asthma and benzoates in medication
After hearing about sodium benzoate in asthma medication at your presentation recently I was a bit shocked, and sure enough it was there in my son’s asthma syrup used for under fives. My son had suddenly developed asthma when he was two months old, just after his first immunisation shot - although at that age they don't call it asthma. When the asthma finally went away we got the second shot. After that, he frequently stopped breathing and was on so much medication we took turns at sitting up with him through the night. Finally we decided that the medication wasn't working constantly enough and took him off it without telling the doctor – and our son slowly got better. He would still have small attacks on occasions so after my husband read your book he decided we should try diet … We were doing great and had almost six months free of any medication then last week our son developed an ear infection and was put on antibiotic syrup and paracetamol syrup for pain, both containing sodium benzoate. Within three days he had an asthma episode.
After much enquiry I have found that sodium benzoate is in almost every single baby medication including pain medication (often along with artificial colours and flavours). Our pharmacist said that the small amount of sodium benzoate couldn't possibly create a reaction like asthma, it's unheard of, and as sodium benzoate is so effective as a preservative it is the most commonly used preservative in medication today and likely to be in the future. God help us!! – mother from Qld. [See the article Asthma worsened by benzoate contained in some antiasthmatic drugs, by Balatsinou L and others, Int J Immunopathol Pharmacol, 2004 ;17(2):225-6: "Drug and food additives are known to induce pseudo-allergic reactions such as urticaria, eczema, asthma and rhinitis. These reactions are often under-diagnosed, above all in allergic patients treated with additive containing drugs. On the contrary, attention to the additives present in some drug formulations and foods may often permit more correct diagnosis."]
[306] Instant answer to my boys' asthma
With the knowledge I gained from your books I was able to trace which foods did what. The cause of my 3 year old's asthma became obvious (sulphites) when he would eat something out of the ordinary such as two apricot fruit bars (which he had not eaten in ages), come home, run around outside and have an asthma attack, which he has not had in ages.
[309] Adult with asthma (December 2003)
I am an adult with asthma. I went off milk and sulphite preservatives about 6 months ago, I have not had asthma since (unless I am 'naughty' and have some sulphite). – email, ACT
[413] I was unaware of the food-asthma connection (excerpt)
Ever since my son - now aged 10 - was a baby he would get a persistent dry cough that would continue relentlessly throughout the day and all through the night of only the winter months every year - at least 6 months every year without fail. The doctors would all say that they couldn't hear wheezing, so stopped short of diagnosing asthma no matter how sick he was. Finally a new local doctor a few years ago suggested asthma and asked me to try a blue puffer with ventolin. It fixed him immediately after 5 months of relentless coughing! He is an extremely active, sporty child, who plays and trains hard every season, but never got the asthma in the summer months.
Ventolin continued to control it, although he was worse after soccer training and games - in recent years accompanied by acute chest pains during games - and often had to come off. Last year, he participated in a school cross country held in May and got into the next level (extremely hilly) in June. After the race he could not stop coughing, had difficulty breathing and was very ill, missing school for some time after, which was when we started to make the exercise connection. We then started to observe and realised the trigger was exercise. Once winter was over he was well again, right up until March this year.
The beginning of March coincided with my reading your books - for other problems, I had forgotten about the asthma as it was controlled with ventolin and seasonal - and the gradual reduction in non failsafe foods in our house in the lead up to going failsafe. During this time he participated in the soccer training and school cross country practices and came first twice - no coughing, no problems. About 90 per cent failsafe, he went to a two day school camp this year – we don’t know what he ate. The next day (Saturday) at soccer he had severe chest pains throughout the game.
After the game his father bought him a sausage sandwich. He started coughing sometime that afternoon and continued for several days. On the Monday and Tuesday at school he came last in the cross country practices on both days, and came home extremely ill on the Tuesday, still coughing continuously. He stayed at home on the Wednesday with ventolin and the vaporizer and gradually recovered.
He was still coughing a little but much better the following Sunday, when we were unavoidably delayed whilst out. The kids were starving at lunchtime and begging for hot chips. At this point I was not aware of the food-asthma connection nor of the sulphites in hot chips. Later that afternoon he quickly began to get much worse again and needed the puffer and vaporiser again on the Sunday and Monday night. By the Tuesday night he didn't need the puffer or vaporiser anymore and went to soccer training on the Wednesday night without coughing or chest pains. He has eaten 100 per cent failsafe since then (4 weeks later) with absolutely no sign of the asthma cough despite plenty of exercise and sport. He actually won his school cross country - no reactions at all afterwards or during, whilst plenty of kids were, in his words, "dropping like flies with asthma attacks all around him" - some quite seriously so! Of course, as usual, the school had a sausage sizzle going all that day to raise money - bizarre isn't it? - reader, NSW.
- cut down on food additives, especially sulphites in dried fruit, sausages, processed meats, drinks and some hot chips
- keep a daily diary of your asthma symptoms, foods you eat (with the additives they contain) and environmental factors - it may become very obvious that you are affected by sulphites, benzoates or MSG
- see a dietitian with an interest in allergy and food intolerance through the Dietitians Association of Australia or our list of Supportive Dietitians and other Health Professionals.
- never discontinue asthma medication without consulting your doctor
- always carry asthma medication when eating because if you inadvertently break your diet you will be affected
- if trialling the elimination diet, do your challenges with the supervision of a doctor or dietitian
- read our factsheets: Dangers of dried fruit, Sulphite preservatives
The World Health Organisation recommends it, Jamie Oliver recommends it, the Centre for Science in the Public interest recommends it: “the obvious public health response would be to remove the irritants from the foods that children eat.” While food regulators procrastinate, you can send a vote against additives to the food manufacturers with every dollar you spend. The message is clear: REFUSE TO BUY!
Abstracts for the references below are available through the medical database PubMed. More relevant studies are available through our scientific references page.
Jamie Oliver at Wingfield Primary School
- See the short video of Jamie’s School Dinners on our DVD - Fed Up with Children's behaviour. The dinners that children had been eating included well-known sources of sulphites such as manufactured meats, hot chips and soft drinks. Drinks – even the new flavoured waters - are also a source of benzoate preservatives.
Sulphites are the additives most associated with asthma
- Fifty-first meeting of the Joint FAO/WHO Expert Committee on Food Additives. Safety Evaluation of Certain Food Additives: evaluation of national assessments of sulfur dioxide and sulfites and addendum, Geneva: World Health Organisation, 1999, http://www.inchem.org/documents/jecfa/jecmono/v042je06.htm
- Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-7. This study found that over 65 per cent of asthmatic children were sensitive to sulphites. https://www.ncbi.nlm.nih.gov/pubmed/6718119
The connection between diet and asthma
- Hoj L, Osterballe O, Bundgaard A, Weeke B, Weiss M. A double-blind controlled trial of elemental diet in severe, perennial asthma. Allergy 1981;36(4):257-62. Hospitalised asthmatics improved on an additive free elemental diet, those in the control group on hospital food made to look like an elemental diet failed to improve and in some cases worsened in life-threatening ways
- Hijazi N, Abalkhail B, Seaton A. Diet and childhood asthma in a society in transition: a study in urban and rural Saudi Arabia. Thorax 2000;55(9):775-9. Increases in the rate of childhood asthma are related to increased processed food in the diet.
- Hodge L, Yan KY, Loblay RL. Assessment of food chemical intolerance in adult asthmatic subjects. Thorax 1996;51(8):805-9.
- Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-7. This study has been widely misunderstood as saying that diets do not work for asthma, which is not the same as saying there is no connection. Diets for asthma do work if patients get the diet right and stick to it – as shown by the one child in the study. But supermarket foods are a minefield of asthmagenic additives and our experience agrees with this study. Some children and adults can get rid of asthma simply by avoiding sulphites in dried fruit, drinks and sausages, but others are more sensitive than that and most families are not prepared to stick to a diet for asthma unless their children have behaviour problems too. This is why children should be protected by removal from our food supply of additives that cause harm.
Why don’t asthmatics notice the connection?
- People usually only make a connection between foods and asthma if the reaction occurs within 30 minutes - McDonald JR, Mathison DA, Stevenson DD. Aspirin intolerance in asthma. Detection by oral challenge. J Allergy Clin Immunol 1972;50(4):198-207. Asthmatics were given an aspirin tablet they were told was not aspirin. Only those who reacted within 30 minutes made the connection between tablet ingestion and asthma symptoms.
- A few asthmatics will react to sulphites with an immediate asthma attack but for most asthmatics, sulphites will cause irritable airways with no obvious symptoms. Corder EH, Buckley CE, 3rd. Aspirin, salicylate, sulfite and tartrazine induced bronchoconstriction. Safe doses and case definition in epidemiological studies. J Clin Epidemiol 1995;48(10):1269-75.
Benzoate preservatives in asthma and other drugs
- Petrus M, Bonaz S, Causse E, Rhabbour M, Moulie N, Netter JC, et al. Asthmé et intolérance aux benzoates. Arch Pédiatr 1996;3(10):984-7. Case report of a child whose adverse reaction to benzoates required avoidance of some drugs, including some of those classically prescribed in the form of syrups for asthma
- Balatsinou L, Di Gioacchino G, Sabatino G, Cavallucci E, Caruso R, E. G. Asthma worsened by benzoate contained in some antiasthmatic drugs. Int J Immunopathol Pharmacol 2004;17(2):225-6. Drug and food additives are known to induce pseudo-allergic reactions such as urticaria, eczema, asthma and rhinitis. These reactions are often under-diagnosed, above all in allergic patients treated with additive containing drugs.
Colours and asthma
- Freedman BJ. Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. Clin Allergy 1977;7(5):407-15
MSG and asthma
- Moneret-Vautrin DA. Monosodium glutamate-induced asthma: study of the potential risk of 30 asthmatics and review of the literature. Allerg Immunol (Paris) 1987;19(1):29-35. See also MSG factsheet for the complexities of industry funded studies
Salicylates and asthma
- Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. Brit Med J 2004;328(7437):434. This review found that many more adult asthmatics are sensitive to salicylates than are aware of their sensitivity. While only 3% reported aspirin sensitivity, 21% of adult asthmatics reacted to oral challenges
- Towns SJ, Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-7.
Sulphite preservatives
Introduction to food intolerance
Fed Up with Asthma by Sue Dengate, published by Random House, 2003 (Now out-of-print but updated and summarised in Fed Up).
The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance. You can see our list of experienced and supportive dietitians http://fedup.com.au/information/support/dietitians
© Sue Dengate update January 2019
