To provide an updated concise review on food additives adverse reactions, diagnosis, and management.Despite the common use of food additives, their adverse reactions seem to be very rare in the general population (0.01-0.23%) but higher in atopic individuals (2-7%). Probably because of the difficulty in diagnosis, most of the available information is based on case reports or small series. Reported reactions are mostly mild and may affect the skin, the gastrointestinal tract, or the airways, and rarely anaphylaxis.Food additives should be suspected as the culprit in patients who report a history of reactions to a number of unrelated foods or to a certain food when commercially prepared but not when prepared at home. The major problem in dealing with reactions to additives is the identification of the offending agent(s). Apart from a careful history taking, allergy skin testing or in-vitro testing are rarely useful. Trials of elimination and reintroduction may be more helpful. If the anticipated reaction is severe, a well designed challenge testing should be carried out. Once the offending additive(s) is confirmed, treatment is avoidance. Because accidental exposure often happens, patients with a history of severe reactions should have self-injectable epinephrine and wear MedicAlert (Turlock, California, USA) identification.