Jo Valone and Carolyn Knight nearly died from allergic reactions to sulfite food preservatives.
When Valone, now 43, slipped into a coma last year, it was Dr. Peter P. Kozak who rushed to her side at St. Joseph Hospital in Orange.
"He wasn't just a doctor who thought of you as a name or a number," recalled Carolyn Knight, 46, also a Kozak patient. "He was concerned about the issue."
Kozak worked with Knight to determine how widespread the use of sulfites had become, and he helped distribute information compiled by Stamp Out Sulfites, a group she had organized.
Jo Valone's husband, Bob of Mission Viejo, recalled Sunday that "it was largely through Dr. Kozak and Dr. (Leo H.) Cummins," both of Orange, and the work of Dr. Ronald Simons at the Scripps Clinic and Research Foundation in La Jolla that the deadly potential of sulfites was revealed.
Years of Controversy
After years of controversy surrounding the issue, the federal Food and Drug Administration on Friday officially proposed banning the use of six sulfites on fresh vegetables and fruits.
But on Friday, Kozak was buried. He died last Monday of a heart attack. Those who remember him--his patients and colleagues--said Kozak would have approved of the FDA's proposed ban but that he also would have believed, as they do, that the ban does not go far enough.
It was through Kozak's efforts that many physicians and potential victims learned of "all the things that had sulfites in them," said Dr. Sherwin Gillman, a colleague and an allergy specialist in Orange.
"He was surprised to find out that a lot of medications (contained sulfites), including some of those we use for asthmatic patients," Gillman said.
Kozak's findings meant that medicines containing sulfite might accidentally be given to sulfite-sensitive patients by "an unsuspecting doctor, not realizing what the problem is. It is really scary."
Medications are unaffected by the proposed FDA ban, as are frozen foods, dried fruits, wine and beer.
The FDA has linked 13 deaths to sulfite preservatives and documented 500 reports of adverse reactions in 1984, up from 50 complaints the previous year. The problems range from hives, nausea and diarrhea to shortness of breath and fatal shock, the FDA said.
Knight, a free-lance writer formerly of Orange, and other activists assert that as many as 500,000 people nationwide, most of them asthmatics, are susceptible to the adverse reactions. Knight, who moved to Canyon Lake near Lake Elsinore in 1981, said as many as 1,100 medications, including "emergency-type" medicines, contain sulfite agents.
The proposed FDA ban "is a wonderful first step," she said. "I'm glad they are finally seeing the seriousness of it. But I'm ambivalent. It's just a first step."
"It's a start," Jo Valone agreed Sunday, "but we have a long way to go."
Kozak, who kept unusually close tabs on Valone during her three-month coma last year, would not "be completely happy" with the FDA action, Valone said. "But he'd be glad that they're starting."
During Valone's coma, Kozak would check the the brain-damaged woman's condition before arriving at his office, during his lunch hour and before going home, even if it was late at night, her husband recalled.
Medications Carry Sulfites
"He was concerned (about) the medication the hospital might give her because so many of the medications carry sulfites that are potentially lethal" to asthmatics, Bob Valone said.
Since recovering from her coma, Jo Valone has regained about 80% of her motor abilities and about 90% of mental functions, her husband said. She recently passed her driver's license test, he said.
"Approximately a year ago we didn't know if she wasn't going to walk or talk or anything else," Bob Valone said.
Jo Valone had experienced several severe respiratory attacks when on Feb. 28, 1984, she ate what a waitress assured her were fresh, cottage-fried potatoes. Tests later showed "a lot of residual sulfite" in the potatoes, an FDA official said.
California and 31 other states have passed laws requiring restaurants to post signs advising diners when food contains sulfites. (The additives, which keep lettuce and other vegetables crisp, became widely used with the rising popularity of salad bars.)
"Restaurant organizations say 90%-plus don't use it now," Bob Valone said. "But I understand that the association of restaurants entails only about 20% of restaurants in the United States and that means that the other 80% or 90% may or may not be doing something about it."
Knight, who in 1979 was the first documented case that linked sulfites to respiratory attacks in asthma sufferers, said, "Kozak was trying with me to come up with a list of safe foods to eat in restaurants.
"I'm wondering how many people who have choked in a restaurant or had a heart attack in a restaurant," she said, actually had a reaction to sulfites in food.