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World Allergy Organization
WAO's mission: To be a global resource and advocate in the field of allergy, advancing excellence in clinical care through education, research and training as a world-wide alliance of allergy and clinical immunology societies.

Ask The Expert

August 12, 2013

Food Intolerance and Chronic Urticaria

Question:

I am an allergist in Australia where low food-chemical diets are often tried in chronic urticaria. Many academic publications from the USA state that such diets have a limited role in this condition. These diets are often used in Europe, where they are often called 'pseudo-allergen diets'. Are there any RCT studies on this intervention? Can you advise on this diet's role in chronic urticaria?

Response:

We do not advise any dietary manipulation in patients with chronic urticaria. We know that food allergy is not the cause and food additives or chemicals in foods have virtually no role either. The pseudo allergen diet was advocated by Drs Torsten Zuberbier and Marcus Maurer from Berlin, and they continue to use it. Other centers in Europe sometimes do so too, but are getting away from it. On the one hand, it is relatively harmless; on the other hand the response rate is uncertain at best. Although Dr. Zuberbier published a study that looked reasonable some years ago, their latest publication had an improvement rate of 30% which is not better than the placebo rate in most studies. It also has no known biochemical mechanism and makes little sense.

The mainstays of therapy are antihistamines in at least 4 times the dose usually used for allergic rhinitis. The two best drugs for refractory cases are omalizumab and cyclosporine.

Allen Kaplan
Medical University of South Carolina – Charleston, South Carolina, USA


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