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August 12, 2013

Food Intolerance and Chronic Urticaria


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?


From the Editors:

We thank Doctors Lang, Zuberbier and Kaplan for their responses. Low food-chemical (AKA pseudo-allergen) diets are often used in Europe. In Australia many allergists will try that diet in selected subjects. North American trained allergists rarely (or never) use that approach. It is indeed useful to receive opinions from experts across the world.

By Dr. David Lang:

In patients with chronic urticaria, an etiologic role for foods and food additives is frequently suspected, but rarely confirmed.

The possibility has been proposed that substances in foods, termed “pseudoallergens” – such as artificial preservatives and dyes in processed foods, or aromatic compounds in natural foods, may be a cause and/or an exacerbating factor for chronic urticaria. . . .

. . . In summary, the evidence is weak that pseudoallergen-free diets lead to improvement in the course of chronic urticaria. Based upon the burden associated with adherence to such a diet, until this intervention is shown to be of benefit in randomized controlled trials, pseudoallergen free diets cannot be recommended as an intervention for patients with chronic urticaria.

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By Dr. Torsten Zuberbier:

. . . The currently suggested diet (see attached) has been evaluated and controlled in trials in different European countries by different groups have shown very similar results. In general the diet is especially helpful in those patients with chronic urticaria with daily or almost daily whealing and the history of intolerance (synonym: pseudoallergy) to Aspirin. The pathology is not clear but it has been shown that those patients with chronic urticaria who have a disturbed gastric permeability are those responding to diet and that adhering to the diet for three to four weeks can restore gastric permeability to normal levels.

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By Dr. Allen Kaplan:

"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 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."

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