Dermatologic and Ocular DiseasesAromatic components of food as novel eliciting factors of pseudoallergic reactions in chronic urticaria☆,☆☆
Section snippets
Subjects
A total of 33 patients (22 female and 11 male patients; mean age, 47.8 years; range, 16-70 years) with chronic urticaria and daily spontaneous occurrence of wheal responses was recruited for the study. All had previously experienced symptom improvement on a pseudoallergen-free diet, as detailed previously,1, 8 and symptoms had recurred on exposure to a full, pseudoallergen-rich meal. Five patients also had physical urticaria (2 cholinergic, 2 dermographic, and 1 heat); 3 had additional skin
Provocation tests
None of the patients studied reacted to any of the test substances on prick testing, and no specific serum IgE to tomato was found in any of the blood samples. Urticarial reactions after oral challenge occurred after a mean latency period of 2 to 4 hours. False-positive reactions on double-blind provocation with placebo were not seen.
Data on the frequency and degree of clinical reactions of the patients with urticaria to the different reagents after oral provocation are summarized in Fig 1 and
Discussion
Although until now artificial food additives have been viewed as primary eliciting agents of PARs to food, the present study demonstrates that such reactions also frequently occur in response to natural ingredients in tomatoes, white wine, and herbs. The pseudoallergic nature of the reactions is demonstrated by a lack of positive skin test responses, no detectable specific serum IgE, and failure of the tomato extract to induce in vitro histamine release from patient skin mast cells.
PARs to
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Cited by (90)
Potential Therapeutic Approaches for Chronic Urticaria: Beyond H1-Antihistamines and Biologics
2023, Journal of Allergy and Clinical Immunology: In PracticeDiversities of allergic pathologies and their modifiers: Report from the second DGAKI-JSA meeting
2022, Allergology InternationalAutoimmune chronic spontaneous urticaria
2022, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Although these triggers and the exacerbation of disease they induce, in many cases, are linked to increased skin mast cell activation, they are not held to be the underlying cause of CSU. Rather, they may be aggravators and disease modifiers or merely bystanders that cannot be reproduced by provocation in a controlled setting.1,11 At least 2 possible causes of CSU, 2 autoimmune endotypes, are recognized, with different types of autoantibodies that have been associated with the activation of skin mast cells.12
Nutrition and urticaria
2022, Clinics in DermatologyCitation Excerpt :In a subset of patients, pseudoallergens may induce or worsen chronic urticaria.13–16 Pseudoallergens include preservatives, dyes, salicylates, and aromatic compounds found in both natural (eg, garlic, artichoke, tomatoes, fruits, and rhubarb) and processed foods (eg, artificial sweeteners and processed meats).17–19 Unlike for true allergens, skin prick testing is negative and exposure does not consistently result in clinical symptoms.20
Triggers of Exacerbation in Chronic Urticaria and Recurrent Angioedema—Prevalence and Relevance
2021, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Although 73% of the participants benefited from a low-pseudoallergen diet (eg, low in food additives, biogenic amines, and other often described trigger foods such as tomatoes, herbs, alcohol, and the like), double-blind placebo-controlled food challenges with food additives provoked symptoms in only 19% of these patients. Seven years later, naturally occurring aromatic food components were shown to be the main elicitors instead.56 Subsequent studies by this working group and others have demonstrated the benefit of a low-pseudoallergen diet observing partial remission in a subgroup of patients with CSU.57-63
Common food flavors are safe in patients with urticaria or atopic dermatitis
2019, Journal of Allergy and Clinical Immunology: In Practice
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Supported by a grant from the Forschungszentrum Karlsruhe (P96009).
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Reprint requests: Torsten Zuberbier, MD, Department of Dermatology and Allergy, Charité Campus Mitte, Schumannstr 20/21, 10117 Berlin, Germany.