Dermatologic and Ocular Diseases
Aromatic components of food as novel eliciting factors of pseudoallergic reactions in chronic urticaria,☆☆

https://doi.org/10.1067/mai.2002.121309Get rights and content

Abstract

Background: Pseudoallergic reactions (PARs) against both additives and natural foods have been reported to elicit chronic urticaria, but in natural food the responsible ingredients are largely unknown. Objective: The study was aimed at identifying novel pseudoallergens in food and focused on evaluating tomatoes, white wine, and herbs as frequently reported food items eliciting wheal responses in urticaria. Methods: In 33 patients with chronic urticaria and PARs to food (proved by means of elimination diet and subsequent re-exposure with provocation meals), oral provocation tests were performed with field-grown tomatoes, organically grown white wine (whole food, steam distillates, and residues), oily extracts from herbs, and food additives. In addition, skin biopsy specimens from patients were studied for in vitro mast-cell histamine release with tomato distillate alone or on subsequent stimulation with anti-IgE, substance P, and C5a. Results: Seventy-six percent of patients reacted to whole tomato (steam distillate, 45%; residue, 15%), 50% to food additives, 47% to herbs, and 44% to whole wine (extract, 27%; residue, 0%). Histamine, protein, and high levels of salicylate were only found in residues. The tomato distillate was further analyzed by means of mass spectroscopy, identifying lowmolecular-weight aldehydes, ketones, and alcohol as major ingredients. In vitro histamine release was not caused by tomato extract itself but was enhanced by means of subsequent stimulation with substance P and C5a but not by anti-IgE. Conclusion: Aromatic volatile ingredients in food are novel agents eliciting PARs in chronic urticaria. Histamine, salicylate, and a direct mast-cell histamine release are not involved in this reactivity to naturally occurring pseudoallergens. (J Allergy Clin Immunol 2002;109:343-8.)

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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    Supported by a grant from the Forschungszentrum Karlsruhe (P96009).

    ☆☆

    Reprint requests: Torsten Zuberbier, MD, Department of Dermatology and Allergy, Charité Campus Mitte, Schumannstr 20/21, 10117 Berlin, Germany.

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