Diet and Chronic Urticaria: Dietary Modification as a Treatment Strategy

Diet and Chronic Urticaria: Dietary Modification as a Treatment Strategy

Authors

Keywords:

chronic urticaria, diet, pseudoallergens, food additives, histamine

Abstract

Patients with chronic urticaria (CU) often ask about dietary modification. Research has indicated that specific dietary changes may be helpful in a subset of patients. Immunological food reactions are rare, but potential triggers of CU include those seen in certain settings, as in patients with a history of tick bites, a history of raw or marinated fish ingestion, or those with celiac disease. Nonimmunological food intolerances may also contribute, although mechanism of action is not well understood. Trials of pseudoallergen-free diets and low-histamine diets have resulted in partial remission in a subset of patients, while oral provocation testing has confirmed that some patients experience worsening of symptoms after ingestion of food additives, tomatoes, herbs, seafood, alcohol, and other foods. An increased prevalence of vitamin D deficiency has also been noted in patients with CU compared with healthy controls. While oral antihistamines remain the mainstay of therapy in CU, education on potential dietary factors may be offered to a selection of the group of patients. For those at risk or reporting symptoms suggestive of celiac disease, vitamin D deficiency, delayed reactions to mammalian meat, or exposure to raw fish, further workup is recommended. While education on dietary modification may be offered to other patients, this approach may benefit only a subset, and no test is available to identify these patients. A minimum of 3 weeks may be needed to determine response, and only specific diets that have been systematically studied should be considered. Any elimination diet should be used with caution because of the potential for nutritional deficiencies.

Author Biographies

Joanna Jaros, University of Illinois College of Medicine, Chicago, IL, USA

Resident Physician PGY-1 Transitional Year at AMITA St. Joseph Hospital

Incoming PGY-2 at Cook County Health Dermatology 

Vivian Y. Shi, Department of Medicine, Dermatology Division, University of Arizona at Tucson, AZ, USA

Assistant Professor Medicine and Dermatology, Department of Medicine, Dermatology Division at University of Arizona-Tucson

Director, Eczema Specialty Clinic

Director, Hidradenitis Suppurativa Specialty Clinic

Director, Inflammatory Skin Research Fellowship Program

 

Rajani Katta, Dermatology, McGovern Medical School at UT Health, Bellaire, TX, USA

Clinical Professor of Dermatology, McGovern Medical School at UT Health

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2019-12-31

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1.
Diet and Chronic Urticaria: Dietary Modification as a Treatment Strategy. Dermatol Pract Concept [Internet]. 2019 Dec. 31 [cited 2024 Dec. 9];:e2020004. Available from: https://dpcj.org/index.php/dpc/article/view/dermatol-pract-concept-articleid-dp1001a04

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