Dietary Habits in Patients with Chronic Spontaneous Urticaria: Evaluation of Food as Trigger of Symptoms Exacerbation

Abstract

Background Many patients with chronic spontaneous urticaria (CSU) identify different foods as triggers of their symptoms and frequently make dietary restrictions without enough information. Objective To explore the diet habits of CSU patients and estimate the clinical impact of the foods most frequently reported to be suspect. Methodology Patients were interrogated about their clinical history of urticaria. Skin prick test and sIgE serum were done for most frequently reported foods by patients. Food challenge test was also performed. A group of healthy subjects was included to compare the dietary habits and the results of the diagnostic tests. Results Patients with CSU (n 245) and healthy (n 127) subjects were included. 164 (66%) subjects from CSU group and 31 (24%) from the control group reported at least one adverse reaction with foods. Food IgE sensitization was similar in both groups (17.5% versus 16.5%, respectively). 410 food challenge tests in 164 CSU patients and 38 in 38 control subjects were performed. 1.2% in CSU group and 0.7% in control group had a positive oral challenge test. Conclusion Despite the high frequency of self-report by patients, foods are uncommon triggers of CSU. Nevertheless, food challenge tests have to be offered early during medical evaluation to avoid unnecessary restrictions.

Frecuencia y caracterización clínica de la urticaria crónica en un hospital de tercer nivel

“…3 Alimentos ricos en histamina como pescados, quesos, bebidas alcohólicas, algunas frutas y verduras; así como aditivos y colorantes utilizados en la fabricación de alimentos pueden desencadenar agudizaciones de la UC. 7 Sánchez et al en 2018 14 informaron de una frecuencia de reacciones adversas a medicamentos de 13 % de, en su mayoría a AINE y antibióticos betalactámicos; en el presente estudio, la frecuencia fue obtenida mediante auto reporte, por lo cual esta prevalencia puede estar sobreestimada. Las reacciones adversas a alimentos se encontraron en una proporción mayor (18 %), comparada con lo reportado por Sánchez et al en 2019, 15 que fue de 1.2 %.…”

Clinical Characterization of Patients with Chronic Spontaneous Urticaria according to Anti-TPO IgE Levels

“…Differences in the prevalence of inducible urticaria and drug reactions have been reported in different parts of the world [2–4, 15, 32–37], suggesting that in addition to the underlying mechanisms, other factors such as sociodemographic characteristics have to be considered as possible explanation for the discrepancies observed between the studies. Independent of the type of extrinsic trigger, we found that inducible urticaria and reactions to NSAIDs—but not to foods—are common comorbidities in patients with CSU and that self-reporting is usually sufficient to confirm associations.…”

“…However, none of the patients met this criterion so we did not exclude any patient from the challenge tests. The protocols used for challenge tests were based on those proposed in international guidelines [11, 12], with modifications described elsewhere [2–4].…”

“…Urticaria can appear at any time and has a marked impact on quality of life. Despite the spontaneous appearance of CSU, a subset of patients also associate the onset of symptoms with several triggers, namely, foods (10 to 40%), drugs (10 to 30%), and physical factors (35 to 70%), such as sports, sun exposure, tight clothing, and temperature (heat, cold) [2–4]. Consequently, patients may avoid certain activities and stop eating specific foods and taking drugs they need.…”

Dietary habits in Japanese patients with chronic spontaneous urticaria

“…Several studies also report that serum 25-hydroxyvitamin D levels are decreased in CSU patients, and that vitamin D supplementation improves the symptoms of CSU. 12,13 Numerous studies have examined the triggering or therapeutic effects of diets on CSU, related to pseudoallergens or vitamin D; 12,14 however, there have been no studies on dietary intakes of individual nutrients or foods in quality and quantity in CSU patients compared with healthy controls, The traditional Japanese diet includes high intake of rice, miso soup, sea products and fish. The dietary habits in Japan differ from those in Western countries.…”