Document Detail

Diagnostic approach for suspected pseudoallergic reaction to food ingredients.
MedLine Citation:
PMID:  19054425     Owner:  NLM     Status:  MEDLINE    
Chronic urticaria, recurrent angioedema and non-allergic asthma have all been associated with pseudoallergic reactions to food ingredients. For atopic dermatitis and diseases of the gastrointestinal tract, this association is controversial. Pseudoallergic reactions can be elicited by additives as well as by natural food ingredients. An altered histamine metabolism may be associated with pseudoallergy. Acute urticaria or a short episode of angioedema is not an indication for exhaustive evaluation. If basic diagnostic screening is negative in chronic urticaria, a low-pseudoallergen diet can be considered. Skin and serological tests are not objective diagnostic parameters for pseudoallergic reactions. The severity of symptoms should be documented while the patient is on a low-pseudoaller-gen diet. Oral provocation with additives leads to reproducible symptoms only in a few cases. Therefore, if a low-pseudoallergen diet brings improvement, the patient is then exposed to a pseudoallergen-rich "super meal". After a positive reaction to the "super meal" the challenge with additives takes place in the form of collective group exposition. When the patient has asthma or a history of anaphylac-toid reactions, testing with individual substances in carefully increasing dosages is required. The suspicion of adverse reactions against histamine can be confirmed by a challenge with histamine dihydrochloride. In the case of respiratory symptoms, provocation by inhalation should be considered. Objectifying symptoms especially in gastrointestinal diseases is mandatory and should include double-blind placebo-controlled food challenge, if possible.
Imke Reese; Torsten Zuberbier; Britta Bunselmeyer; Stephan Erdmann; Margot Henzgen; Thomas Fuchs; Lothar Jäger; Jörg Kleine-Tebbe; Ute Lepp; Bodo Niggemann; Martin Raithel; Joachim Saloga; Stephan Vieths; Thomas Werfel
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-11-24
Journal Detail:
Title:  Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG     Volume:  7     ISSN:  1610-0387     ISO Abbreviation:  J Dtsch Dermatol Ges     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-13     Completed Date:  2009-04-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101164708     Medline TA:  J Dtsch Dermatol Ges     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  70-7     Citation Subset:  IM    
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MeSH Terms
Dermatitis, Atopic / diagnosis*,  etiology
Food / adverse effects*
Food Hypersensitivity / diagnosis*
Gastrointestinal Diseases / diagnosis*,  etiology
Practice Guidelines as Topic*
Skin Tests / methods,  standards*
Urticaria / diagnosis*,  etiology

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