Nutrition and urticaria

The prevelance of food allergy in patients with chronic idiopathic urticaria: a systematic review and meta-analysis

Chronic idiopathic urticaria (CIU) is difficult for patients and healthcare professionals to manage owing to its chronic and unpredictable nature. While the exact cause of CIU is unknown, it is suggested that food allergies may contribute to the development of symptoms. To determine the prevalence of food allergy in patients diagnosed with CIU. This systematic review is reported in accordance with PRISMA guidelines. We included all relevant articles published from inception to April 2023 in Scopus, Midline, and Web of Science. The initial search yielded 282 articles, of which only seven were included after applying the inclusion and exclusion criteria. The systematic review included a total of 1551 patients with urticaria. Approximately 25% of patients with food allergies had CIU. The prevalence of a family history of atopy was 37.9% (range, 24.3-53.8%, P = 0.133). There was a significant risk of angioedema in patients with urticaria (P = 0.039). The risk of CIU among patients with food allergies was estimated to be one in every four patients with urticaria, with a similar risk among the adult and pediatric populations. Patients with food allergies and a history of atopy were at higher risk of CIU. Angioedema is a common concomitant manifestation associated with common urticaria. This knowledge is important to identify patients at higher risk of urticaria and implement the necessary management to minimize potential complications and maintain a controlled disease.

The Added-on of Ziziphus jujube Syrup in the Treatment of Chronic Spontaneous Urticaria Resistant to Standard-Dose of Secondary-generation H1 Antihistamine: A Double-Blind Randomized Clinical Trial

Background

Although antihistamines are the first-line treatment for chronic spontaneous urticaria (CSU), 50% of patients don't respond to standard doses. In this study, the effectiveness of Ziziphus jujube fruit syrup in combination with antihistamines was assessed in patients with CSU.

Methods

This double-blind randomized clinical trial was conducted in Shiraz between December 2019 and December 2020. 64 patients with CSU who had experienced hives for at least six weeks and did not respond to the usual treatments were enrolled in the study. They were randomly assigned to intervention and control groups using permuted block random allocation. For four weeks, the intervention group received 7.5 mL Ziziphus jujube syrup twice a day, while the control group received 7.5 mL simple jujube syrup twice a day. Both groups received cetirizine 10 mg every night. Urticaria activity score (UAS) and CU-Q2oL questionnaires were used to assess urticaria state and sleep quality before and after each week for four consecutive weeks. Data were analyzed using SPSS software version 18, and P<0.05 was considered statistically significant.

Results

Before the intervention, there was no statistically significant difference between the two groups' mean of UAS (P=0.490) and sleep quality (P=0.423). During the follow-up, UAS in the intervention group was significantly lower (P=0.001). Moreover, this difference was significant on the day 28 (P=0.046). During the follow-up, the quality of sleep in both groups improved significantly, and this improvement was more significant in the intervention group.

Conclusion

Ziziphus jujube syrup could be an effective adjuvant treatment for CSU.Trial Registration Number: IRCT20190304042916N1.

IgG food hypersensitivity: A potential hidden precipitant for chronic spontaneous urticaria A case report

BACKGROUND

While the link between foods and chronic spontaneous urticaria (CSU) is controversial, many immunological mechanisms have been proposed to establish a causal relationship.

OBJECTIVE

To explore the potential benefit of avoiding immunoglobulin G (IgG)-mediated food hypersensitivity as a triggering factor in a case with CSU.

HISTORY

The patient is a 50-year-old woman who complained of CSU for 1 and half year, which responded partially and temporarily to antihistamine medications. Of interest, it started 6 months after she followed an oat-rich diet. Her Urticaria Activity Score 7 was 23 out of 40.

RESULTS

Specific immunoglobulin E responses to common food and inhalant allergens were negative. A food-specific IgG antibody test was conducted, and it was mainly elevated for chicken eggs, rye, sweet pepper, gluten, garlic, wheat, and pineapple. Avoiding these foods had a curative effect on the CSU over a 2-month period.

CONCLUSION

To the best of our knowledge, this is the first case report of symptoms of CSU that resolved after identifying and avoiding food items with IgG antibodies. Furthermore, well-controlled studies are advocated to verify the potential role of IgG food hypersensitivity in the pathogenesis of CSU.