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Giornale Italiano di Dermatologia e Venereologia 2004 October;139(5):455-63


language: English, Italian

Role of foodstuffs in angioedema urticaria syndrome

Pigatto P. D., Persichini P., Arancio L.

Department of Dermatological Sciences University of Milan IRCCS Ospedale Maggiore, Milan, Italy


When asked about the possible causes of urticaria, most patients indicate dietary allergens, whereas the results of population studies have demonstrated a much lower prevalence. The pathogenetic mechanisms underlying the majority of reactions to food are still only partially understood. Milk, eggs, fish and soya are the most frequent culprits in children, whereas peanuts, walnuts, hazel nuts, cereals, fish, crustaceans, eggs and fresh fruit are the most common causes. Other foods act by means of an extra-immunological mechanism and, for example, may have direct lytic effects on mast cells. The clinical pictures of the dietary form are no different from those observed in other forms of urticaria. The most frequent (and often the only) symptom is urticaria/angioedema, whereas edema of the glottis seems to be the most frequent severe adverse reaction to foods. Anaphylaxis is the most feared consequence of dietary allergy and, in some cases, may be triggered by even minimal amounts of food. Diagnosis is based on anamnesis, skin tests (including those using fresh foods), specific serum IgE measurements, elimination diets, and tests of oral food exposure under various conditions. In addition to preventive measures, treatment includes symptomatic therapies ranging from anti-histamines and steroids for general purposes, to adrenaline for emergency cases. The most likely therapeutic hypotheses for the near future range from the infusion of anti-IgE monoclonal antibody to the use of vaccines in which the allergen is conjugated to specific segments of DNA that could stably modify Th2 responses to the allergen itself. Finally, genetic studies are currently under way with the aim of creating genetically modified foods devoid of allergenic proteins.

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