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• W2194950194 abstract "To the Editor: We read with great interest the Continuing Medical Education article by Murzaku and colleagues1Murzaku E.C. Bronsnick T. Rao B.K. Diet in dermatology: part II. Melanoma, chronic urticaria, and psoriasis.J Am Acad Dermatol. 2014; 71: 1053.e1-1053.e16Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar on dietary therapies for various skin conditions including chronic urticaria. The authors concluded that a pseudoallergen-free diet might be recommended for a subset of patients with chronic urticaria based on 3 “double-blind, placebo-controlled trials” and level IB evidence suggesting its efficacy.2Supramaniam G. Warner J.O. Artificial food additive intolerance in patients with angio-oedema and urticaria.Lancet. 1986; 2: 907-909Abstract PubMed Scopus (117) Google Scholar, 3Zuberbier T. Chantraine-Hess S. Hartmann K. Czarnetzki B.M. Pseudoallergen-free diet in the treatment of chronic urticaria. A prospective study.Acta Derm Venereol. 1995; 75: 484-487PubMed Google Scholar, 4Pigatto P.D. Valsecchi R.H. Chronic urticaria: a mystery.Allergy. 2000; 55: 306-308Crossref PubMed Scopus (66) Google Scholar Upon review of the cited primary literature, we are concerned about the quality of evidence behind this recommendation. None of the 3 cited studies represented experimental trials to address whether the pseudoallergen-free diet is efficacious in treating chronic urticaria. The first article was comprised of 47 children with chronic urticaria, who already reported benefits from a pseudoallergen-free diet and who underwent double-blind, placebo-controlled oral challenge with food additives.2Supramaniam G. Warner J.O. Artificial food additive intolerance in patients with angio-oedema and urticaria.Lancet. 1986; 2: 907-909Abstract PubMed Scopus (117) Google Scholar The other 2 articles comprised 67 and 348 patients with chronic urticaria, of whom 64 and 202, respectively, underwent a pseudoallergen-free diet either empirically or based on suggestive dietary causes.3Zuberbier T. Chantraine-Hess S. Hartmann K. Czarnetzki B.M. Pseudoallergen-free diet in the treatment of chronic urticaria. A prospective study.Acta Derm Venereol. 1995; 75: 484-487PubMed Google Scholar, 4Pigatto P.D. Valsecchi R.H. Chronic urticaria: a mystery.Allergy. 2000; 55: 306-308Crossref PubMed Scopus (66) Google Scholar Among 47 and 126 patients, respectively, who responded benefits from the diet, similar double-blind, placebo-controlled oral challenges were undertaken. The food challenge aspects of these studies were indeed double-blind, placebo-controlled interventions; however, they tested potential associations between the reintroduction of specific food additives and chronic urticaria activity and did not lend direct evidence on whether the removal of such additives from a general diet in the first place was efficacious in treating chronic urticaria. Because a subset of these patients had responded to this dietary intervention, these studies only represented observational, and not experimental, evidence for its efficacy. The American Academy of Allergy, Asthma, and Immunology 2014 guideline updates, based on a systematic review of the weak existing evidence, reported that the “avoidance of pseudoallergens in the diet is not recommended” for the management of chronic urticaria with a level C strength of recommendation.5Bernstein J.A. Lang D.M. Khan D.A. et al.The diagnosis and management of acute and chronic urticaria: 2014 update.J Allergy Clin Immunol. 2014; 133: 1270-1277Abstract Full Text Full Text PDF PubMed Scopus (475) Google Scholar Although we agree that such diet may impose low direct cost to the patient, the burden of adhering to significant dietary restrictions may impact the patient's quality of life and nutritional status. Although brief deployment as a diagnostic tool may be helpful in selected patients, we believe that the current evidence does not support the routine use of a pseudoallergen-free diet to treat patients with chronic urticaria without identifiable dietary triggers. Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasisJournal of the American Academy of DermatologyVol. 71Issue 6PreviewThe roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. Full-Text PDF Response to: “Evidence on pseudoallergen-free diet for chronic urticaria”Journal of the American Academy of DermatologyVol. 72Issue 6PreviewTo the Editor: We thank Drs Yeung and Swerlick for their comments on our continuing medical education article “Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis.”1 We agree that the benefits of a pseudoallergen-free diet are controversial. Additionally, a pseudoallergen elimination diet may be of limited utility in the majority of chronic urticaria patients.1,2 Indeed, it is important to emphasize that a recent trial found sensitivity to pseudoallergens in less than 1% of a cohort of 100 patients with chronic urticaria. Full-Text PDF" @default.
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• W2194950194 title "Evidence on pseudoallergen-free diet for chronic urticaria" @default.
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