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Dietary Pseudoallergens and Chronic Urticaria

Emma K Wedgeworth, MA, MRCP and Clive EH Grattan, MA, MD, FRCP

Chronic urticaria is defined as recurrent wealing (Figure 1) – with or without angioedema – occurring at least twice a week for ≥6 weeks. It is a common condition, which causes considerable morbidity and has been shown to have significant associated healthcare costs [1]. Chronic spontaneous urticaria (chronic ordinary urticaria; CU) presents with spontaneous weals, whereas the physical urticarias are induced by one or more specific exogenous stimuli that can be determined by physical challenge testing. The mast cell appears to be a key player in the etiology of urticaria. Although the absolute numbers of these are probably not increased in CU, there appears to be heightened releasability of inflammatory factors from these cells. The mechanisms leading to mast cell activation are not entirely understood. Circulating immunoglobulin G (IgG) autoantibodies to the high-affinity IgE receptors or IgE on mast cells are believed to be pathogenic in a subset of patients with autoimmune urticaria [2]. The role of basophils in urticaria has also attracted attention, as basopenia has been noted in CU patients, leading to the suggestion that active recruitment of basophils into lesional skin occurs [3]. However, it is often not possible to identify a single cause; the disease appears to be multifactorial in many patients and may involve dietary pseudoallergens.

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