Acta Dermato-Venereologica 99-2CompleteContent | Page 7

127 REVIEW ARTICLE Effect of Diet in Chronic Spontaneous Urticaria: A Systematic Review Hélène CORNILLIER 1 , Bruno GIRAUDEAU 2 , Mahtab SAMIMI 1 , Stéphane MUNCK 3 , Florence HACARD 4 , Annie-Pierre JONVILLE- BERA 2,5 , Marie-Hélène JEGOU 6 , Gwenaëlle D’ACREMONT 7 , Bach-nga PHAM 8 , Olivier CHOSIDOW 9 and Annabel MARUANI 1,2 ; CENTRE DE PREUVES EN DERMATOLOGIE 1 Department of Dermatology, University François Rabelais Tours, CHRU Tours, Tours, 2 SPHERE - INSERM 1246. University of Tours and Nantes, 3 Department of Teaching and Research in General Practice, University Nice Sophia Antipolis, Nice, 4 Department of Allergology and Immunology, University Hospital Center of Lyon, Lyon, 5 Department of Clinical Pharmacology, CHRU Tours, Tours, 6 Dermatology Office, Blanquefort, 7 Pediatric Office, Paris, 8 Laboratory of Immunology, University Hospital Centre of Reims, Reims, and 9 EA 7379 EpiDermE and CIC INSERM 1430, AP-HP, Hospital Henri Mondor, UPEC, Créteil, France Strategies for diets in chronic spontaneous urticaria (CSU) are controversial. This systematic review asses- sed the interest in diet for managing CSU. We sear- ched for original reports in MEDLINE, EMBASE, CEN- TRAL and LILACS. Among the 278 reports screened, 20 were included, involving 1,734 patients. Reports des- cribed 3 types of systematic diet: pseudoallergen-free diet (n  = 1,555 patients), low-histamine diet (n  = 223) and diet without fish products (n  = 47), which induced complete remission in 4.8%, 11.7% and 10.6% of pa- tients, respectively, and partial remission in 37.0%, 43.9% and 4.3%. Eight reports described personalized exclusion diets (66 patients) adapted to symptoms/ allergological test results and led to complete remis- sion in 74.6% of patients, although the diagnosis of CSU was doubtful. No comparative randomized studies of diets were available. The only randomized studies were based on oral provocation tests with the suspec- ted responsible diet. Population and outcomes were heterogeneous. In conclusion, there is evidence for the benefit of diets in CSU only in individual patients with clinical symptoms. However, the level of evidence is low for the benefit of systematic diets in CSU be- cause systematic double-blind controlled trials of diet are lacking. Key words: chronic urticaria; spontaneous urticaria; diet; food; allergological tests. Accepted Aug 7, 2018; E-published Aug 7, 2018 Acta Derm Venereol 2019; 99: 127–132. Corr: Hélène Cornillier, Department of Dermatology, CHRU Tours – Hospi- tal Trousseau, Avenue de la République, FR-37044, Tours Cedex 9, Tours, France. E-mail: [email protected] C hronic urticaria is an inflammatory skin and mucosa dermatitis, defined as the occurrence of spontaneous wheals, angioedema, or both, for more than 6 weeks. The guidelines of the European Academy of Allergy and Clinical Immunology, Global Allergy and Asthma Euro- pean Network, European Dermatology Forum and World Allergy Organization (EAACI/GA 2 LEN/EDF/WAO) divide chronic urticaria into 2 groups: chronic inducible urticaria and chronic spontaneous urticaria (CSU) (1). Chronic inducible urticaria includes symptomatic dermo- SIGNIFICANCE Chronic spontaneous urticaria is an inflammatory skin and mucosa disease, defined as the occurrence of spontaneous wheals or oedema for more than 6 weeks. Chronic sponta- neous urticaria treatment frequently includes H1-antihista- mine drugs as first-line treatment. Strategies for diets are controversial. A systematic review was performed to assess the value of diets in managing chronic spontaneous urtica- ria. The review shows that the level of scientific evidence is low because controlled studies of diets and of allergological tests in chronic spontaneous urticaria are lacking. However, the data suggest no benefit of systematic diets in chronic spontaneous urticaria, but benefit of personalized diets in individual patients with clinical symptoms. graphism, cold urticaria, delayed pressure urticaria, solar and heat urticaria, vibratory angiooedema, cholinergic urticaria, contact urticaria and aquagenic urticaria. The causes of CSU are frequently unknown. CSU might oc- cur at any age, but is more frequent in young adults and has a female predominance. CSU is the consequence of mast cell activation. Activated mast cells release histamine first, then other mediators, such as platelet-activating factor, leukotrienes and prostaglandins that induce sensory nerve activation, vasodilatation, and plasma extravasation. These effects are responsible for dermal oedema, whose clinical fea- tures are urticarial characteristic lesions. In CSU, mast cells are pre-activated via an immunological pathway (IgE, IgG, complement) or non-immunological pathway by transmembrane receptors or intracellular signals (2). Complete mast cell activation is triggered by other mul- tiple signals, including infections, drugs, stress, foods and other agents. Foods might be responsible for urticaria if they are rich in histamine or are able to activate mast cells via the non-immunological pathway and induce histamine release. Foods that might be involved include cheese, fish, vegetables, fruits, chocolate and alcohol (this is a non-exhaustive list). Contrary to acute urticaria being linked to food allergy, the mechanism of CSU is not an IgE-mediated type I reaction, but is rather dose- dependent, usually a delayed pseudoallergic reaction This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3015 Acta Derm Venereol 2019; 99: 127–132