Effect of Diet in Chronic Spontaneous Urticaria: A Systematic Review
Hélène Cornillier, Bruno Giraudeau, Mahtab Samimi, Stéphane Munck, Florence Hacard, Annie-Pierre Jonville-Bera, Marie-Hélène Jegou, Gwenaëlle d'Acremont, Bach-nga Pham, Olivier Chosidow, Annabel Maruani
Strategies for diets in chronic spontaneous urticaria (CSU) are controversial. This systematic review assessed the interest in diet for managing CSU. We searched for original reports in MEDLINE, EMBASE, CENTRAL and LILACS. Among the 278 reports screened, 20 were included, involving 1,734 patients. Reports described 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 patients, 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 remission 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 suspected 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 because systematic double-blind controlled trials of diet are lacking.
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 spontaneous urticaria treatment frequently includes H1-antihistamine 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 urticaria. 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.