In urticaria, adverse reactions to food are only a frequent finding in the subset of patients with chronic continuous urticaria. Mostly these reactions are of pseudoallergic nature, directed against artificial additives as well as naturally occurring aromatic components. IgE-mediated allergic reactions are a rare cause in acute urticaria as well as in recurrent chronic urticaria. In other types of urticaria, e.g. physical urticaria, food plays hardly any role as an eliciting agent with the exception of ice-cold drinks in cold urticaria. By contrast, exercise-induced anaphylaxis is frequently food-dependent. Two subtypes are distinguished: unspecific food-dependent exercise-induced anaphylaxis (FDEIA), where the filling of the stomach independently of the kind of food ingested prior to exercise is responsible for the symptoms. In specific FDEIA, an IgE-mediated food allergy causes symptoms only in combination with exercise. In the latter group, wheat is an important allergen.

1.
Zuberbier T, Greaves M, Juhlin L, Lennart J, Kobza-Black A, Maurer D, Stingl G, Henz B: Definition, classification and routine diagnosis of urticaria: A consensus report. J Invest Dermatol Symp Proc 2001;6:123–127.
2.
Romano A, Di Fonso M, Giuffreda F, Papa G, Artesani MC, Viola M, Venuti A, Palmieri V, Zeppilli P: Food-dependent exercise-induced anaphylaxis: Clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 2001;125:265–272.
3.
Aihara M, Miyazawa M, Osuna H, Tsubaki K, Ikebe T, Aihara Y, Ikezawa Z: Food-dependent exercise-induced anaphylaxis: Influence of concurrent aspirin administration on skin testing and provocation. Br J Dermatol 2002;146:466–467.
4.
Briner WW Jr: Introduction: Exercise and allergy. Med Sci Sports Exerc 1992;24:843–844.
5.
Schwartz HJ: Elevated serum tryptase in exercise-induced anaphylaxis J Allergy Clin Immunol 1995;95:917–919.
6.
Zuberbier T: The role of allergens and pseudoallergens in urticaria. J Invest Dermatol Symp Proc 2001;6:132–134.
7.
Aoki T, Kojima M, Horiko T: Acute urticaria: History and natural course of 50 patients. J Dermatol 1994;21:73–77. (7a) Wüthrich B, Haecki-Hermann D: Zur Ätiologie der Urtikaria. Eine retrospektive Studie anhand von 316 konsekutiven Fällen. Z Hautkr 1980;55:102–111.
8.
Kauppinen K, Juntunen K, Lanki H: Urticaria in children. Retrospective evaluation and follow-up. Allergy 1984;39:469–472.
9.
Zuberbier T, Chantraine-Hess S, Hartmann K, Czarnetzki BM: Pseudoallergen-free diet in the treatment of chronic urticaria – A prospective study. Acta Derm Venereol 1995;75:484–487.
10.
Juhlin L: Recurrent urticaria: Clinical investigation of 330 patients. Br J Dermatol 1981;104:369–381.
11.
Pigatto PD, Valsecchi RH: Chronic urticaria: A mystery. Allergy 2000;55:306–308.
12.
Zuberbier T, Pfrommer C, Specht K, Vieths S, Bastl-Borrmann R, Worm M, Henz BM: Aromatic components of food as novel eliciting factors of pseudoallergic reactions in chronic urticaria. J Allergy Clin Immunol 2002;109:343–348.
13.
Buehner S, Ehlers I, Kuehl F, Zuberbier T, Lochs H: Gastrointestinal barrier in patients with chronic recurrent urticaria: Influence of a low pseudoallergen diet. Gastroenterology 1998;114:A868.
14.
Hide M, Francis DM, Grattan GEH, Hakimi J, Kochan JP, Greaves MW: Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in chronic urticaria. N Engl J Med 1983;328:1599–1604.
15.
Fiebiger E, Hammerschmid F, Stingl G, Maurer D: Anti-FceRI autantibodies in autoimmune-mediated disorders. J Clin Invest 1998;101:243–251.
16.
Zuberbier T, Fiebiger E, Maurer D, Stingl G, Henz BM: Anti-FceRIa serum autoantibodies in different subtypes of urticaria. Allergy 2000;55:951–954.
17.
Henz BM, Zuberbier T, Grabbe J, Monroe E: Urticaria: Clinical, Diagnostic and Therapeutic Aspects. Berlin, Springer, 1998, pp 69–78, 196.
18.
Wakelin SH: Contact urticaria. Clin Exp Dermatol 2001;26:132–136.
19.
Zuberbier T, Althaus C, Chantraine-Hess S, Czarnetzki B: Prevalence of cholinergic urticaria in young adults. J Am Acad Dermatol 1994;31:978–981.
20.
Zuberbier T, Greaves M, Lennart J, Merk H, Stingl G, Henz B: Management of urticaria: A consensus report. J Invest Dermatol Symp Proc 2001;6:128–131.
21.
Kutting B, Brehler R: Exercise-induced anaphylaxis. Allergy 2000;55:585–586.
22.
Aihara Y, Takahashi Y, Kotoyori T, Mitsuda T, Ito R, Aihara M, Ikezawa Z, Yokota S: Frequency of food-dependent, exercise-induced anaphylaxis in Japanese junior high school students. J Allergy Clin Immunol 2001;108:1035–1039.
23.
Shadick NA, Liang MH, Partridge AJ, Bingham C, Wright E, Fossel AH, Sheffer AL: The natural history of exercise-induced anaphylaxis: Survey results from a 10-year follow-up study. J Allergy Clin Immunol 1999;104:123–127.
24.
Hosey RG, Carek PJ, Goo A: Exercise-induced anaphylaxis and urticaria. Am Fam Physician 2001;64:1367–1372.
25.
Norgaard A, Skov PS, Bindslev-Jensen C: Egg and milk allergy in adults: Comparison between fresh foods and commercial allergen extracts in skin prick test and histamine release from basophils. Clin Exp Allergy 1992;22:940–947.
26.
Maulitz RM, Pratt DS, Schocket AL: Exercise-induced anaphylactic reaction to shellfish. J Allergy Clin Immunol 1979;63:433–434.
27.
Palosuo K, Alenius H, Varjonen E, Koivuluhta M, Mikkola J, Keskinen H, Kalkkinen N, Reunala T: A novel wheat gliadin as a cause of exercise-induced anaphylaxis. J Allergy Clin Immunol 1999;103:912–917.
28.
Harada S, Horikawa T, Ashida M, Kamo T, Nishioka E, Ichihashi M: Aspirin enhances the induction of type I allergic symptoms when combined with food and exercise in patients with food-dependent, exercise-induced anaphylaxis. Br J Dermatol 2001;145:336–339.
29.
Senna G, Mezzelani P, Pacor ML: Anaphylaxis induced by exertion. Recent Prog Med 1993;84:203–209.
30.
Von Vigier R, Sheffer AL, Pichler WJ: Exercise-induced urticaria and anaphylaxis. Dtsch Med Wochenschr 1995;13;120:1381–1386.
31.
Hanakawa Y, Tohyama M, Shirakata Y, Murakami S, Hashimoto K: Food-dependent exercise-induced anaphylaxis: A case related to the amount of food allergen ingested. Br J Dermatol 1998;138:898–900.
32.
Aihara Y, Kotoyori T, Takahashi Y, Osuna H, Ohnuma S, Ikezawa Z: The necessity for dual food intake to provoke food-dependent, exercise-induced anaphylaxis (FEIA): A case report of FEIA with simultaneous intake of wheat and umeboshi. J Allergy Clin Immunol 2001;107:1100–1105.
33.
Marone G, Kagey-Sobotka A, Lichtenstein LM: Effects of arachidonic acid and its metabolites on antigen-induced histamine release from human basophils in vitro. J Immunol 1979;123:1669–1677.
34.
Bandmann HJ, Kaess H, Langer HD: Mastocytosis simulating a food allergy. Hautarzt 1983;34:217–220.
35.
Guinnepain MT, Eloit C, Raffard M, Brunet-Moret MJ, Rassemont R, Laurent J: Exercise-induced anaphylaxis: Useful screening of food sensitization. Ann Allergy Asthma Immunol 1996;77:491–496.
36.
Fujimoto S, Kurihara N, Hirata K, Kamimori T, Tanaka S, Takeda T: Successful prophylaxis of wheat-dependent exercise-induced anaphylaxis with terfenadine. Intern Med 1995;34:654–656.
37.
Warin RP, Smith RJ: Challenge test battery in chronic urticaria. Br J Dermatol 1976;94:401–405.
38.
Genton C, Frei PC, Pecoud A: Value of oral provocation tests to aspirin and food additives in routine investigation of asthma and chronic urticaria. J Allergy Clin Immunol 1985;76:40–45.
39.
Michaelsson G, Juhlin L: Urticaria induced by preservatives and dye additives in food and drugs. Br J Dermatol 1973;88:525–532.
40.
Thune P, Granholt A: Provocation tests with antiphlogistica and food additives in recurrent urticaria. Dermatologica 1975;151:360–367.
41.
Wüthrich B, Fabro L: Acetylsalicylsäure- und Lebensmitteladditiva-Intoleranz bei Urtikaria, Asthma bronchiale und chronischer Rhinopathie. Schweiz Med Wochenschr 1981;111:1445–1450.
42.
Juhlin L: Recurrent urticaria: Clinical investigation of 330 patients. Br J Dermatol 1981;104:369–381.
43.
Ortolani C, Pastorello E, Luraghi MT, Della Torre F, Bellani M, Zanussi C: Diagnosis of intolerance to food additives. Ann Allergy 1984;53:587–591.
44.
Rudzki E, Czubalski K, Grzywa Z: Detection of urticaria with food additives intolerance by means of diet. Dermatologica 1980;161:57–62.
45.
Ros AM, Juhlin L, Michaelsson G: A follow-up study of patients with recurrent urticaria and hypersensitivity to aspirin, benzoates and azo dyes. Br J Dermatol 1976;95:19–24.
46.
Verschave A, Stevens E, Degreef H: Pseudo-allergen-free diet in chronic urticaria. Dermatologica 1983;167:256–259.
47.
Gibson A, Clancy R: Management of chronic idiopathic urticaria by the identification and exclusion of dietary factors. Clin Allergy 1980;10:699–704.
48.
Kirchhof B, Haustein UF, Rytter M: Azetylsalizylsäure-Additiva-Intoleranzphänomene bei chronisch rezidivierender Urtikaria. Dermatol Monatsschr 1982;168:513–519.
49.
Supramaniam G, Warner JO: Artificial food additive intolerance in patients wit angio-oedema and urticaria. Lancet 1986;ii:907–909.
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