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RESEARCH PRODUCT

A Popular myth - low-histamine diet improves chronic spontaneous urticaria - fact or fiction?

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Background Chronic spontaneous urticaria (CsU) is a frequent dermatological disease that might last for months or years with high impact on quality of life. Known causes are autoreactive phenomena, infections or intolerances, rarely IgE-mediated allergies. One third of CsU patients benefit from a low-pseudoallergen diet. Additionally, it is often discussed, that reducing histamine ingestion alone might improve clinical symptoms and quality of life in CsU-patients despite the uncertain role of the histamine-degrading enzyme diamine oxidase (DAO). Objective Aim of this study is to investigate the impact of low-histamine diet on symptoms and quality of life in patients with CsU. Methods Patients suffering from CsU accompanied by gastrointestinal symptoms were included in the study. They underwent low-histamine diet for at least 3 weeks. During the whole study, urticaria activity score (UAS) was recorded daily in a patient′s diary. Quality of life was assessed during screening, baseline and post-diet visits by completing questionnaires (DLQI and CuQ(2)oL). Diamine oxidase (DAO)- activity was measured before and after elimination diet. Results 75 % of the patients had a benefit from the low-histamine diet. 34 of 56 patients (61 %) reached the primary endpoint of the study, an improvement of UAS 4 of ≥ 3. Overall a significant reduction from 9.05 to 4.23 points (p=0.004) was achieved; the average reduction in a strongly affected subgroup was 8.59 points (p<0.001). DAO activity remained stable. Conclusion Low-histamine diet is a therapeutically useful, simple and cost-free tool to decrease symptoms and increase quality of life in CsU-patients with gastrointestinal involvement. Further research is needed to understand the role of diamine oxidase. This article is protected by copyright. All rights reserved.