[Low pseudoallergen and histamine diet: a therapeutic approach in patients with chronic spontaneous urticaria.]

Abstract

Background: This article analyzes the effects of a histamine- and pseudoallergen-restricted diet as an additional strategy in the treatment of chronic spontaneous urticaria (CSU). A comprehensive review of the literature was conducted using PubMed and Google Scholar, employing both MeSH and non-MeSH terms related to urticaria, histamine, and diet. The review included 78 selected articles published between 2014 and 2024. CSU is a persistent disease in which a considerable number of patients do not respond optimally to standard treatments. Up to one-third of these patients may benefit from reducing the intake of pseudoallergens and histamine-rich foods. Bioactive amines present in various foods tend to exacerbate CSU symptoms by promoting the release of histamine and other inflammatory mediators. The restriction of dietary histamine and the enhancement of diamine oxidase (DAO) enzyme function appear to alleviate symptoms, although variability in reported histamine levels across studies complicates the development of standardized guidelines. It is concluded that a low-histamine and pseudoallergen diet is a promising option for reducing symptoms in patients with chronic spontaneous urticaria (CSU), particularly those who do not achieve adequate control with antihistamines. Evaluating the effectiveness of this diet over a period of three to four weeks is recommended to observe potential benefits. Nevertheless, additional studies and further standardization are necessary to define safe histamine levels in foods and improve therapeutic recommendations.