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Diet & Skin Problems
Eczema, Hives, Urticaria etc.

Research Menu Page ||| Updated 11/23/2013

Listed in reverse date order:
Magerl 2010  Effects of a pseudoallergen-free diet on chronic spontaneous urticaria: a prospective trial.
Vally 2009  Clinical effects of sulphite additives.
Dodiq 2008  Chronic autoimmune urticaria in children.
Healy 2008  Control of salicylate intolerance with fish oils.
Inomata 2006  Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl.
Moneret Vautrin 2003  Allergic and pseudo-allergic reactions to foods in chronic urticaria.
Nettis 2003  Suspected tartrazine-induced acute urticaria/angioedema is only rarely reproducible by oral rechallenge.
Czop 2002Green skin discoloration associated with multiple organ failure.
Pacor 2001Efficacy of leukotriene receptor antagonist in chronic urticaria....
Worm 2001Increased leukotriene production by food additives in patients with atopic dermatitis and proven food intolerance
Zuberbier 2001The role of allergens and pseudoallergens in urticaria.
Reilly 2000Toothpaste Allergy With Intractable Perioral Rash in a 10-year old Boy
Worm 2000Clinical relevance of food additives in adult patients with atopic dermatitis.
Yoneyama 2000The effect of DPT and BCG vaccinations on atopic disorders
Zillich 2000Skin discoloration with blue food coloring.
Cilliers 1999The case of the red lingerie - chromhidrosis revisited.
Kalinke 1999Purpura pigmentosa progressiva in type III cryoglobulinemia and tartrazine intolerance. A follow-up over 20 years.
Arai 1998Food and food additives hypersensitivity in adult asthmatics. III. Adverse reaction to sulfites in adult asthmatics
Huang 1998Study of skin rashes after antibiotic use in young children.
Orchard 1997Fixed drug eruption to tartrazine.
Petrus 1997Clinico-immunological study of 16 cases of benzoate intolerance in children
Businco 1996Evaluation of the efficacy of oral cromolyn sodium or an oligoantigenic diet in children with atopic dermatitis: a multicenter study of 1085 patients.
Jimenez Aranda 1996  Prevalence of chronic urticaria following the ingestion of food additives in a third tier hospital
Kurek 1996 Pseudoallergic reactions. Intolerance to natural and synthetic food constituents masquerading as food allergy.
Antico 1995The role of additives in chronic pseudo-allergic dermatopathies from food intolerance
Lester 1995Sulfite sensitivity: significance in human health.
Zuberbier 1995Pseudoallergen-free diet in the treatment of chronic urticaria. A prospective study.
Kanny 1994Allergy and intolerance to flavouring agents in atopic dermatitis in young children.
Wuthrich 1993Adverse reactions to food additives.
Sloper 1991Children with atopic eczema. I: Clinical response to food elimination and subsequent double-blind food challenge.
Veien 1991Cutaneous vasculitis induced by food additives.
Pacor 1990Eczema and food allergy in the adult
Malanin 1989The results of skin testing with food additives and the effect of an elimination diet in chronic and recurrent urticaria and recurrent angioedema.
Montano 1989 Frequency of urticaria and angioedema induced by food additives
Pachor 1989Is the Melkersson-Rosenthal syndrome related to the exposure to food additives? A case report.
Van Bever 1989Food and food additives in severe atopic dermatitis.
Juhlin 1987 Additives and chronic urticaria.
Paul 1987Skin reactions to food and food constituents--allergic and pseudoallergic reactions
Cant 1986Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studie
Chudwin 1986Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis.
Galland 1986Increased requirements for essential fatty acids in atopic individuals: a review with clinical descriptions.
Warrington 1986Cell-mediated immune responses to artificial food additives in chronic urticaria.
Genton 1985Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria.
Kemp 1985An elimination diet for chronic urticaria of childhood.
Villaveces 1985Experience with an elemental diet (Vivonex).
Egger 1983 Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment.
Verschave 1983Pseudo-allergen-free diet in chronic urticaria.
Guin 1982 Treatment of Urticaria.
Miller 1982 Sensitivity to tartrazine.
Illig 1981 Urticaria and "aspirin intolerance"--part of an interdisciplinary pathogenetic principle?
Wuthrich 1981Acetylsalicylic acid and food additive intolerance in urticaria, bronchial asthma and rhinopathy
Gibson 1980Management of chronic idiopathic urticaria by the identification and exclusion of dietary factors.
Rudzki 1980Detection of urticaria with food additives intolerance by means of diet.
Valverde 1980In vitro stimulation of lymphocytes in patients with chronic urticaria induced by additives and food.
Lindemayr 1979Intolerance to acetylsalicylacid and food additives in patients suffering from recurrent urticaria.
Neuman 1978   The danger of "yellow dyes" (tartrazine) to allergic subjects.
Mikkelsen 1978   Hypersensitivity reactions to food colours with special reference to the natural colour annatto extract (butter colour).
Lockey 1977 Hypersensitivity to tartrazine (FD&C Yellow No. 5) and other dyes and additives present in foods and pharmaceutical products.
Ros 1976 A follow-up study of patients with recurrent urticaria and hypersensitivity to aspirin, benzoates and azo dyes.
Doeglas 1975Reactions to aspirin and food additives in patients with chronic urticaria, including the physical urticarias.
Settipane 1975Aspirin intolerance. III. Subtypes, familial occurence, and cross-reactivity with tartarazine.
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  1. The role of additives in chronic pseudo-allergic dermatopathies from food intolerance, Antico A, Di Berardino L, Allerg Immunol (Paris), 1995 May;27(5):157-60
    "... real IgE-mediated allergic reactions are rather rare. More commonly observed and apparently on a constant rise in Western countries are reactions from food intolerance, especially in relationship with the massive exposure to additives used in industrial food products. ... The link between symptoms and intolerance to food additives has been proved on the basis of the efficacy of a strict diet that eliminates certain foods and the positivity of the provocation test in double-blind trial controlled with a placebo in 165 patients ... These results lead us to conclude that additives are a frequent cause of chronic pseudo-allergic dermatopathies in adult patients and, in general, a problem of primary importance in the allergology practice."

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  2. Food and food additives hypersensitivity in adult asthmatics. III. Adverse reaction to sulfites in adult asthmatics, Arai Y, Muto H, Sano Y, Ito K, Arerugi 1998 Nov;47(11):1163-7
    "...Twenty adult asthmatic patients, who were non-steroid-dependent and without a suggestive history of sulfite sensitivity, underwent challenge with oral solution of metabisulfite. ... 12 patients reacted to metabisulfite. They demonstrated airway obstruction 5 (41.7%), urticaria 4 (36.7%), skin manifestation 2 (16.7%) and nasal congestion 1 (8.3%). All patients who demonstrated airway obstruction, were sensitive to aspirin..."

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  3. Evaluation of the efficacy of oral cromolyn sodium or an oligoantigenic diet in children with atopic dermatitis: a multicenter study of 1085 patients. Businco L et al., J Investig Allergol Clin Immunol 1996 Mar-Apr;6(2):103-9
    "...At the end of the trial there was a significant improvement in skin lesions in the two groups: 61% of the patients in the sodium cromoglycate group and 69% in the restricted diet showed a significant improvement in atopic dermatitis. We concluded that, at least in our experimental design, both sodium cromoglycate and a restricted diet are equally effective in atopic dermatitis."

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  4. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies, Cant AJ, Bailes JA, Marsden RA, Hewitt D, British Medical Journal (Clin Res Ed) 1986 Jul 26;293(6541):231-3
    "Thirty seven breast fed infants with eczema were studied to see whether changes in their mothers' diets affected their skin condition....Maternal dietary exclusion seems to benefit some breast fed babies with eczema."

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  5. Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis. Chudwin DS, Strub M, Golden HE, Frey C, Richmond GW, Luskin AT, Ann Allergy 1986 Aug;57(2):133-4
    " A woman experienced exacerbations of bronchial asthma after taking aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. On oral challenges, she developed an urticarial reaction after tartrazine; urticarial and bronchospastic reactions after salicylsalicylic acid; and urticarial and bronchospastic reactions after choline magnesium trisalicylate. . . . The results of sensitivity studies of our patient indicates that such patients may also be sensitive to non-acetylated salicylates."

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  6. The case of the red lingerie - chromhidrosis revisited. Cilliers J, de Beer C. Dermatology 1999;199(2):149-52
    " Chromhidrosis or the production of coloured sweat is a rare clinical finding. A 26-year-old female presented with marked pink staining of her uniform and lingerie. Extractions of clothing, skin surface samples, eccrine sebum, urine and a fast food product were spectrophotometrically analysed to identify the pink staining pigment. Three water-soluble colouring agents have been identified. An eccrine (sweat) route of excretion probably produced chromhidrosis. An overview is presented. "

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  7. Green skin discoloration associated with multiple organ failure., Czop M, Herr DL. Crit Care Med. 2002 Mar;30(3):598-601.
    " . . . .A 67-yr-old woman with unstable angina, electrocardiographic S-T segment elevation, and a left ventricle thrombus requiring emergent coronary revascularization surgery. . . . The patient developed an intense green skin color. CONCLUSION: Patients with multiple organ failure may be at risk for unusual pigmentation effects from tube feeding dyes. "

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  8. Chronic autoimmune urticaria in children., Dodig S, Richter D., Acta Dermatovenerologica Croatica. 2008;16(2):65-71.
    " . . . Complete or partial remission was obtained with treatment that included antihistamines, low salicylate-low preservative diet in all, and high dose intravenous immunoglobulin in 3 children. "

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  9. Reactions to aspirin and food additives in patients with chronic urticaria, including the physical urticarias. Doeglas HM, Br J Dermatol 1975 Aug;93(2):135-44
    "... The patients with reactions to aspirin were also tested with tartrazine, sodium benzoate, 4-hydroxybenzoic acid, sodium- and phenyl salicylate and the analgesics indomethacin, paracetamol and mefanamic acid. In nineteen of twenty three aspirin sensitive patients, positive reactions to one or more of these substances were observed. Indomethacin and tartrazine had the highest scores. ..."

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  10. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment., Egger J et al., Lancet 1983 Oct 15;2(8355):865-9
    "93% of 88 children with severe frequent migraine recovered on oligoantigenic diets; ... the role of the foods provoking migraine was established by a double-blind controlled trial in 40 of the children. ... Associated symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. In most of the patients in whom migraine was provoked by non-specific factors, such as blows to the head, exercise, and flashing lights, this provocation no longer occurred while they were on the diet."

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  11. Increased requirements for essential fatty acids in atopic individuals: a review with clinical descriptions. Galland L, J Am Coll Nutr 1986;5(2):213-28
    " Patients with atopic eczema and a mixture of allergic illnesses show biochemical evidence suggesting impairment in the desaturation of linoleic acid and linolenic acid by the enzyme delta-6 dehydrogenase. . . . A distortion in the production of prostaglandins and leukotrienes, which might result from this block, can account for the immunological defects of atopy and a variety of clinical symptoms experienced by atopic individuals. Dietary supplementation with essential fatty acids relieves the signs and symptoms of atopic eczema, may improve other types of allergic inflammation, and may also correct coexisting symptoms as diverse as excessive thirst and dysmenorrhea. . . "

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  12. Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria. Genton C, Frei PC, Pecoud A, Journal of Allergy and Clinical Immunology 1985 Jul;76(1):40-5
    "...Twenty-four of the 34 patients (nine with asthma and 15 with urticaria) were intolerant to at least one compound. However, no serious reaction was observed. In 20 of these 24 patients [83%](six with asthma and 14 with urticaria), a diet free of additives and nonsteroidal anti-inflammatory drugs resulted, within 5 days, in a marked improvement of symptoms, which persisted 8 to 14 mo after starting the diet..."

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  13. Management of chronic idiopathic urticaria by the identification and exclusion of dietary factors. Gibson A, Clancy R, Clin Allergy 1980 Nov;10(6):699-704
    " The role played by dietary chemical factors in the pathogenesis of chronic idiopathic urticaria (CIU) was assessed in seventy-six patients by challenge. Stable remission was first established by using an empirically established 'exclusion diet'. A diet modified to exclude those chemicals giving a positive response to challlenge was demonstrated to be of therapeutic value for time periods of up to 18 months. Re-testing twelve patients at 12 months indicated that most patients positive to salicylate or benzoate challenge retained this pattern of reactivity."

    Full text of study - Get Password

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  14. Treatment of Urticaria. Guin JD, Medical Clinics of North America, 1982 Jul;66(4):831-49.
    "... Multiple factors, such as aspirin and other nonsteroidal anti-inflammatory agents, direct histamine-releasing agents (including benzoates), tartrazine and other azo dyes, and perhaps blockers of beta 2-adrenergic activity and H2 receptors, adversely influence histamine release either directly or indirectly. Vasodilation is also detrimental. Treatment of both acute and chronic urticaria necessitates removal of the patient from aggravating factors as well as the cause of the outbreak (if one can be found), along with effective antihistaminic agents ..."

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  15. Control of salicylate intolerance with fish oils. Healy E, Newell L, Howarth P, Friedmann PS., British Journal of Dermatology 2008 Dec;159(6):1368-9. Epub 2008 Sep 15.
    "We report three patients with disabling salicylate-induced intolerance who experienced abrogation of symptoms following dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs). All three patients experienced severe urticaria, asthma requiring systemic steroid therapy and anaphylactic reactions. After dietary supplementation with 10 g daily of fish oils rich in omega-3 PUFAs for 6-8 weeks all three experienced complete or virtually complete resolution of symptoms allowing discontinuation of systemic corticosteroid therapy. Symptoms relapsed after dose reduction. Fish oil appears a safe and effective treatment for this difficult and often serious condition."

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  16. Study of skin rashes after antibiotic use in young children. Huang SW, Borum PR, Clin Pediatr (Phila) 1998 Oct;37(10):601-7
    After having a rash upon antibiotic use, 62 children were given dye-free antibiotics at the next infection. "... Of the 62 patients who received dye-free suspensions, only eight developed a mild skin rash, which was managed successfully. ..."

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  17. Urticaria and "aspirin intolerance"--part of an interdisciplinary pathogenetic principle? Illig L, Z Hautkr 1981 Mar 15;56(6):347-67
    "Like the so-called "aspirin asthma", the aspirin-induced provocation of chronic urticaria is a symptom of the intolerance syndrome. This may also be induced by various other drugs, particularly by indomethacin and food additives. ... An exact differentiation is only possible in patients without any clinical symptoms after additive-free diet ..."

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  18. Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl. Inomata N, Osuna H, Fujita H, Ogawa T, Ikezawa Z., Allergology International 2006 Jun;55(2):203-5.
    " ... We present a 5-year-old girl who suffered from recurrent reactions accompanied by urticaria, angioedema, headaches, dyspnea, loss of consciousness, and abdominal pain ... Her diet diary revealed that symptoms occurred after ingestion of colorful sweets such as candies and jellybeans. Open challenge tests with food additives and nonsteroidal anti-inflammatory drugs (NSAIDs) were performed after elimination of these items. ... Consequently, intolerance to azo dyes and NSAIDs such as aspirin was diagnosed.

    However, she appeared to react to multiple chemical odors such as those of cigarette smoke, disinfectant, detergent, cleaning compounds, perfume, and hairdressing, all while avoiding additives and NSAIDs. On the basis of her history and the neuro-ophthalmological abnormalities, a diagnosis of severe MCS was made and she was prescribed multiple vitamins and glutathione. CONCLUSIONS: The present results suggest that in pediatric MCS, food and drug additives containing azo dyes might play important roles as elicitors. "

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  19. Prevalence of chronic urticaria following the ingestion of food additives in a third tier hospital Jimenez-Aranda GS, Flores-Sandoval G, Gomez-Vera J, Orea-Solano M, Rev Alerg Mex 1996 Nov-Dec;43(6):152-6
    " We studied 40 patients with the clinical diagnostic of chronic urticaria from January to June, 1995 ... We performed a basic clinics history and the oral challenge tests (PRO) included Tartrazine (Ta), Sodium Metabisulfite (MS), Potasium Metabisulfite (MP) and Sodium Bisulfite (BS) in consecutive days with increasing doses unless an adverse reactions appear. ... 63.8% (23/36) had positive PRO. 47.2% (17/36) positives to Ta,, 36.1% (13/36) to MS, 33.3% (12/36) to BS and 30.5% (11/36) to MP. 72.2% (26/36) had positive PC [skin prick test] to one or more foods, 65.3% (17/26) besides had positive PRO. 41.1% (7/17) of the patients who had positive PRO and positive PC to foods had sinusitis. .... Ta was the additive that cause more reactivity. It is possible to find reactivity to one or more additives in a patient with chronic urticaria."

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  20. Additives and chronic urticaria. Juhlin L, Annals of Allergy 1987 Nov;59(5 Pt 2):119-23
    In patients with chronic urticaria, adverse reactions to food additives are worth looking for. Improvement on a diet free from the additives and a positive double-blind provocation test is today the only way to prove the diagnosis.

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  21. Purpura pigmentosa progressiva in type III cryoglobulinemia and tartrazine intolerance. A follow-up over 20 years Kalinke DU, Wuthrich B., Hautarzt 1999 Jan;50(1):47-51
    " A 58 year old patient with hepatitis virus C (HCV) infection had a secondary polyclonal IgG-IgM cryoglobulinemia with a benign 20 year course. . . . Food containing tartrazine triggered flares of the PPP, as demonstrated with controlled oral provocation testing. . . . "

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  22. Allergy and intolerance to flavouring agents in atopic dermatitis in young children. Kanny G, Hatahet R, Moneret-Vautrin DA, Kohler C, Bellut A.
    " The role of flavouring was studied in eleven children under five years of age suffering from severe atopic dermatitis. . . .Double-blind oral provocation tests were carried out with balsam of Peru (225 mg), natural vanilla (50 mg), artificial vanillin (12.5 mg). . . . The eviction of food flavouring agents brought about a clear improvement in six children. The authors point out the risk of increasing consumption of flavouring agents, and bring into question the traditional attitude of considering food flavouring agents as innocuous."

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  23. An elimination diet for chronic urticaria of childhood. Kemp AS, Schembri G, Med J Aust 1985 Sep 16;143(6):234-5
    "...Eighteen completed the period of dietary elimination; in seven of the 18 children there was a marked remission of the urticaria during the second week of the diet..."

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  24. Pseudoallergic reactions. Intolerance to natural and synthetic food constituents masquerading as food allergy. Kurek M, Pediatr Pol 1996 Sep;71(9):743-52
    " Adverse hypersensitivity reactions to natural foods and certain drugs and food additives are mediated by immunological (allergy) or non-immunological mechanisms. ...This observation has led to the concept of "pseudoallergic reactions-PAR". PAR can be triggered in various ways such as: interactions with the central or peripherical nervous system, non-specific release of mediators, enzyme inhibition due to hereditary or pharmacologically induced enzyme deficiencies and pharmacological properties of some natural food constituents such as biogenic amines... PAR to food additives occurs frequently in patients suffering from urticaria, asthma ... The same additives (azo dyes, sulphites, benzoates) are used in various drug formulations and may be responsible for eliciting PAR... Skin tests and "in vitro" tests are only sporadically informative. ... Individually performed exclusion regimes are the principal methods of prevention." The Feingold diet is one way to do this.

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  25. Sulfite sensitivity: significance in human health. Lester MR , J Am Coll Nutr 1995 Jun;14(3):229-32
    "... As food additives, sulfiting agents were first used in 1664 and approved in the United States as long ago as the 1800s...They are currently used for a variety of preservative properties, including controlling microbial growth, preventing browning and spoilage, and bleaching some foods. ... Adverse reactions to sulfites in nonasthmatics are extremely rare. Asthmatics who are steroid-dependent or who have a higher degree of airway hyperreactivity may be at greater risk of experiencing a reaction to sulfite-containing foods... The majority of reactions are mild. These manifestations may include dermatologic, respiratory, or gastrointestinal signs and symptoms. ... Broncho-constriction is the most common sensitivity response in asthmatics... Inhalation of sulfur dioxide (SO2) generated in the stomach following ingestion of sulfite-containing foods or beverages, a deficiency in a mitochondrial enzyme, and an IgE-mediated immune response have all been implicated."

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  26. Intolerance to acetylsalicylacid and food additives in patients suffering from recurrent urticaria Lindemayr H, Schmidt J, Wien Klin Wochenschr. 1979 Dec 21;91(24):817-22. [article in German]
    "Ninety patients suffering from recurrent urticaria were orally exposed to 500 mg acetyl salicylic acid (ASA). 36.6% proved to be ASA intolerant in this group. 26 ASA-positive and 18 ASA-negative probands were selected to take part in an additional provocation test with 8 different food additives (preservative and colouring matters). Altogether 31 tests sheets were exaluated. Urticarial reactions were seen after administration of p-hydroxybenzoic acid methylester (5), p-hydroxybenzoic acid propylester (6), benzoic acid (9), sodium benzoate (6), tartrazine [yellow #5] (6). Ponceau rouge [red #4 - banned in US] (5) and indigo carmine [blue #2] (3). Detailed research was carried out on the occurrence of the tested substances. With a diet avoiding salicylates, benzoates and colouring matter 20% of these patients recovered spontaneously and became symptom-free, whilst a further 55% of cases showed marked improvement."

    Note - That is a total of 75% who improved markedly or completely recovered on a diet similar to the Feingold diet (a list of foods containing natural benzoates as well as a list of benzoate preservatives are provided in the Handbook).

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  27. Hypersensitivity to tartrazine (FD&C Yellow No. 5) and other dyes and additives present in foods and pharmaceutical products. Lockey SD Sr, Annals of Allergy 1977 Mar;38(3):206-10
    "Tartrazine (FD&C Yellow No. 5) and other allowed certified color additives may have an exacerbating effect in chronic urticaria and asthma sufferers. . ."

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  28. Effects of a pseudoallergen-free diet on chronic spontaneous urticaria: a prospective trial. Magerl M, Pisarevskaja D, Scheufele R, Zuberbier T, Maurer M., Allergy. 2010 Jan;65(1):78-83. Epub 2009 Oct 1.
    " BACKGROUND: Chronic spontaneous urticaria is a skin disorder that is difficult to manage and can last for years. 'Pseudoallergens' are substances that induce hypersensitive/intolerance reactions that are similar to true allergic reactions. They include food additives, vasoactive substances such as histamine, and some natural substances in fruits, vegetables and spices. Eliminating pseudoallergens from the diet can reduce symptom severity and improve patient quality of life. AIM: To assess the effects of a pseudoallergen-free diet on disease activity and quality of life in patient's chronic spontaneous urticaria. METHODS: Study subjects had moderate or severe chronic spontaneous urticaria that had not responded adequately to treatment in primary care. For 3 weeks, subjects followed a pseudoallergen-free diet. . . RESULTS: From the 140 subjects, there were 20 (14%) strong responders and 19 (14%) partial responders. Additionally, there were nine (6%) subjects who made a substantial reduction in their medication without experiencing worse symptoms or quality of life. CONCLUSIONS: Altogether the pseudoallergen-free diet is beneficial for one in three patients. The pseudoallergen-free diet is a safe, healthy and cost-free measure to identify patients with chronic spontaneous urticaria that will benefit from avoiding pseudoallergens. "

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  29. The results of skin testing with food additives and the effect of an elimination diet in chronic and recurrent urticaria and recurrent angioedema. Malanin G, Kalimo K, Clinical and Experimental Allergy 1989 Sep;19(5):539-43
    Of 91 subjects with chronic or recurrent urticaria or recurrent angioedema, 26% tested positive on at least one of 18 skin tests with food additives. 89% of those who tested positive improved on an additive-free diet, and 40% of those who tested negative improved on the diet.

    The authors conclude that allergy testing is useful to predict who should benefit from an additive-free diet. We think that one should not deprive the 40% of those who don't happen to test positive to the chosen 18 skin test items from the possible benefit of an additive-free diet.

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  30. Hypersensitivity reactions to food colours with special reference to the natural colour annatto extract (butter colour). Mikkelsen H, Larsen JC, Tarding F., Archives of Toxicology Suppl. 1978;(1):141-3.
    " It is well known that synthetic food colours especially some azo dyes can provoke hypersensitivity reactions such as urticaria, angioneurotic oedema, and astma (MichaŽlsson and Juhlin, 1973, Granholt and Thune, 1975). . . Among 61 consecutive patients suffereing (sic) from chornic (sic) urticaria and/or angioneurotic oedema 56 patients were orally provoked by annatto extract during elimination diet. Challenge was performed with a dose equivalent to the amount used in 25 grammes of butter. Twentysix per cent of the patients reacted to this colour 4 hours (SD: 2,6) after intake. Similar challenges with synthetic dyes showed the following results: Tartrazine [Yellow 5] 11%, Sunset Yellow FCF [Yellow 6] 17%, Food Red 17 [Red 40] 16%, Amaranth [Red 2] 9%, Ponceau 4 R [Red 4] 15%, Erythrosine [Red 3] 12% and Brillant Blue FCF [Blue 1] 14%. The present study indicates that natural food colours may induce hypersensitivity reactions as frequent as synthetic dyes. "

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  31. Sensitivity to tartrazine. Miller K., British Medical Journal (Clin Res Ed). 1982 Dec 4;285(6355):1597-8.
    " ...Intolerance to tartrazine was first reported in 1959, and its part in the induction of intractable urticaria has been recognized since 1975. Non-thrombocytopenic purpura is also reported to be due to hypersensitivity to tartrazine - which suggests the possibility that tartrazine may act as a hapten bound to the endothelial cells of small blood vessels. ...People sensitive to acetylsalicylic acid [aspirin] who are allergic to foods should avoid tartrazine as a food dye..."

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  32. Allergic and pseudo-allergic reactions to foods in chronic urticaria. Moneret-Vautrin DA., Ann Dermatol Venereol. 2003 May;130 Spec No 1:1S35-42.
    " . . . Possible links exist between chronic urticaria and intolerance to additives, intolerance or allergy to contaminants, pseudo-allergic reactions to foods and IgE-dependent food allergy. . . . Flavours are being suspected but have not been validated by such oral challenges. . . . The author puts forward a methodology to search for the implication of foods in chronic urticaria. . .the diagnosis can finally be based on the recovery after the implementation of strict avoidance diets. "

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  33. Frequency of urticaria and angioedema induced by food additives, Montano Garcia ML, Orea M, Rev Alerg Mex 1989 Jan-Feb;36(1):15-8
    "...Thirty-three patients with chronic urticaria and angioneurotic edema ... were challenged orally in a double-blind study with increasing doses of the following additives: sodium benzoate, sodium metabisulfite and tartrazine and lactose as placebo. Ten of the 33 patients (30.3%) were intolerant to at least one compound. ..."

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  34. Suspected tartrazine-induced acute urticaria/angioedema is only rarely reproducible by oral rechallenge. Nettis E, Colanardi MC, Ferrannini A, Tursi A. Clin Exp Allergy. 2003 Dec;33(12):1725-9.
    " . . . The aim of this study is to determine the incidence of intolerance to tartrazine among subjects who experienced an acute episode of urticaria/angioedema following the ingestion of a meal or a product containing this substance. . . .Only one subject (1%) had reactions [in a double-blinded study] after ingestion of 5 mg of tartrazine. . . . This study shows that the percentage of acute urticaria and/or angioedema induced by tartrazine is very low (1%). In view of our results, we suggest that all physicians with patients who have suffered adverse reactions that could be attributed to tartrazine should also carefully evaluate other possible causes."

    We have written to Dr. Nettis to request clarification as to the reason only 5 mg of tartrazine was used as the test material, in view of the likelihood of a much higher exposure in "real life." We will post the answer here.

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  35. The danger of "yellow dyes" (tartrazine) to allergic subjects. Neuman I, Elian R, Nahum H, Shaked P, Creter D. Clin Allergy. 1978 Jan;8(1):65-8.
    " Oral administration of 50 mg tartrazine to 122 patients with a variety of allergic disorders caused the following reactions: general weakness, heatwaves, palpitations, blurred vision, rhinorrhoea, feeling of suffocation, pruritus and urticaria. There was activation of the fibrinolytic pathway . . ."
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  36. Fixed drug eruption to tartrazine. Orchard DC, Varigos GA, Australas J Dermatol 1997 Nov;38(4):212-4
    " An 11-year-old girl with a recurrent fixed drug eruption to tartrazine on the dorsum of the left hand is presented. Oral provocation tests to both the suspected food, an artificially coloured cheese crisp, and to tartrazine were positive. This case highlights fire [sic] need to consider artificial flavours, colours and preservatives as potential culprits in classic drug eruptions."

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  37. Is the Melkersson-Rosenthal syndrome related to the exposure to food additives? A case report. Pachor ML, et al, Oral Surg Oral Med Oral Pathol. 1989 Apr;67(4):393-5.
    " We present a case of Melkersson-Rosenthal syndrome that occurred in an adult patient who experienced intolerance to the food additives sodium benzoate and tartrazine. The main symptoms were the facial swelling, hypertrophy of the gums, and a typical infiltration of lymphocytes and plasma cells around the small vessels observed in the biopsy of the gums. . . . All clinical manifestations went into remission once the food additives were excluded from the usual diet. "

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  38. Eczema and food allergy in the adult, Pacor ML et al., Recenti Progressi in Medicina 1990 Mar;81(3):139-41
    Eczema in 14 out of 15 subjects [93%] was improved by elimination diet. "Challenge test was positive in 10 patients. Nuts, tomatoes, milk, eggs and cereals were most frequently involved... With the use of dietary elimination procedure the symptoms completely disappeared. The results obtained for the treatment of eczema with this procedure may be very encouraging."

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  39. Efficacy of leukotriene receptor antagonist in chronic urticaria. A double-blind, placebo-controlled comparison of treatment with montelukast and cetirizine in patients with chronic urticaria with intolerance to food additive and/or acetylsalicylic acid. Pacor ML, Di Lorenzo G, Corrocher R., Clin Exp Allergy 2001 Oct;31(10):1607-14
    " . . . chronic urticaria is often difficult to treat and may not be controlled by antihistamines alone. It has been postulated that mediators other than histamine, such as kinins, prostaglandin and leukotrienes, may be responsible for some of the symptoms in urticaria which are not controlled by antihistamines. . . A group of 51 patients, ranging in age from 15 to 71 years, with chronic urticaria and positive challenge to food additives and/or ASA, participated in this study for a period of 4 weeks. . . Finally, a low incidence of adverse events was observed in this study. CONCLUSION: The results of this comparative study demonstrate that montelukast orally administered once a day is very effective for the treatment of cutaneous symptoms in patients with chronic urticaria due to food additives and/or ASA. "

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  40. Skin reactions to food and food constituents--allergic and pseudoallergic reactions Paul E, Z Hautkr 1987;62 Suppl 1:79-87
    " Which skin reactions, with allergic or pseudo-allergic mechanism, are actuated by food? Contact urticaria or "forme-fruste-anaphylaxis" is the most common. Tests, using purchasable allergen extracts, mostly produce negative results . . . cellular immune reactions to food and its components are also not uncommon.. . . The importance of natural salicylate for the aetiopathogenesis of chronic urticaria has not yet been ascertained; nevertheless, a suitable diet is recommended on the understanding that degranulation of the mast cells, possibly due to subclinical stimuli, is triggered off."

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  41. Clinico-immunological study of 16 cases of benzoate intolerance in children, Petrus M, Bonaz S, Causse E, Micheau P, Rhabbour M, Netter JC, Bildstein G, Allerg Immunol (Paris) 1997 Feb;29(2):36-8
    " ...Sixteen children (9 boys and 7 girls) were directed to the Hospital of Tarbes from June 1995 to July 1995, for recurring urticaria (7/16) combined with asthma (1/16), atopic eczema (2/16), dermorespiratory syndrome (2/16) and asthma (1/16). All were subject to an immunological examination ... whose confirmation is certified by the benefit of the food eviction. ... besides food such as grey shrimps, sodas and antibiotic syrups, one finds benzoates in the antiallergic syrups initially prescribed as a preventive measure. "

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  42. Toothpaste Allergy With Intractable Perioral Rash in a 10-year old Boy, Reilly, K.E.H. & McCarthy, L.H., J Am Board Fam Pract 2000, 13(1):73-75.
    "Allergic reactions and contact dermatitis caused by the ingredients in toothpaste have been reported.[1] ... allergic reactions to the flavorings used, especially cinnamic aldehyde.[2,3] ... to the preservatives, especially sodium benzoate,[4-6] and to aluminum.[7] Still others have shown contact dermatitis caused by sodium lauryl sulfate and propylene glycol, both common ingredients in every commercial toothpaste brand, even the all-natural brands.[8] Allergy to toothpaste ingredients is considered rare, but its rarity might be because it is hard to diagnose. Treatment options are linked to the symptom (the rash) as opposed to the cause (the allergen). ... We report here a case of an intractable perioral rash of long duration that we eventually determined to be allergy to toothpaste. "

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  43. A follow-up study of patients with recurrent urticaria and hypersensitivity to aspirin, benzoates and azo dyes. Ros AM, Juhlin L, MichaŽlsson G. British Journal of Dermatology, 1976 Jul;95(1):19-24.
    "We have studied seventy-five patients with recurrent urticaria and angio-oedema of more than 4 months duration and with positive provocation tests to aspirin, azo dyes, and/or benzoates. Cross-reactions between the test compounds were common. The patients were recommended to be on a diet free from salicylates, benzoates, and azo dyes. They were then followed for 6-24 months. At the follow-up, 24% were free from symptoms, 57% considered themselves much better and 19% stated that they were slightly better or unchanged. All patients had followed the diet for at least 1-3 months. Most of those who became totally free of symptoms did not continue with the diet, while most of the patients who considered themselves much better found that it was necessary to continue on the recommended diet. They usually developed symptoms as soon as they ingested something containing azo dyes or benzoates. To be able to maintain such a diet, it is important that the content of additives in food and drugs be properly declared."

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  44. Detection of urticaria with food additives intolerance by means of diet. Rudzki E, Czubalski K, Grzywa Z., Dermatologica, 1980;161(1):57-62.
    "A diet free of salicylates, benzoates and azo dyes was applied to 158 patients with chronic urticaria. On the basis of the results of this diet, 50 persons were recognized as 'sensitive' to food additives. Psychosomatic examination of the latter patients demonstrated that they do not differ significantly from the remaining ones as regards exacerbations of skin changes by psychological stress. On the other hand, the coexistence of a frustrating situation at the beginning of appearance of skin changes is markedly less frequent in persons 'sensitive' to food additives. Patients are described in whom intolerance to food additives occurred together with hypersensitivity to drugs or some kinds of food."

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  45. Aspirin intolerance. III. Subtypes, familial occurence, and cross-reactivity with tartarazine. Settipane GA, Pudupakkam RK, J Allergy Clin Immunol 1975 Sep;56(3):215-21
    "Evidence has been presented supporting the hypothesis that at least 2 different types of mechanisms may be involved in aspirin intolerance, one resulting in bronchospasm [asthmatic-type difficulty breathing] and the other producing urticaria/angioedema [hives]. Bronchospasm is the predominant symptom of aspirin intolerance in patients who have asthma. In contrast, the predominant symptom of aspirin intolerance in patients who have rhinitis is urticaria/angioedema. . ."

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  46. Children with atopic eczema. I: Clinical response to food elimination and subsequent double-blind food challenge. , Sloper KS, Wadsworth J, Brostoff J, Quarterly Journal of Medicine 1991 Aug;80(292):677-93
    "The role of foods in the exacerbation of atopic eczema was studied by offering a food elimination diet and subsequent random order, double-blind food challenges to 91 eczematous patients... Eczema improved in 49 of 66 (74 %). The longer a food had been avoided, the less likely was the chance of a positive food reaction. Clinical history did not predict response to dietary manipulation. A standard elimination diet avoiding cows' milk, egg, tomatoes and possibly colours and preservatives should help up to three-quarters of patients, and is easy to implement with the help of a dietician. This diet may be considered in all children with moderate or severe eczema."

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  47. Clinical effects of sulphite additives. Vally H, Misso NL, Madan V., Clinical and Experimental Allergy. 2009 Nov;39(11):1643-51. Epub 2009 Sep 22.
    " Sulphites are widely used as preservative and antioxidant additives in the food and pharmaceutical industries. Topical, oral or parenteral exposure to sulphites has been reported to induce a range of adverse clinical effects in sensitive individuals, ranging from dermatitis, urticaria, flushing, hypotension, abdominal pain and diarrhoea to life-threatening anaphylactic and asthmatic reactions. Exposure to the sulphites arises mainly from the consumption of foods and drinks that contain these additives; however, exposure may also occur through the use of pharmaceutical products, as well as in occupational settings. . . To date, the mechanisms underlying sulphite sensitivity remain unclear, although a number of potential mechanisms have been proposed. Physicians should be aware of the range of clinical manifestations of sulphite sensitivity, as well as the potential sources of exposure. Minor modifications to diet or behaviour lead to excellent clinical outcomes for sulphite-sensitive individuals."

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  48. In vitro stimulation of lymphocytes in patients with chronic urticaria induced by additives and food. Valverde E, Vich JM, Garcia-Calderon JV, Garcia-Calderon PA, Clinical Allergy 1980 Nov; 10(6):691-8.
    " We studied the stimulation of lymphocytes in 258 patients with urticaria and/or angioedema using a series of food extracts and additives. ... A positive RI (response index) to both aspirin and tartrazine was revealed in 25% and to all the additives tested in 11% of the cases. Diets from which food extracts and additives were excluded achieved total remission in 159 (61.1%), partial remission in fifty-seven cases (22%) and no remission in forty-two (16.2%)."

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  49. Food and food additives in severe atopic dermatitis. Van Bever HP, Docx M, Stevens WJ, Allergy 1989 Nov;44(8):588-94
    "In this study the role of food additives, tyramine and acetylsalicylic acid, was investigated by double-blind placebo-controlled challenges (DBPCC) in 25 children with severe atopic dermatitis (AD). All children challenged with foods (n = 24), except one, showed one or more positive reactions to the DBPCC with foods. Positive reactions presented as different combinations of flares of skin symptoms, intestinal symptoms and respiratory symptoms... Six children underwent DBPCC with food additives, tyramine and acetylsalicylic acid. All were found to demonstrate positive skin and/or intestinal reactions to at least one of the food additives. Two children reacted to tartrazine, three to sodium benzoate, two to sodium glutamate, two to sodium metabisulfite, four to acetylsalicylic acid and one to tyramine. It is concluded that some foods, food additives, tyramine and acetylsalicylic acid, can cause positive DBPCC in children with severe AD."

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  50. Cutaneous vasculitis induced by food additives. Veien NK, Krogdahl A, Acta Dermato-Venereologica 1991;71(1):73-4
    A case of leukocytoclastic vasculitis [inflamation of small blood vessels] in a 24-year-old woman is described. A severe eruption of vasculitis occurred after placebo-controlled oral challenge with 50 mg ponceau [FD&C Red No.4 not allowed in U.S., E 124 Europe]. The patient was asked to adhere to a diet free from food additives, and the vasculitis faded after a period of 2 months.

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  51. Pseudo-allergen-free diet in chronic urticaria. Verschave A, Stevens E, Degreef H, Dermatologica 1983;167(5):256-9
    "An elimination diet for additives and tyramine was prescribed to 67 patients with chronic urticaria. 55% of them reacted favorably..."

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  52. Experience with an elemental diet (Vivonex). Villaveces JW, Heiner DC, Ann Allergy 1985 Dec;55(6):783-9
    " Six patients with intractable atopic dermatitis completed this study which consisted of a baseline week, 1 to 2 weeks on an elemental diet, then sequential specific food additions... Symptom/sign scores improved in five of six patients, some dramatically..."

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  53. Cell-mediated immune responses to artificial food additives in chronic urticaria. Warrington RJ, Sauder PJ, McPhillips S, Clin Allergy 1986 Nov;16(6):527-33
    "In some cases of chronic urticaria it is suspected that food additives such as tartrazine and sodium benzoate or salicylates may play a role in the pathogenesis of the condition. ... It was found that significant production of LIF [T cell-derived lymphokine leucocyte inhibitory factor] occurred in response to tartrazine and sodium benzoate in those individuals with chronic additive induced urticaria. In addition, tartrazine caused LIF release from mononuclear cells of ASA-sensitive asthmatics. These results may indicate a possible role for additive-induced cell-mediated immune responses in the pathogenesis of some cases of chronic urticaria and suggest a potential diagnostic test for this condition."

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  54. Increased leukotriene production by food additives in patients with atopic dermatitis and proven food intolerance. Worm M, Vieth W, Ehlers I, Sterry W, Zuberbier T. Clinical and experimental allergy 2001 Feb;31(2):265-73      
    " Recently, we identified a subgroup of patients with atopic dermatitis (AD) with a clinical relevant food intolerance proven by double blind placebo controlled challenge. . . . Ten non-atopic donors (A), nine AD patients of the diet responder group with negative oral provocation test against food additives (B) and nine patients of the responder group with positive reactions after the oral provocation test (C) were investigated. . . .in group C increased sLT (sulfidoleukotriene) production was observed with food colour mix in 1/9, with tartrazine in 3/9, with benzoate in 4/9, with nitrite in 5/9, with salicylate in 2/9 and with metabisulfite in 1/9. . . . These findings indicate that single food additives as aggravating factors in AD patients may trigger the disease through increased sLT production as a pathophysiological mechanism. "

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  55. Clinical relevance of food additives in adult patients with atopic dermatitis. Worm M, Ehlers I, Sterry W, Zuberbier T.,
    " ... To date the role of pseudoallergic reactions as an aggravating factor in AD (atopic dermatitis) of adult patients remains controversial. However, many adult patients report on food-related aggravation of the disease and nonallergic hypersensitivity reactions have been incriminated repeatedly. . . . Fifty patients were monitored over 4 weeks under regular diet followed by 6 weeks of a diet omitting known pseudoallergens. . . RESULTS: Nine of fifty patients dropped out, 26 [63.4%] showed a significant improvement . . . Responder patients (24/26) were orally challenged with food rich in pseudoallergens followed by double-blind exposure to food additives (n = 15). A worsening of the eczema was seen in 19/24 [79%] patients after intake of pseudoallergen-rich food and in 6/15 [40%] patients after exposure to food additives. . . "

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  56. Acetylsalicylic acid and food additive intolerance in urticaria, bronchial asthma and rhinopathy, Wuthrich B, Fabro L, Schweiz Med Wochenschr 1981 Sep 26;111(39):1445-50
    "Adverse reactions (urticaria, angio-edema, bronchoconstriction, purpura) to Aspirin (ASS) and food-and-drug additives such as the yellow dye tartrazine and the preservative benzoate are observed all over the world... it is described as intolerance or pseudo-allergy and has been related to an imbalance of prostaglandin synthesis. ... More than two thirds of the intolerant patients were improved by an elimination diet and by the avoidance of "aspirin-like" drugs. More than one third of chronic urticaria patients became symptomfree. ... Moreover, azo-dyes must no longer be used for colouring of drugs."

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  57. Adverse reactions to food additives., Wuthrich B, Ann Allergy 1993 Oct;71(4):379-84
    " Food additives can induce a wide range of adverse reactions in sensitive individuals. ... The complexity of the different pathophysiologic mechanisms possibly involved in the allergic (immunologic) or in the intolerant (nonimmunologic) reactions to food additives continues to create great difficulties in the understanding of such conditions. ... The pathogenic mechanisms of adverse reactions to the azo dye tartrazine and to sulfite preservatives are discussed briefly. Due to the lack of reliable skin or in vitro tests, the diagnosis of an intolerance to food additives is still based on placebo-controlled oral provocation tests. Two typical cases of a "restaurant syndrome" due to sulfite allergy or sensitivity are described, as well as a case of disulfite-induced urticaria-vasculitis and a case of anaphylactoid purpura associated with tartrazine and benzoates."

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  58. The effect of DPT and BCG vaccinations on atopic disorders. Yoneyama H, Suzuki M, Fujii K, Odajima Y, Arerugi 2000 Jul;49(7):585-92
    " ...Among the 82 children aged 0-3, out of the 39 who received DPT vaccination, 10 (25.6%) suffered from bronchial asthma and this ratio was significantly higher than among the children who have not received DPT vaccination (1 in 43, 2.3%), ... This was also the case concerning atopic dermatitis (... 18.0% vs ... 2.3%) . ... if ... (bronchial asthma, allergic rhinitis and atopic dermatitis) were combined (... 56.4% vs ... 9.3%) ... From these results, we conclude that DPT vaccination has some effect in the promotion of atopic disorders, ..."

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  59. Skin discoloration with blue food coloring.    Zillich AJ, Kuhn RJ, Petersen TJ, Ann Pharmacother 2000 Jul-Aug;34(7-8):868-70
    " . . . Twelve hours after the start of enteral nutrition, the patient appeared cyanotic . . . The pediatric code response team was called. Enteral nutrition was stopped and then restarted without blue food coloring. . . . blue food coloring is used with enteral nutrition for detecting aspiration of stomach contents. . . Nurses place an unstandardized amount of blue food coloring into each enteral nutrition bag. . . . No toxicity studies exist for acute or human ingestion, but the National Academy of Sciences lists 363 mg/d of FD&C Blue No. 1 as a safe level for humans. We estimated this child ingested 780-3,940 mg of dye over a 12-hour period. CONCLUSIONS: This is the first known report of an adverse effect from blue food coloring. To prevent similar occurrences within our institution, the blue food coloring for tube feedings will be dispensed by the pharmacy department in standardized units."

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  60. Pseudoallergen-free diet in the treatment of chronic urticaria. A prospective study. Zuberbier T, Chantraine-Hess S, Hartmann K, Czarnetzki BM, Acta Dermato-Venereologica 1995 Nov;75(6):484-7
    "...In 73% of patients, symptoms ceased or were greatly reduced within 2 weeks on diet...11% responded to treatment of an associated inflammatory disease, and in 16%, no cause of the urticaria was ascertained....An additive-free, stringently controlled diet thus provides a simple means of diagnosing and treating the majority of patients with chronic urticaria. "

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  61. The role of allergens and pseudoallergens in urticaria. Zuberbier T.,   J Investig Dermatol Symp Proc 2001 Nov;6(2):132-4
    " Adverse reactions to food are a frequently discussed cause of urticaria. . . in acute urticaria pseudoallergic reactions against NSAID are responsible for approximately 9% of cases, and in a subset of patients with chronic urticaria a diet low in pseudoallergens has been proven to be beneficial in several studies, with response rates observed in more than 55% of patients. Double-blind, placebo-controlled challenge tests have shown that artificial food additives are not only to blame, with the majority of reactions being traced back to naturally occuring pseudoallergens in food. "

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