USE OF PSEUDOALLERGEN DIETS IN CHRONIC SPONTANEOUS URTICARIA MANAGEMENT

Chronic spontaneous urticaria (CSU) is a common chronic inflammatory skin disease that significantly impairs quality of life. The chronic nature of the symptoms often leads to psychosocial problems as well as physical discomfort in patients. Over the past several decades, various treatment approaches have been investigated. Pseudoallergenic diets are one of the supportive strategies recommended in the management of CSU. These diets aim to eliminate dietary triggers, such as food additives, salicylates, and vasoactive compounds like histamine, that may exacerbate symptoms. The underlying rationale for this approach is grounded in current pathophysiological understanding. Pseudoallergens are believed to activate mast cells directly through pathways that do not involve Immunoglobulin E (IgE), setting them apart from the classic IgE-mediated allergic reactions. This type of non-allergic mast cell activa-tion can result in the release of inflammatory mediators and the emergence of urticarial lesions—even in patients who test negative for IgE-mediated allergies. This mechanism provides a plausible theo-retical basis for considering pseudoallergen-free diets as an adjunctive strategy in the management of CSU. Nevertheless, while such diets may offer potential benefit to carefully selected patient groups, they are not recommended as replacements for established first-line pharmacological treatments. The evidence supporting their use remains inconclusive; notably, results from randomized, double-blind, placebo-controlled studies have not reliably demonstrated their efficacy. Future research in this area would benefit from incorporating advanced methodologies, such as biomarker and genetic testing, to clarify the mechanisms underlying pseudoallergen sensitivity. These strategies could help identify which CSU patients are most likely to respond to dietary interventions and support the development of personalized dietary approaches. Customizing dietary management based on patients’ genetic and immunological profiles might improve clinical outcomes and quality of life. Notably, randomized, double-blind, placebo-controlled studies have not consistently demonstrated their efficacy, and such diets are not recommended as a substitute for established pharmacological treatments.