China spice syndrome T78.1

Intolerance reaction after ingestion of food to which L-monosodium glutamate (MSG) has been added as a flavour enhancer.

It is assumed that exogenously supplied as well as endogenously produced glutamate (threshold dose of 1.5-3 g) lead to a stimulation of nitrate synthesis with consecutive stimulation of the so-called "nitric oxide-mediated neurotransmission pathway" and cause the described sensory deficits in sensitive individuals. Sensitivity to MSG may be genetically determined.

Burning, tingling, feeling of stiffness, heat, pressure and tightness, flushing on the face, neck, upper thorax, shoulders and upper arms 15-25 minutes after eating food containing MSG, mostly (but not exclusively) dishes from Asian cuisine. Duration of symptoms 2-3 hours, spontaneously reversible. Inconstant symptoms are headache, sweating, nausea and vomiting.

In case of atopic disposition, sometimes provocation of bronchial asthma, with possibly life-threatening asthma attacks, which can occur with a delay of up to 12 hours.

1. Geha RS et al (2000) Review of alleged reaction to monosodium glutamate and outcome of a multicenter double-blind placebo-controlled study. J Nutr 130(4S Suppl): 1058S-1062S
2. Ho Man Kwok R (1968) Chinese restaurant syndrome. N Engl J Med 278: 796
3. Kenney RA (1986) The Chinese restaurant syndrome. An anecdote reviseted. Fd Chem Toxic 24: 351-354
4. Rutten EP et al (2003) The effect of a glutamate load on symptoms of the Chinese restaurant syndrome. Clin Nutr 22: S27