Synonym(s)
DefinitionThis section has been translated automatically.
Urticaria persisting for longer than 6 weeks (in many cases the clinical picture persists for > 5 years). A distinction is made according to the clinical course:
- chronic-continuous spontaneous urticaria with daily attacks
- chronic-recurrent spontaneous urticaria with an intermittent course, in which wheal attacks alternate with symptom-free intervals.
The term spontaneous or idiopathic urticaria refers to the unknown aetiology and is in contrast to chronic inducible urticaria (causes known or easily ascertainable e.g. physical urticaria see below. urticaria)
ClassificationThis section has been translated automatically.
S.u. Urticaria
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Occurrence/EpidemiologyThis section has been translated automatically.
EtiopathogenesisThis section has been translated automatically.
- Up to 70% of the disease is idiopathic.
- Positive atopy history exists in about 1/4 of patients. Total IgE is elevated in > 50% of cases.
- The model of molecular mimicry of epitopes as a possible trigger of chronic urticaria is discussed again and again. The model is based e.g. on the transient presence of various antibodies (e.g. thyroid autoantibodies TAK/TPO) as well as transient or permanent susceptibility to non-immunological hypersensitivity reactions (e.g. intolerance reactions characterized by non-IgE-mediated histamine release ).
- Depending on the type of urticaria, very different triggers come into question:
- Drugs or foods (non-IgE-mediated; see also intolerance reaction; biogenic amines).
- Food additives: dyes, benzoates, salicylates , sulfites, glutamates (non-IgE-mediated); data on this are contradictory; causative in < 5% of patients).
- Acetylsalicylic acid: no association with salicylate-containing foods (non-IgE-mediated)
- Food (IgE-mediated allergic reactions) or contamination (e.g. residues of antibiotics in meat etc.): such reactions are rather rare (< 1% in children and adults)
- Bacterial infections (Helicobacter pylori [for this mode of infection there is the highest evidence], streptococci, staphylococci, yersinia); for infections in the dental and ENT area, there are no confirmed correlations between therapy and urticaria course, although in individual cases these correlations are postulated.
- Viral infections (reports on hepatitis virus infections and norovirus infections are available [no convincing evidence so far]).
- parasites (lamblia, entamoeba, worm infections; trichomonads, trichinella, Toxocara canis)
- Autoimmune processes (autologous serum test, thyroid autoantibodies - see autoreactive urticaria)
- Rarely: tumors, hepatitis.
ManifestationThis section has been translated automatically.
Clinical featuresThis section has been translated automatically.
LaboratoryThis section has been translated automatically.
HistologyThis section has been translated automatically.
DiagnosisThis section has been translated automatically.
Step-by-step programme for the diagnosis of chronic urticaria (according to Ring/Przybilla). Diagnosis of urticaria requires patience and consistent implementation of a clearly defined diagnostic program (discussed with the patient in advance) (see Table 1). When the patient is free of symptoms, the targeted provocation tests can be started. The following provocation diets can be recommended according to the patient's medical history and previous test results:
- Advanced diet
- Additiva rich diet
- Salicylate-rich diet
- Biogenic amines
- Oral provocation test for idiosyncrasy (OPTI).
- Pseudoallergic/intolerance reaction: About 20-50% of cases of chronic urticaria are caused by non-immunological i.e. as pseudoallergic reactions (especially acetylsalicylic acid). An antigen-antibody reaction does not take place in these reactions. IgE cannot be detected in increased quantities. RAST determinations in this sense are therefore not possible. Pseudo-allergic reactions can be triggered by various pathomechanisms, e.g. direct complement activation, direct mediator release, enzyme defects, Jarisch-Herxheimer reaction, neuro-psychogenic. The CAST (cellular antigen stimulation test) is available as a laboratory test for suspected pseudoallergic reactions. Provocation diets with biogenic amines can substantiate the suspicion.
- Salicycylate: Acetylsalicylic acid is the most common substance that can trigger an intolerance reaction. The pathomechanism has not yet been clearly clarified. Inhibition of cyclooxygenase is being discussed, which leads to a lack of protective prostaglandins and to increased formation of lipoxygenase metabolites or can cause direct mediator release, direct complement activation and altered platelet reactivity. There are pronounced cross-reactions with pharmacologically similar acting agents, e.g. other NSA, but also with other chemicals such as food dyes (tartrazine) and preservatives. If an intolerance reaction to ASA is known, Coxibe (e.g. Celecoxib) can be given if necessary.
Differential diagnosisThis section has been translated automatically.
General therapyThis section has been translated automatically.
Elimination or avoidance of the triggering factors after careful anamnesis and diagnostics.
- Focus search: Remediation of a chronic focus or treatment of the underlying disease (e.g. antibiotic or surgical treatment of dental and ENT foci [no firm evidence]; eradication of Helicobacter pylori [high level of evidence], treatment of candida infections [no firm evidence]; see also candidiasis, enteritis, etc.).
- In case of parasitic cause: adequate therapy.
- Medications: Discontinuation or conversion of possibly causative medications (e.g. analgesics, antibiotics such as penicillin, acetylsalicylic acid, insulin, vaccinations).
- If food or additives are possible triggers and other trigger factors have been ruled out, a standardized pseudoallergen-free basic diet (see Table 4) should be followed for 4-6 months. 70% of the patients are clearly improved or free of symptoms(placebo effect?). During the diet, a food/complaint protocol including an assessment of urticaria severity should be performed. About 50% of the patients tolerate whole food again after 6 months of diet.
External therapyThis section has been translated automatically.
Blande, itch-killing local therapy e.g. Optiderm Lotion, Tannolact Lotio, Lotio alba, Lotio Cordes, Zinc oxide emulsion LAW, if necessary with addition of 2-5% polidocanol (e.g. Thesit, rp. 200 rp. 196 ) or 1% menthol rp. 160 . If necessary topical glucocorticoids as lotio (e.g. Triamgalen Lotion, rp. 123 ) or cream (e.g. Triamgalen Cream, rp. 121 rp. 120 ). Alternatively gels containing antihistamines (e.g. Fenistil, Tavegil, Soventol).
Radiation therapyThis section has been translated automatically.
The use of UVA irradiation can lead to clinical improvement in individual cases. UVB therapy is more reserved for cholinergic urticaria and urticaria factitia.
Internal therapyThis section has been translated automatically.
For evidence-based therapy, see below. Urticaria (the therapy options listed here are partly based on smaller study results or also personal experience).
- Antihistamines: Oral administration of non-sedating antihistamines (H1 blockers) of the 2nd generation such as loratadine 10mg (e.g. Lisino) 1 tbl. p.o. 1 time/day, desloratadine 5mg (e.g. Aerius) 1 tbl. p.o. 1 time/day, Cetirizine 10mg (e.g. Zyrtec) 1 time/day 1 tbl. p.o. or Levocetirizine 5mg (Xusal) 1 time/day 1 tbl. p.o. In case of therapy failure (after 14 days) change to antihistaminic high-dose therapy:
- Antihistaminic high-dose therapy: If response is insufficient, individually adjusted dose increases (e.g., desloratadine in increasing doses up to 4 times the standard dose) may be used.
- Alternative: Combinations: The response to the different H1 blockers varies greatly from individual to individual, therefore the success of their combination is equally variable. Different H1 blockers can be combined in double combinations (e.g., levocetericin and fexofenadine) or in triple combinations (levocetericin and fexofenadine plus levocetericin at twice the standard dose. Combinations with H2 receptor blockers such as cimetidine (e.g. Tagamet) 400-800 mg/day or ranitidine (e.g. Sostril) 1 time/day 300 mg or 2 times/day 150 mg p.o. have also been successfully described.
- Alternative: omalizumab (Xolair): Approved in (refractory) chronic spontaneous urticaria since 2014. Dosage 300mg/s.c. every 28 days. Clinical efficacy has been demonstrated in several studies (Staubach P et al. 2016).
- Alternative: Sedating antihistamines (therapeutic principle is considered obsolete by many authors). Especially in hospitalized patients, sedating antihistamines such as hydroxyzine (e.g. Atarax®) 1-3 tbl./day may be considered at night.
- Alternative: Anti-allergic drugs with antihistaminic and PAF-blocking effect such as rupatadine (e.g. Rupafin) 10 mg/day p.o.
- Alternative: combinations of H1 blockers with a leukotriene antagonist (e.g. montelukast), especially in patients with concomitant angioedema.
- Alternative: combination of an H1-AH (e.g., desloratadine 10 mg/day) with dapsone (50-150 mg/day).
- Alternative: ciclosporin (good evidence) (2.5 mg/kg bw p.o. in 2 ED). However, ciclosporin should only be used in severe, absolutely refractory chronic urticaria, gfls. in combination with an H1-AH.
- Casuistic: Dapsone (low evidence):50-100 mg/day p.o. for 3-6 months. No longer mentioned in the latest guideline.
- Mast cell stabilizers (low evidence): For additional intestinal intolerance reactions, success with disodium cromoglicic acid (4 times/day 200 mg or 400 mg 15-30 min before exposure) is described.
- Casuistic (low evidence): Successes with high-dose intravenous immunoglobulin therapy(IVIG) have been described.
- Casuistic: Plasmapheresis/immunadsorbtion(low evidence): Last but not least, chronic urticaria in its pronounced form, especially after failure of other therapeutic approaches, represents an indication for plasmapheresis or immunadsorbtion. The method seems to be particularly successful in patients in whom autoantibodies against the high affinity part of IgE (α-chain) have been detected. These AK cause degranulation and histamine release via binding to the IgE receptor, e.g. at the surface of basophils or mast cells. Furthermore, this finding offers the possibility of a cost-saving reduction of the complex diagnostics in a part of the patients. At the same time, the high costs of the procedure must be pointed out!
- Not recommended for long-term therapy: Glucocorticoids (no longer listed in the guidelines or considered obsolete): Glucocorticoids in medium doses are usually very effective in cases of pronounced findings and pronounced, therapy-resistant symptoms(pruritus). Glucocorticoids are indicated for intermittent relapsing activity. Prednisolone (e.g. Solu Decortin H) initially 40-60 mg/day i.v., gradual dose reduction to lowest possible maintenance dose and switch to oral administration. Caveat. Maintenance dose should be below Cushing's threshold. Gastric protection is required for oral use.
- Therapy in pregnancy: Nothing is known about H1-AH-induced fertility damage. If treatment of pregnant women or nursing mothers is necessary, loratadine or cetericine in usual dosage should be used. The best study results are available for loratadine. No safety data are available for H1-AH high-dose therapy.
Progression/forecastThis section has been translated automatically.
NaturopathyThis section has been translated automatically.
- Week 1:
- Nystatin Drg. 3 times/day 2 Drg.
- Ozovit powder: 2 times/day 2 measuring spoons.
- Week 2-4:
- Markalact powder: 2 times/day 3 teaspoons.
- Amara drops Pascoe: 2 times/day 10 trp.
- Hepar-Pasc 100: 2 times/day 2 tbl.
- week 5-12:
- Markalakt powder: 2 times/day 3 teaspoons.
- Hepar-Pasc 100: 2 times/day 2 tbl.
- Amara mixture: 2 times/day 30 trp. of the mixture of 25 ml Amara drops of Pascoe/20 ml Pascoepankreat Novo drops/20 ml Quassia Similiaplex drops.
- MDS: 2 times/day 30 trp.
TablesThis section has been translated automatically.
Three-step programme of urticaria diagnostics
Level |
Diagnostic measures |
I |
Basic examination with careful anamnesis |
Recording of findings | |
General clinical examination and routine laboratory | |
Allergological test procedures | |
Atopy screening (cat, HST mite, grass) | |
Food Standard (Prick) | |
Physical provocation tests (cold, heat, pressure, exertion, dermographism, light staircase if necessary) | |
If necessary, skin biopsy with direct immunofluorescence | |
Urticaria-Basis-Diet: tea-potato-rice to exclude frequent food allergies | |
II |
Intensive Care Unit |
Diet diary | |
Infect allergic focus search (e.g. gastroscopy with Helicobacter pylori testing, C13 breath test) | |
III |
Elimination diet and provocation testing |
Elimination diet: Suspicious substances are removed one after the other and the clinical response is assessed. | |
Exploratory diet / provocation diet: Certain foods are given in sequence under control of the clinical findings. Reliable evaluation is only possible if the patient has been free of symptoms for at least 2 days before the test. | |
Oral provocation test for idiosyncrasy (OPTI) |
Urticaria diagnostics (proposal for an in-patient diagnostic programme)
Physical causes | |||
Dermographism |
occurs O |
positive O |
negative O |
Cold test/heat test |
occurs O |
positive O |
negative O |
Autologous serum test |
occurs O |
positive O |
negative O |
Print test |
occurs O |
positive O |
negative O |
Sweat test |
occurs O |
positive O |
negative O |
Doryl test (on the ward / allergy laboratory) |
occurs O |
positive O |
negative O |
(light stairs) |
occurs O |
positive O |
negative O |
Laboratory | |||
BSG |
occurs O |
increased O |
normal O |
Leukocytes |
occurs O |
increased O |
normal O |
Eosinophils |
occurs O |
increased O |
normal O |
ASL |
occurs O |
increased O |
normal O |
RF |
occurs O |
increased O |
normal O |
ANA |
occurs O |
increased O |
normal O |
Complement (C3,C4, CH50,C1-esterase inhibitor) |
occurs O |
increased O |
diminishedO |
Total IgE |
occurs O |
increased O |
normal O |
SX-1 |
occurs O |
positive O |
negative O |
RAST (Specific IgE) |
occurs O |
increased O |
negative O |
CAST |
occurs O |
increased O |
normal O |
CD 4/8 ratio |
occurs O |
pathol O |
normal O |
Thyroid hormones (T3, T4, TSH) |
occurs O |
increased O |
normal O |
SD-AK (MAK, TAK, TRAK, TPO) |
occurs O |
increased O |
normal O |
Hepatitis Serology |
occurs O |
positive O |
negative O |
Cryoglobulins |
occurs O |
increased O |
normal O |
Porphyrins |
occurs O |
increased O |
normal O |
Yersinia-KBR |
occurs O |
positive O |
negative O |
Candida AK |
occurs O |
positive O |
negative O |
Focal events | |||
Imprint tongue e.g. oral candidiasis |
occurs O |
positive O |
negative O |
stool on yeasts, parasites, pathogenic germs |
occurs O |
positive O |
negative O |
Vaginal swab on yeast |
occurs O |
positive O |
negative O |
Gynaecological consultation |
occurs O |
Focus O |
undetected. O |
ENT-Consultation |
occurs O |
Focus O |
undetected. O |
Dental Consil |
occurs O |
Focus O |
undetected. O |
Urological consultation |
occurs O |
Focus O |
undetected. O |
Rö-NNH |
occurs O |
Focus O |
undetected. O |
Orthopantomogram |
occurs O |
Focus O |
undetected. O |
Rö-Thorax |
occurs O |
Focus O |
undetected. O |
Abdomen Sonography |
occurs O |
Focus O |
undetected. O |
Gastroscopy with Helicobacter rapid test |
occurs O |
Focus O |
undetected. O |
Skin tests (allergy laboratory) | |||
After antihistamine free interval of 35 days |
|||
Prick test: inhalation allergens, food, additives, medicines |
occurs O |
positive O |
negative O |
Scratch test - food, medicines |
occurs O |
positive O |
negative O |
Friction test - food |
occurs O |
positive O |
negative O |
Intracutaneous test (not for Urticaria factitia) |
occurs O |
positive O |
negative O |
Multitest-Merieux |
occurs O |
conspicuous O |
undetected. O |
Exposure tests | |||
Dyestuff mix |
occurs O |
conspicuous O |
undetected. O |
Preservative mix |
occurs O |
conspicuous O |
undetected. O |
Potassium metabisulphite |
occurs O |
conspicuous O |
undetected. O |
Indomethacin |
occurs O |
conspicuous O |
undetected. O |
Acetylsalicylic acid |
occurs O |
conspicuous O |
undetected. O |
Placebo |
occurs O |
conspicuous O |
undetected. O |
Paracetamol |
occurs O |
conspicuous O |
undetected. O |
Ibuprofen |
occurs O |
conspicuous O |
undetected. O |
Na-glutamate |
occurs O |
conspicuous O |
undetected. O |
p-Coumaric acid |
occurs O |
conspicuous O |
undetected. O |
Provocative diet | |||
Additiva rich diet |
occurs O |
conspicuous O |
undetected. O |
Salicylate-rich diet |
occurs O |
conspicuous O |
undetected. O |
Urticaria basic diet (tea-potato-rice diet)
|
Allowed |
Forbidden |
Staple food |
Rice wafers, rice crackers, wheat rolls (wheat flour type 405, fresh yeast, sugar, iodized salt, water, corn oil) |
All other types of bread and cereals |
Potato dishes |
Boiled potatoes, fried potatoes, baked potatoes, potato rösti, potato cookies, potato pancakes, French fries |
All not mentioned |
Rice dishes |
Husked rice, brown rice, wild rice, rice noodles |
All not mentioned |
Spices |
iodized salt, sugar |
No other |
Grease |
Corn oil, Becel diet margarine |
No others, no butter |
Beverages |
Mineral water, black tea |
No other |
Oligo-Allergenic Basic Diet
Food |
Products |
Baked goods |
100% rye bread, Wasa rye crispbread (green package), Hammermühle bread: chestnut bread, millet bread, Pfälzer white bread (gluten-free), corn wafers, wafer bread, Mondamin bread (own production) |
Meat products |
Lamb, turkey (only salted, roasted with maize-germ oil or cooked) |
Vegetables |
Potatoes (cooked), mashed potatoes, fried potatoes with corn oil or French fries, broccoli, cauliflower, carrots, kohlrabi, zucchini, cucumber without skin |
Rice and noodles |
Chicken egg-free and wheat-free noodles, corn and rice noodles, rice (long grain or brown rice), Humana apple porridge or children's semolina (milk-free) both based on corn or rice |
Fruit |
Cooked unsweetened pear, apple pulp |
Greases |
Vitagen margarine (from Vitaquell), maize germ oil (with high content of polyunsaturated fatty acids) |
Sweetener |
pear syrup, sugar beet juice |
Beverages |
Calcium-rich mineral water, Humana SL, Milupa SOM, apple juice (100% naturally cloudy from Dr. Koch's) |
Egg replacement |
Egg substitute powder (e.g. hammer mill) |
Miscellaneous |
Nestargel (locust bean gum), rice wafers, cornflakes (unsweetened), popcorn, pop rice |
Build-up diet1
Food |
Products |
Dairy products |
Buttermilk, young semi-hard cheese |
Animal food |
Meat: Cold cuts, roast beef, turkey |
Fish: saithe, trout, plaice, cod | |
Eggs | |
Fruit |
banana, ripe sweet pear, watermelon |
Miscellaneous |
Fresh herbs, herbal teas, pear juice, vegetable juice, sugar beet syrup (bread topping) |
Provocation diet: Food rich in additives
Meal |
Food/Products |
Breakfast |
Whole grain bread, multivitamin jam, large quantities of cocoa drink (Kaba, Nesquick) |
Snack |
fruit yoghurt, cocktail cherries, chewing gum (Hubba Bubba, Vivil Mash), chocolate bars (Mars, Nuts) |
Noon |
instant soup (bag/Knorr, Maggi), ham rolls with mayonnaise (preserved), instant mashed potatoes, delicatessen salad, beans, spinach, red gelatine with cocktail cherries |
Coffee |
orange juice (coloured), chocolate dragees, wine gum with colouring, chewing gum |
Evening |
wholemeal bread/grey bread (preserved), salami/ham, salmon substitute, fish semi-preserved, delicatessen salad, horseradish, 2 glasses of white or red wine |
Night |
raspberry syrup drink, chewing gum, tomato juice (ready-to-drink), camembert |
Provocation diet - Salicylate-rich food: Without colouring, without seasoning
Meal |
Food/Products |
Breakfast |
Rolls/bread of your choice, diet margarine, cream cheese without additives, edible quark, jam, nut nougat cream, muesli cup, apple, dried plums, peppermint tea with sugar and lemon, 0.2 l orange juice |
Noon |
Fresh vegetable soup (leek, carrots, celery, salt, spices, herbs, potatoes), roasted or cooked meat (without ready sauce), boiled potatoes, rice (all kinds), noodles, raw vegetables (chicory, endive, paprika, radish, cucumber fresh, peas fresh, kale, gherkin, courgette, olives |
Dessert |
Red currant, raspberries with sugar or cranberry, raspberry or blueberry compote |
Afternoon |
0.2 l grape juice, pastries with almonds, peppermint tea or coffee with canned milk and sugar |
Dinner |
Bread of your choice, diet margarine, cream cheese without additives, potatoes in the skin, quark, jam, gherkin, carrots, raw vegetables (apple, lemon, onion), 0.2 l orange juice or black currant juice |
Provocation Day - Biogenic Amines
Biogenic amines |
Food/Products |
Histamine rich food |
Tuna, mackerel, raw and long-life sausages, tomatoes, sauerkraut, red wine, cheese (Emmental) |
Tyramine rich food |
raspberries, banana, oranges, Chianti wine, fish, cheese (Camembert), chocolate, cocoa |
Serotonin-rich foods |
Banana, cheese (Gouda, Edam) |
Oral provocation test for idiosyncrasy (OPTI)
Test day |
Test Substances |
Day 1 (dye mix I-II) |
Tartrazine (E 102) 25 mg; quinoline yellow (E 104) 12.5 mg; sunset yellow (E 110) 12.5 mg; azorubine (E 122) 12.5 mg; amaranth (E123) 2.5 mg; cochineal red (E 124) 20 mg; erythrosine (E127) 10 mg, also possible: patent blue (E 131); indigotine (E132); brilliant black (E 151); iron oxide (E 127). |
Day 2 (Preservative mix) |
Sorbic acid (E 200) 50 mg: Has an antimycotic effect, no effect against yeasts, is contained in bread and cheese. 2,4 unsaturated fatty acid, occurs naturally in the saturated form as caproic acid in butter. |
Na-benzoate (E 211) 50 mg: Benzoic acid occurs naturally in cranberries (in concentrations of 0.1-0.2%), has an antifungal and bacteriostatic effect. | |
PHB ester (p-OH-benzoic acid ethyl ester) (E 214) 50 mg: Ester is more antimycotic, acts even at higher pH, effective against coliform bacteria, staphylococci, streptococci, salmonella, klebsielles, proteus. | |
Day 3 (Potassium metabisulphite) |
Especially for the preservation of wine, inhibits the growth of mould and yeast from 20 mg/l. |
Day 4 (Indometacin) |
(1:1000; 1:100; 1:10; original preparation) |
Day 5 (Acetylsalicylic acid) |
(Pseudoallergy, previously CAST to ASS). Dose-dependent reaction, beginning with 50 mg, increasing in hourly intervals to 100 mg, 250 mg, 500 mg, 1000 mg. |
Day 6 (Possibly) Placebo |
|
Day 7 (other) |
E.g. paracetamol 1:1000, 1:100, 1:10, 1:1, ibuprofen 1:1000, 1:100, 1:10, 1:1, Na-glutamate (E 621) 124 Kps., p-coumaric acid 124 Kps. |
Rules of thumb for differentiating between allergic and pseudoallergic reactions (according to Ring J, Applied Allergology, MMW)
Allergy |
Pseudoallergy |
Awareness raising |
no sensitisation |
rather rare (< 5%) |
rather frequently (> 5%) |
common clinical symptoms |
often unspecific symptoms |
inducing small doses |
partly dose-dependent (e.g. infusions: speed) |
Family history sometimes positive |
Family history negative (exception: enzyme defect) |
slight psychological influence |
strong psychological influence |
Low salicylate diet (with proven ASS intolerance)
Food * |
Examples |
Fruit |
Apricots, oranges, blackberries, cherries, blueberries, gooseberries, cranberries, currants, nectarines, peaches, raspberries, strawberries, lemons |
Vegetables |
Aubergine, chicory, endive, paprika, pepperoni, radish, fresh cucumber, gherkin, zucchini |
Seeds |
Almonds |
Beverages |
aperitifs, beer, cognac, cola drinks, fruit juices from the above mentioned fruits, raspberry syrup, peppermint tea, wine |
Low pseudoallergen diet
|
Allowed |
Forbidden |
Staple food |
Bread, bread rolls without preservatives, semolina, millet, potatoes, rice, durum wheat noodles (without egg), rice wafers (only rice/salt) |
e.g. noodle products, egg pasta, cakes, French fries |
Greases |
Butter, vegetable oils (cold pressing) |
Margarine, mayonnaise etc. |
Dairy products |
Fresh milk, fresh cream, quark. natural yoghurt, unseasoned cream cheese, young Gouda |
All other dairy products |
Animal foodstuffs |
Fresh meat, fresh minced meat |
All processed animal food, eggs, fish, shellfish |
Vegetables |
lettuce, carrots, zucchini, Brussels sprouts, white cabbage, Chinese cabbage, broccoli, asparagus |
Artichokes, peas, mushrooms, rhubarb, spinach, tomatoes and tomato products, olives, peppers |
Fruit |
No fruit |
All kinds of fruit and fruit products, also dried, e.g. raisins |
Spices |
salt, chives, sugar, onions |
All other spices, no garlic, no herbs |
Sweets |
None |
All candy, sweetener, chewing gum |
Beverages |
milk, mineral water, coffee, black tea |
All other drinks, herbal teas, alcohol. Drinks |
Bread toppings |
honey, curd cheese, unseasoned cream cheese, young Gouda |
All rubbers not mentioned |
LiteratureThis section has been translated automatically.
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- Engin B et al (2008) Prospective randomized non-blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patines with chronic urticaria. JEAV 22: 481-486
- Godse KV (2011) Omalizumab in treatment-resistant chronic spontaneous urticaria. Indian J Dermatol 56:444
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- Maurer M et al (2011) Efficacy and safety of omalizumab in patients with chronic urticaria who exhibit IgE against thyroperoxidase. J Allergy Clin Immunol 128:202-209
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- Schulz S et al (2009) Antipruritic efficacy of a high-dose antihistamine therapy. Dermatologist 60: 564-568
- Staubach P et al(2016) Effect of omalizumab on angioedema in H1 -antihistamine-resistant chronic spontaneous urticaria patients: results from X-ACT, a randomized controlled trial. Allergy 71:1135-1144
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- Termeer C et al (2015) Chronic spontaneous urticaria- A treatment path for diagnosis and therapy in the practice. JDDG 13: 419-429
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Incoming links (31)
Amines, biogenic; Analgesic intolerance syndrome (ais); Angioedema histamine-mediated; Antihistamines, systemic; Antihistamines, systemic; Chronic lymphocytic leukemia; Contact urticaria; Dermatitis herpetiformis; Focus; Focus; ... Show allOutgoing links (52)
Acetylsalicylic acid; Amines, biogenic; Analgesics; Antibiotics; Antihistamines, systemic; Atopy; Benzoates; Candidosis, enteral; Celecoxib; Cetirizine; ... Show allDisclaimer
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