Pseudoallergies, which cause typical allergic reactions without the presence of antibodies to the substance in question, cause as much suffering as true allergies. However, diagnosis is more difficult because countless triggers for the symptoms come into question. Once ill with a pseudoallergy, however, this does not mean a lifelong renunciation.
What is a pseudoallergy?
Pseudoallergies do not involve antibodies. Instead, the pseudoallergic reaction is either via histamine or mast cells. Typical symptoms are identical to those of a true allergy. Sufferers may experience skin rashes, hives, wheals, swelling and redness of the skin. The digestive tract can also be affected. Sufferers then complain of itching in the mouth or throat, stomach pain, nausea and diarrhea. Other symptoms include asthmatic attacks, headaches, circulatory problems and rhinitis. Pseudoallergies are not preceded by a sensitization phase. This means that symptoms may occur at the first contact with a particular substance. Furthermore, the reaction is strongly dependent on the amount that the affected person has ingested. Small amounts can be tolerated without problems, whereas higher amounts can also lead to life-threatening conditions.
Causes
The causes of pseudoallergies are numerous at first glance, but they are always triggers contained in medications or foods, which is why the term pseudoallergic food intolerance is used. Very often drugs as well as food additives are responsible for the pseudoallergic reaction. Food additives may be colorants such as quinoline yellow. Preservatives, flavor enhancers and sweeteners are also possible triggers. Another group of triggers are biogenic amines, such as those found in aged hard cheeses, wine and chocolate. A third group is salicylates. Salicylates are found in various fruits, vegetables, and spices, as well as in some medications. In addition, natural flavorings can also trigger pseudoallergic food intolerance. The above triggers activate mast cells non-specifically, triggering the reaction. To be distinguished from these triggers is a reaction due to histamine contained in food. If it cannot be broken down due to an enzyme deficiency, the characteristic allergy symptoms occur here as well. However, this is called histamine intolerance and not pseudoallergy.
Symptoms, complaints, and signs
A pseudoallergy is associated with symptoms similar to those of a conventional allergy. When the sufferer comes into contact with an allergen, rhinitis, cough, and asthmatic symptoms set in. Redness and itchy wheals develop on the skin, mostly on the arms and legs and on the face and neck. Furthermore, nasal polyps form, which can cause breathing difficulties. They also cause the patient to have a nasal murmur. In the gastrointestinal tract, nausea, vomiting and diarrhea often occur. Accompanying headaches occur, and often the sufferer feels a strong malaise. In severe allergic reactions, there are circulatory problems such as palpitations, high blood pressure and dizziness, and even circulatory failure. Normally, however, a pseudoallergy progresses with mild symptoms. The sufferer therefore often believes the symptoms to be a harmless intolerance. However, after prolonged contact with the triggering substance, the symptoms increase. As a result, the quality of life of the sufferer decreases, and there is a risk that psychological complaints will develop. A chronic pseudoallergy can cause respiratory problems, permanent organ damage and skin changes. Sufferers usually have a sickly appearance with pale skin, puffy eyes, and a stuffy nose.
Diagnosis and course
Diagnosis of pseudoallergy is difficult because of many differential diagnoses. Thus, allergy, enzyme deficiency, or inadequate intestinal digestion may also be present. In contrast to the diseases mentioned above, there are no simple tests available to detect a pseudoallergy. In addition, many hours can pass before the symptoms appear, which makes the search for the cause of the symptoms even more difficult.For the diagnosis of a pseudoallergy, the differential diagnoses should first be ruled out using skin tests, blood tests and breath tests. Subsequently, an abstinence phase of several weeks must be carried out, during which possible triggers must be avoided. After that, provocation tests are performed, which should be done under medical supervision.
Complications
Pseudoallergy is mislabeled as intolerance or intolerance. Even though there is no true immune response in pseudoallergic reactions, pseudoallergies can lead to complications. For example, pseudoallergic reactions to medications or additives in foods can potentially lead to the same symptoms as an allergy to one of the active ingredients. The problem with pseudoallergies whose trigger cannot be determined is that they often receive only symptomatic treatment. However, symptom suppression does not always work. Symptoms may subsequently become chronic, for example chronic pruritus, chronic urticaria or irritable bowel syndrome. Diet-related pseudoallergies may result in periodic or persistent diarrhea and intestinal disturbances. Those affected usually try to exclude certain suspected substances from their diet as a self-help measure in the case of diet-related complications. These may be foods with high levels of biogenic amines. Alternatively, sufferers may consider additives such as dyes or preservatives to be triggers of their problems. Subsequently, they avoid all foods containing these substances. As a result, the diet may become one-sided and unbalanced. As a result, nutritional disorders and serious deficiency symptoms can occur. To prevent further complications, an elaborate search for the triggering substance would be necessary. However, this is only undertaken if a drug-induced pseudoallergy is suspected.
When should one go to the doctor?
Asthmatic symptoms, circulatory reactions, and gastrointestinal symptoms indicate a pseudoallergy. A doctor should be consulted if symptoms do not subside within a few days. If the symptoms become more severe and have a very negative effect on well-being, a visit to the doctor is recommended. People who regularly take certain medications (e.g., nonsteroidal anti-inflammatory drugs or opiates) are particularly at risk. People who are sensitive to preservatives, acidifiers or radiological contrast agents are also among the risk groups. If a pseudoallergy is suspected, these individuals should in any case consult their family physician and have their symptoms clarified and, if necessary, treated. If the prescribed antihistamines or ointments do not have the desired effect, the doctor must be informed. A pseudoallergy is treated by the family doctor, an ENT specialist or a specialist in allergic diseases. In case of severe circulatory reactions, skin changes or even an allergic shock, the emergency medical service should be called. The affected person must be treated medically in any case to avoid complications.
Treatment and therapy
If a pseudoallergy has been diagnosed, the trigger or triggers must first be avoided until the symptoms have subsided. Only then can an increasing amount of the trigger be slowly integrated into the daily diet. In this way, the individually tolerated threshold can be determined. Affected persons, since they usually tolerate a small amount of the triggering substance, do not have to practice lifelong renunciation. However, they must check all pre-packaged goods to see whether they contain the trigger substance in question. Other goods, such as baked goods at the bakery or the portion of French fries at the fast food restaurant, may also contain the trigger. Caution is also advisable with medications. In some cases, however, the pseudoallergy disappears in the course of life and the former sufferers are no longer subject to restrictions in their food choices. In the case of acute symptoms, medications can also be taken to alleviate the symptoms. The respective medication can be prescribed by a specialist. For example, it is possible to administer antihistamines for pseudoallergic reactions.
Prevention
Pseudoallergies cannot be prevented. Nevertheless, a diet with fresh foods as much as possible and avoidance of food additives is advisable.
Aftercare
Follow-up of pseudoallergy is not generally necessary or required over a long period of time. Because symptoms similar to those of an allergy have occurred in the patient and had to be treated, the pseudoallergy may recur. To rule out recurrence, it should be determined what triggered this reaction. The activation of the allergic reaction did not occur by activation of the antibodies, but non-specifically, which complicates treatment and thus follow-up. In many cases, there is no specific follow-up or sustained therapy for the patient. However, it is known that certain substances can trigger a non-specific activation and thus limit the causes. These are certain groups of drugs and food ingredients. Acute treatment is in the foreground and is often provided by the use of antihistamines. Follow-up care in this case refers mainly to patient education and not to drug treatment or control examinations, since it is not possible to examine antibodies in the blood. By knowing the pseudoallergy, the patient should be advised to log ingested foods and medications so that, if it recurs, the cause can be appropriately limited and thus avoided.
What you can do yourself
A pseudoallergy can be prevented with the help of various measures and remedies from the household and nature. First, however, it is important to diagnose the triggering substance. Then, appropriate measures can be taken to specifically avoid the triggering products. People suffering from a pseudoallergy should avoid contact with the triggering substance as far as possible. It is advisable to carefully study all ingredient lists as well as content information in order to avoid contact and the associated allergic reaction. Should a reaction nevertheless occur, a doctor must be consulted. In case of acute symptoms, the appropriate emergency medication must be taken. A healthy diet with fresh foods reduces the risk of developing a pseudoallergy. Sufficient sleep as well as regular exercise also have a positive effect on the clinical picture. In addition, people suffering from pseudoallergy should follow the doctor’s instructions. The physician will first recommend avoiding contact with the triggering substances. Depending on the trigger, this can be achieved by wearing appropriate clothing or by changing jobs. In the case of food allergies, the diet must be changed.