Pseudoallergy: Prevention

To prevent pseudoallergy, attention must be paid to reducing individual risk factors. Behavioral risk factors

• Diet
  • Foods high in vaso- or psychoactive biogenic amines (naturally occurring flavor and taste compounds found in foods, such as tyramine, serotonin, histamine, synephrine, feruloylputrescine, putrescine, cadaverine, spermidine, spermine)
  • Foods that lead to increased histamine release such as strawberries, chocolate, citrus fruits, tomatoes.
  • Food additives or naturally occurring food ingredients in food, such as:
    • Antioxidants (e.g. butylated hydroxyanisole (BHA)/E320, butylated hydroxytoluene (BHT)/E321, gallates/E310 – E312).
    • Flavorings
    • Colorants or azo dyes (e.g. amaranth/E123, quinoline yellow/E104, cochineal red, erythrosine/E 127, yellow orange S/E127, indigotine (indigcarmine)/E132, curcumin/E100, patent blue/E131, tartrazine/E102, etc.; see under food additives/dyes).
    • Gelling agents (e.g. mannitol/E421, sorbitol/E420/).
    • Flavor enhancers (glutamic acid and its salts (glutamates)/E620-625).
    • Preservatives (benzoates – p-hydroxybenzoic acid: benzoic acid and its salts/E210; metasulfites, nitrites and nitrates/E49 – E252, PHB esters/E214 – E219, propionic acid, sulfur dioxide and sulfites/E 221 – E227, sorbic acid and its salts/E200).
    • Acidity regulators (e.g. tartrate/E337).
    • Stabilizers or gelling agents (eg sorbitol/E420/, mannitol/E421).
    • Salicylates (salicylic acid)
  • Pesticide residues

Medication groups*

• Anesthetics (intravenous)
• Analgesics
  • Acetylsalicylic acid (ASA)
  • Β-lactam antibiotics
  • Non-acid analgesics (ketoprofen, metamizole, paracetamol).
  • Non-steroidal anti-inflammatory drugs (diclofenac, flurbiprofen, ibuprofen, meclofenamic acid, mefenamic acid, naproxen).
• Antiadiposita (orlistat).
• Antibiotics
  • Aminoglycosides (gentamycin (gentamicin), gentamycin-AT, streptomycin, tobramycin).
  • Cephalosporins (cefoxitin, ceftazidime, ceftriaxone, cefuroxime).
  • Quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin, moxifloxacin, nalidixic acid, norfloxacin, lomefloxacin, levofloxacin, ofloxacin).
  • Dapsone
  • Glycopeptide antibiotics (teicoplanin, vancomycin).
• Antiepileptic drugs (carbamazepine, gabapentin, pregabalin).
• Antiglutamatergic drugs (memantine).
• Anticonvulsants (carbamazepine, oxcarbamazepine).
• Antimalarials (atovaquone, quinine, hydroquinine, pyrimethazine).
• Antiparkinsonian drug (amantadine).
• Antituberculostat drug (rifampicin)
• Beta blockers
  • Local beta-blockers (betaxolol, timolol).
• Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors; gliptins) – saxagliptin.
• Hemorrhoidal agents (Policresulen).
• Hormones
  • Antiandrogens (cyproterone acetate)
  • Prostaglandin derivatives (local) – bimatoprost, latanoprost, travoprost, unoprostone.
  • 5-α-reductase inhibitors (dutasteride, finasteride).
• Immunosuppressants (azathioprine
• Colloidal plasma substitutes
• Local anesthetics
• Muscle relaxants/antispasmodics (tolperisone)
• X-ray contrast media
• Sedatives (clomethiazole)
• Sympathomimetics
  • Α-sympathomimetics (oxymetazoline, xylometazoline).

Drugs that are inhibitors of DAO (diamine oxidase):

• Antibiotics
  • Aminoglycosides (framycetin, neomycin, paromomycin).
  • Clavulanic acid
  • Isoniazid
• Antiarrhythmics
  • Calcium antagonists (verapamil)
• Antidepressants
  • Tricyclic antidepressants (amitriptyline).
• Antiemetics (metoclopramide).
• Antimalarials (chloroquine)
• Antiprotozoal agents (pentamidine)
• Antipsychotics (neuroleptics) – promethazine
• Bronchospasmolytics (aminophylline).
• Expectorants (ambroxol, N-acetylcysteine).
• Parasympatholytics (pirenzepine).
• Plasma expander (gelatin)
• Vasodilators (dihydralazine).

Non-steroidal analgesics or anti-inflammatory drugs listed below may additionally lead to histamine release in individuals with allergic disposition, so there may be an increased histamine effect:

• Acetylsalicylic acid
• Diclofenac
• Indometacin
• Flurbiprofen
• Ketoprofen
• Meclofenamic acid
• Mefenamic acid
• Naproxen

For allergy sufferers suitable analgesic or antiphlogistic drugs that inhibit allergen-specific histamine release are:

• Fenbufen
• Levamisole
• Ibuprofen

* Patients with pseudoallergies often also react to components (e.g., dyes) of drugs: the azo dye tartrazine (E 102) and yellow orange S (E 110) is often added to various drugs, including anti-allergy drugs Other dyes in drugs with allergy risk are: Quinoline Yellow (E 104), True Yellow (E 105) and Ponceau 4R (E 124)! (Note: this list is only exemplary!).