allergic reactions to foods are rarely the cause of chronic urticaria but patients are often referred to hospital in the belief that foods are responsible
a practical approach is to start by excluding an atopic diathesis by undertaking skin prick tests (SPTs) to a panel of aeroallergens
if negative, this significantly reduces the likelihood of an IgE-mediated allergic reaction to foods and other allergens
additional skin testing can also be helpful to some of the foods that the patient suspects as the cause of their urticaria
the sight of a negative SPT helps to reassure the patient that allergy is not the cause of their symptoms and may contribute to improved concordance with long-term antihistamines
however, foods may be responsible for the symptoms of acute intermittent urticaria, for example wheat followed by exercise can cause urticaria/angio-oedema and even anaphylaxis
in this situation the patient is often atopic and has a positive SPT and/or specific IgE to the implicated food
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