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The authors review the pathophysiology, presentation, assessment, and management of food-induced skin pruritus. The common sources of food-induced skin pruritus include histamine-rich foods such as nuts, seafood, vegetables, wheat, dairy, soy, legumes, and spices. Immune-mediated pruritic food reactions include food allergy syndromes, immunologic urticaria, dermatitis herpetiformis, delayed food-triggered atopic dermatitis, and fixed food eruption. Non–immune-mediated pruritic food reactions include phytophotodermatitis and histamine intolerance.
The key to the diagnosis of food-induced urticaria or pruritus is obtaining a thorough medical history and the potential triggers of food-induced urticaria can be further investigated using skin prick testing, oral food challenges, or elimination diets.
Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in dermatology on food-induced pruritus. In addition, itch severity is rarely mentioned. Food can induce pruritus through either ingestion or direct contact with skin or mucosal membranes. The most common type of itch provoked by food is acute urticaria, often through the classical immunoglobulin E (IgE)–mediated pathway. Other mechanisms include non-IgE–mediated, mixed (IgE-mediated and non-IgE–mediated), T-cell–mediated, and nonimmune reactions. For patients presenting with urticaria, generalized pruritus, oral pruritus, or dermatitis, a thorough history is warranted, and possible food associations should be considered and assessed. Although any food seems to have the potential to elicit an immune response, certain foods are especially immunogenic. Treatment includes avoidance of the trigger and symptom management. Careful consideration should be used as to avoid unnecessarily restrictive elimination diets.