Exploring gluten sensitivity in chronic spontaneous urticaria

Background. Chronic spontaneous urticaria (CSU) is a common, challenging condition, usually impairs patients' quality of life. While current medications are mainly symptom-based, many people still suffer. There is limited and inconclusive evidence suggesting a possible role of gluten sensitivity in CSU, and current international guidelines do not recommend a gluten-free diet as a standard therapeutic approach. This study aimed to assess the effect of a gluten-free diet (GFD) on CSU activity. Methods. This one-arm sequential interventional study was conducted on 89 CSU patients at Ain Shams University Hospitals. Celiac patients were excluded, and only patients with negative anti-TTG were allowed. Participants underwent a skin prick test for wheat and gluten. They followed a GFD for three weeks, after which gluten was reintroduced, and patients were reassessed over an additional short-term follow-up period of about one week. Urticaria Activity Score 7 (UAS7) was used to evaluate severity. Laboratory investigations were conducted. Results. After three weeks on GFD, forty-three patients (48.3%) showed improvement in urticaria activity following gluten elimination and subsequent symptom worsening after gluten rechallenge. This was documented by UAS7 score which varied significantly (p < 0.001). CRP was significantly higher among the non-gluten sensitive group; other laboratory parameters were comparable. Conclusions. Gluten elimination was associated with reduced urticaria activity in a subset of patients with CSU. However, controlled studies are needed to establish its efficacy.