Comment on “Effect of the Mediterranean diet in patients with chronic spontaneous urticaria”

Dear Editor,

We were delighted to read the article by Ayvaz HH¹. The article established that the Mediterranean diet was effective in suppressing the symptoms of chronic idiopathic urticaria. This may open up new possibilities for the treatment of chronic spontaneous urticaria (CSU). The authors used multivariate analysis to find that the Mediterranean diet score (MDS), HDL levels, and depression were significantly related to CSU. It also broadens the thinking for the treatment of CSU. However, in our point of view, there are still some issues that need further discussion.

The average age of the patient group was 38.6±13.0 years (18–65 years), and the average age of the control group was 38.7±13.8 years (p=0.983). Therefore, the authors did not conduct experiments on children and adolescents under the age of 18 years. Due to tight schoolwork and high learning pressure, students are more likely to have emotional eating behaviors². Moreover, presenting restrained eating behaviors is statistically associated with older age and higher adherence to the Mediterranean diet. In addition, gender³ is also a factor that affects CSU. The neutral ratio of the experimental subjects is not coordinated, which may also affect the reliability of the results. Therefore, we recommend that the authors can adjust the male-to-female ratio and age span of the experimental subjects so that the results and conclusions may be more convincing.

Furthermore, in this article, the authors used the urticaria symptom activity score over 7 days (UAS7) to measure the severity of chronic idiopathic urticaria. However, UAS7 does not clearly indicate the overall or average severity of itching during the evaluation period⁴. In addition, patients’ quantitative itching was subacute and inconclusive. The itch severity and hive counts may change rapidly. Therefore, we suggest that the authors can provide quantitative data, such as the proportion of differentially expressed transcripts between disease and non-disease at baseline. This way the authors can improve the reliability and validity of the conclusion.

Additionally, the Mediterranean diet is widely used in the prevention and treatment of chronic inflammatory diseases. Many experts have explained and introduced this diet in detail, and some exercise patterns may be used to reflect its effects. Skeletal muscle mass and strength are positively correlated with Mediterranean diet patterns⁵. Among the patients surveyed, diet and exercise are likely to be related to each other. For example, some patients may rarely exercise, while others may insist on exercising and having a strong body. Their skeletal muscle content may affect the results of the experiment. However, the authors did not mention the influence of exercise on the results of this research and did not exclude its influence in the experiment.

• Funding: none.

REFERENCES

• ¹
  Ayvaz HH, Kuyumcu A. Effect of the Mediterranean diet in patients with chronic spontaneous urticaria. Rev Assoc Med Bras. 2021;67(5):675-80. https://doi.org/10.1590/1806-9282.20201076
  » https://doi.org/10.1590/1806-9282.20201076
• ²
  Ferreira-Pego C, Rodrigues J, Costa A, Sousa B. Eating behavior: the influence of age, nutrition knowledge, and Mediterranean diet. Nutr Health. 2020;26(4):303-9. https://doi.org/10.1177/0260106020945076
  » https://doi.org/10.1177/0260106020945076
• ³
  Sabate-Bresco M, Rodriguez-Garijo N, Azofra J, Baeza ML, Donado CD, Gaig P, et al. A comparative study of sex distribution, autoimmunity, blood, and inflammatory parameters in chronic spontaneous urticaria with angioedema and chronic histaminergic angioedema. J Allergy Clin Immunol Pract. 2021;9(6):2284-92. https://doi.org/10.1016/j.jaip.2021.03.038
  » https://doi.org/10.1016/j.jaip.2021.03.038
• ⁴
  Hollis K, Proctor C, McBride D, Balp MM, McLeod L, Hunter S, et al. Comparison of urticaria activity score over 7 days (UAS7) values obtained from once-daily and twice-daily versions: results from the ASSURE-CSU study. Am J Clin Dermatol. 2018;19(2):267-74. https://doi.org/10.1007/s40257-017-0331-8
  » https://doi.org/10.1007/s40257-017-0331-8
• ⁵
  Kelaiditi E, Jennings A, Steves CJ, Skinner J, Cassidy A, MacGregor AJ, et al. Measurements of skeletal muscle mass and power are positively related to a Mediterranean dietary pattern in women. Osteoporos Int. 2016;27(11):3251-60. https://doi.org/10.1007/s00198-016-3665-9
  » https://doi.org/10.1007/s00198-016-3665-9

Publication Dates

• Publication in this collection
  15 Apr 2022
• Date of issue
  Mar 2022

History

• Received
  22 Nov 2021
• Accepted
  07 Dec 2021