General guidlines on foods?

[Guest guest]

Hi, I'm wondering what foods tend to irritate our condition.

I've heard that histamines and niacin in foods are problematic. And

I know big meals or spicy and hot foods often are a problem. What

I'm after is information on foods that contain alot of niacin or

histamines. Any websites you've found helpful that give a list of

foods to avoid or simply detailed nutritional information? And, by

all means, if you have foods that seem to affect you post that too.

What I'm wondering about is more along the lines of which foods tend

to make the overall condition worse--increase the " base " of general

redness and thus reactivity to triggers. Of couse, information on

problem foods that contribute to worsening the condition an hour so

after eating--once they're in the system--is great too. Thanks all.

[Guest guest]

Hi, I'm wondering what foods tend to irritate our condition.

I've heard that histamines and niacin in foods are problematic. And

I know big meals or spicy and hot foods often are a problem. What

I'm after is information on foods that contain alot of niacin or

histamines. Any websites you've found helpful that give a list of

foods to avoid or simply detailed nutritional information? And, by

all means, if you have foods that seem to affect you post that too.

What I'm wondering about is more along the lines of which foods tend

to make the overall condition worse--increase the " base " of general

redness and thus reactivity to triggers. Of couse, information on

problem foods that contribute to worsening the condition an hour so

after eating--once they're in the system--is great too. Thanks all.

[Guest guest]

, here's a copy & paste on some dietary and non-dietary

information I posted on June 11th to the group. I prefaced these

comments with a disclaimer -- these are my ideas and opinions. Please

read this in that spirit and NOT as medical advice or medical

information. I added some new comments at the end, also completely my

own opinion.

" ...Regarding food triggers that cause flushing: first, everyone

agrees that there are foods/drinks like alcohol and spicy foods that

cause immediate flushing in many people, rosaceans and non-rosaceans.

Statistically, they are likely culprits -- although it's important

that not all rosaceans will flush to even these common triggers.

Also, some may flush only with certain amounts or with combined

triggers such as beer under a hot sun, red wine when under emotional

stress, etc.

Much less commonly, there are people on this list and elsewhere who

attribute immediate flushing to foods that contain or release small

peptides such as histamine; whether this is related to a deficiency

in an enzyme as some hypothesize or some kind of vascular reaction, I

don't know. The list of foods varies from Web site and references,

and I don't know what to believe so I'm listing all I found (in no

particular order): cheese, sour cream, spinach, eggplant, red wine,

mackerel, anchovies, herring, sardines, yeast, sausage, sauerkraut,

canned tuna, preserves, spinach, tomatoes, strawberry, chocolate,

protease-containing fruits like bananas and papayas, alcohol, citrus

fruits, avocado, raisins, and vinegar. Obviously most rosaceans don't

flush to any of these.

Third, a number of people on this list and in the lay press attribute

rosacean triggers to to food allergies/intolerances. Unlike the

above, food allergies/intolerances usually manifest as a skin

inflammation (itchy, red, hives or small papules on the epidermis) or

as angioedema (painless swelling of the dermis).

(If a food allergy manifests by flushing, it should be accompanied by

low blood pressure and with a major allergic reaction. (This is in

distinction to the rosacea triggers and histamine-containing foods

discussed above, where flushing may be accompanied with minor

lightheadedness, but not the systemic systems that are part of an

allergic reaction.))

Intolerances also involve the immune system, but not the stereotypic

pathways involved in an allergic reaction. Intolerances also tend to

be delayed by hours or even days. Most commonly, food intolerances

are accompanied by GI symptoms, but not uniformly so. They can just

involve only skin inflammation, although the face is not the most

common place they manifest.

Statistically, the most common foods to induce food intolerances in

the general public are wheat products, gluten products (Celiac

disease is one form of gluten intolerance, and for a number of

reasons it's tempting to see a relationship between rosacea and

Celiac disease, but Celiac's dermatologic feature looks nothing like

rosacea and is rarely just on the face), cow dairy products, and soy

products. I've not found evidence that explains whether rosaceans are

more suspectable to food intolerances, or more suspectible to

manifest food intolerances as facial rashes.

So here's how I would put it together, considering dietary and non-

dietary triggers:

With a flush alone, the most common triggers are environmental and

individual (physical or emotional stress), but some foods like

alcohol or spicy foods are also common culprits. Over the months, it

should be clear whether any of these triggers affect a particular

person, alone or in combination, and how much exposure can be

tolerated, if any. If flushing presents at times when none of the

most common triggers apply, it's reasonable to consider side effects

of one's medications and hormonal states such as menopause, and then

subtle environmental factors or histamine-associated foods.

Identification is made easy because the trigger causes an immediate

flush reaction; the flush will be while still in the pizzeria, not

two hours later. Also, rest assured that if you aren't being rushed

to the hospital then the flush isn't the result of any kind of

allergy. (As explained above, a flush is a serious manifestation of

an allergy usually accompanied by hypotension and other systemic

symptoms.)

In contrast to flushing, what triggers the irritative/inflammatory

symptoms of rosacea can be much harder to identify, largely because

the trigger can be hours if not days away. Far and away the most

common triggers of irritative/inflammatory rosacean symptoms are from

topicals -- something applied directly the skin. Topicals can cause

an immediate sensitivity such as burning or itching and/or delayed

symptoms, by hours or days (rarely, weeks). So the new soap today may

result in a worsening of papules and redness (not flushing redness,

but inflammatory redness) two days from now, after we've already

tried the new moisturizer. Or the reaction may occur a week later,

after the ingredients have built up in the skin or sensitization has

occurred. The most classic type of reaction here is an irritative

contact dermatitis, but consider other types of contact dermatitis as

well, such as nickel from eyeglasses or new face or hand jewelry, or

even nail polish.

What challenges most rosaceans is differentiating between the normal

exacerbation and remissions that characterize vascular and

inflammatory rosacea, with more subtle triggers that could be from

many sources, including histamine-related foods and food

intolerances, respectively.

I respect that many in this group give a higher priority to diet and

rosacea. In my opinion, the kind of elimination and other restrictive

diets aren't likely to impact the health of most rosaceans -- in

contrast to things that are likely to benefit most everyone, like

drinking 6-8 glasses of water/day, taking a good multivitamin with

healthy doses of B vitamins, getting a good nite's sleep each night,

and using the smallest amounts of basic cleansers and moisturizers

without frequent changes that risk sensitizing sensitive skin

further.

After a month of just doing these basic things, with attention to

reactions from common triggers, I would think a rosacean is in a

better position to assess whether any trigger needs to be avoided and

if so, under what conditions. I would think it's also a good place to

re-consider medications such as oral and/or topical antibiotics,

advancing as necessary under a competent dermatologist's care to

medications helpful in controlling flushing, and topicals helpful in

controlling inflammation. Setting forth a skin maintenance regimen

and getting familiar with one's exacerbations and remissions over a

course of many months would help determine if rosacea is being well

managed -- never cured or controlled, but managed. If not, that would

be the point to consider rarer causes of rosacea or rosacean-like

conditions, such as co-existing conditions that complicate diagnosis

and care, including the presence of histamine-related food and food

intolerances. "

Addendum: since histamine-related foods would result in an immediate

or near-immediate flush, a simple test should suffice: after not

eating anything for several hours, eat a fresh tomato. If there's no

flush within, say, an hour, I would think there's no sensitivity to

histamine-related foods. If there is a reaction, rechallange with one

or two other foods on the list to see if it's specific to some foods,

or if all histamine-related foods are triggers.

Determining food intolerances is far more difficult, since the

results are usually not near-immediate and the manifestation is not a

straightforward flush but a more subtle skin reaction. But one can

probably get a good sense by being attentive to delayed skin

reactions after eating foods that commonly elicit food intolerances

as lisited above, then rechallenging to insure the intolerance is

reproducible.

Hope this helps.

Marjorie

Marjorie Lazoff, MD

> Hi, I'm wondering what foods tend to irritate our condition.

> I've heard that histamines and niacin in foods are problematic.

And

> I know big meals or spicy and hot foods often are a problem. What

> I'm after is information on foods that contain alot of niacin or

> histamines. Any websites you've found helpful that give a list of

> foods to avoid or simply detailed nutritional information? And, by

> all means, if you have foods that seem to affect you post that

too.

> What I'm wondering about is more along the lines of which foods

tend

> to make the overall condition worse--increase the " base " of general

> redness and thus reactivity to triggers. Of couse, information on

> problem foods that contribute to worsening the condition an hour so

> after eating--once they're in the system--is great too. Thanks all.

>

>

[Guest guest]

, here's a copy & paste on some dietary and non-dietary

information I posted on June 11th to the group. I prefaced these

comments with a disclaimer -- these are my ideas and opinions. Please

read this in that spirit and NOT as medical advice or medical

information. I added some new comments at the end, also completely my

own opinion.

" ...Regarding food triggers that cause flushing: first, everyone

agrees that there are foods/drinks like alcohol and spicy foods that

cause immediate flushing in many people, rosaceans and non-rosaceans.

Statistically, they are likely culprits -- although it's important

that not all rosaceans will flush to even these common triggers.

Also, some may flush only with certain amounts or with combined

triggers such as beer under a hot sun, red wine when under emotional

stress, etc.

Much less commonly, there are people on this list and elsewhere who

attribute immediate flushing to foods that contain or release small

peptides such as histamine; whether this is related to a deficiency

in an enzyme as some hypothesize or some kind of vascular reaction, I

don't know. The list of foods varies from Web site and references,

and I don't know what to believe so I'm listing all I found (in no

particular order): cheese, sour cream, spinach, eggplant, red wine,

mackerel, anchovies, herring, sardines, yeast, sausage, sauerkraut,

canned tuna, preserves, spinach, tomatoes, strawberry, chocolate,

protease-containing fruits like bananas and papayas, alcohol, citrus

fruits, avocado, raisins, and vinegar. Obviously most rosaceans don't

flush to any of these.

Third, a number of people on this list and in the lay press attribute

rosacean triggers to to food allergies/intolerances. Unlike the

above, food allergies/intolerances usually manifest as a skin

inflammation (itchy, red, hives or small papules on the epidermis) or

as angioedema (painless swelling of the dermis).

(If a food allergy manifests by flushing, it should be accompanied by

low blood pressure and with a major allergic reaction. (This is in

distinction to the rosacea triggers and histamine-containing foods

discussed above, where flushing may be accompanied with minor

lightheadedness, but not the systemic systems that are part of an

allergic reaction.))

Intolerances also involve the immune system, but not the stereotypic

pathways involved in an allergic reaction. Intolerances also tend to

be delayed by hours or even days. Most commonly, food intolerances

are accompanied by GI symptoms, but not uniformly so. They can just

involve only skin inflammation, although the face is not the most

common place they manifest.

Statistically, the most common foods to induce food intolerances in

the general public are wheat products, gluten products (Celiac

disease is one form of gluten intolerance, and for a number of

reasons it's tempting to see a relationship between rosacea and

Celiac disease, but Celiac's dermatologic feature looks nothing like

rosacea and is rarely just on the face), cow dairy products, and soy

products. I've not found evidence that explains whether rosaceans are

more suspectable to food intolerances, or more suspectible to

manifest food intolerances as facial rashes.

So here's how I would put it together, considering dietary and non-

dietary triggers:

With a flush alone, the most common triggers are environmental and

individual (physical or emotional stress), but some foods like

alcohol or spicy foods are also common culprits. Over the months, it

should be clear whether any of these triggers affect a particular

person, alone or in combination, and how much exposure can be

tolerated, if any. If flushing presents at times when none of the

most common triggers apply, it's reasonable to consider side effects

of one's medications and hormonal states such as menopause, and then

subtle environmental factors or histamine-associated foods.

Identification is made easy because the trigger causes an immediate

flush reaction; the flush will be while still in the pizzeria, not

two hours later. Also, rest assured that if you aren't being rushed

to the hospital then the flush isn't the result of any kind of

allergy. (As explained above, a flush is a serious manifestation of

an allergy usually accompanied by hypotension and other systemic

symptoms.)

In contrast to flushing, what triggers the irritative/inflammatory

symptoms of rosacea can be much harder to identify, largely because

the trigger can be hours if not days away. Far and away the most

common triggers of irritative/inflammatory rosacean symptoms are from

topicals -- something applied directly the skin. Topicals can cause

an immediate sensitivity such as burning or itching and/or delayed

symptoms, by hours or days (rarely, weeks). So the new soap today may

result in a worsening of papules and redness (not flushing redness,

but inflammatory redness) two days from now, after we've already

tried the new moisturizer. Or the reaction may occur a week later,

after the ingredients have built up in the skin or sensitization has

occurred. The most classic type of reaction here is an irritative

contact dermatitis, but consider other types of contact dermatitis as

well, such as nickel from eyeglasses or new face or hand jewelry, or

even nail polish.

What challenges most rosaceans is differentiating between the normal

exacerbation and remissions that characterize vascular and

inflammatory rosacea, with more subtle triggers that could be from

many sources, including histamine-related foods and food

intolerances, respectively.

I respect that many in this group give a higher priority to diet and

rosacea. In my opinion, the kind of elimination and other restrictive

diets aren't likely to impact the health of most rosaceans -- in

contrast to things that are likely to benefit most everyone, like

drinking 6-8 glasses of water/day, taking a good multivitamin with

healthy doses of B vitamins, getting a good nite's sleep each night,

and using the smallest amounts of basic cleansers and moisturizers

without frequent changes that risk sensitizing sensitive skin

further.

After a month of just doing these basic things, with attention to

reactions from common triggers, I would think a rosacean is in a

better position to assess whether any trigger needs to be avoided and

if so, under what conditions. I would think it's also a good place to

re-consider medications such as oral and/or topical antibiotics,

advancing as necessary under a competent dermatologist's care to

medications helpful in controlling flushing, and topicals helpful in

controlling inflammation. Setting forth a skin maintenance regimen

and getting familiar with one's exacerbations and remissions over a

course of many months would help determine if rosacea is being well

managed -- never cured or controlled, but managed. If not, that would

be the point to consider rarer causes of rosacea or rosacean-like

conditions, such as co-existing conditions that complicate diagnosis

and care, including the presence of histamine-related food and food

intolerances. "

Addendum: since histamine-related foods would result in an immediate

or near-immediate flush, a simple test should suffice: after not

eating anything for several hours, eat a fresh tomato. If there's no

flush within, say, an hour, I would think there's no sensitivity to

histamine-related foods. If there is a reaction, rechallange with one

or two other foods on the list to see if it's specific to some foods,

or if all histamine-related foods are triggers.

Determining food intolerances is far more difficult, since the

results are usually not near-immediate and the manifestation is not a

straightforward flush but a more subtle skin reaction. But one can

probably get a good sense by being attentive to delayed skin

reactions after eating foods that commonly elicit food intolerances

as lisited above, then rechallenging to insure the intolerance is

reproducible.

Hope this helps.

Marjorie

Marjorie Lazoff, MD

> Hi, I'm wondering what foods tend to irritate our condition.

> I've heard that histamines and niacin in foods are problematic.

And

> I know big meals or spicy and hot foods often are a problem. What

> I'm after is information on foods that contain alot of niacin or

> histamines. Any websites you've found helpful that give a list of

> foods to avoid or simply detailed nutritional information? And, by

> all means, if you have foods that seem to affect you post that

too.

> What I'm wondering about is more along the lines of which foods

tend

> to make the overall condition worse--increase the " base " of general

> redness and thus reactivity to triggers. Of couse, information on

> problem foods that contribute to worsening the condition an hour so

> after eating--once they're in the system--is great too. Thanks all.

>

>

[Guest guest]

Thanks for that information. So, as far as foods are concerned,

flushing is almost always immediate when there is a problem food?

So, my question about contributing to a more pronounced " background

flush " is that general diet (if healthy) does not make the overall

condition worse because of a few, regular problem items one eats?

This is my understanding from the post, at least.

[Guest guest]

Thanks for that information. So, as far as foods are concerned,

flushing is almost always immediate when there is a problem food?

So, my question about contributing to a more pronounced " background

flush " is that general diet (if healthy) does not make the overall

condition worse because of a few, regular problem items one eats?

This is my understanding from the post, at least.

[Guest guest]

> So, as far as foods are concerned,

> flushing is almost always immediate when there is a problem food?

Right, , that's my understanding as well. Based on the

physiologic mechanism that causes a flush, there can be no delayed

(post-digestion) flush caused by food. That's because flushing is a

trigger reaction. Though it may take a lot of exposure or multiple

culprits to trigger a flush response, but once triggered it is a near-

immediate phenomenon -- and that's not just from food, from any

source (environmental, medication, etc).

Once flushed, of course, we rosaceans can *continue* the flush for

hours or days... <g>

> So, my question about contributing to a more pronounced " background

> flush " is that general diet (if healthy) does not make the overall

> condition worse because of a few, regular problem items one eats?

> This is my understanding from the post, at least.

I would agree with that. Food intolerances are quite common, but the

singular manifestation of background redness on the face doesn't fit

in with even the most liberal diagnosis of food intolerance, unless

there are also unexplained chronic GI symptoms (usually diarrhea)

and/or rashes elsewhere on the body.

But even if present, we're not talking about rosacea, this would be a

skin manifestation of a food intolerance, a co-existing second

condition. And there's nothing I'm aware of that would lead us to

anticipate an increased incidence of food intolerances among

rosaceans.

Marjorie

Marjorie Lazoff, MD

[Guest guest]

> So, as far as foods are concerned,

> flushing is almost always immediate when there is a problem food?

Right, , that's my understanding as well. Based on the

physiologic mechanism that causes a flush, there can be no delayed

(post-digestion) flush caused by food. That's because flushing is a

trigger reaction. Though it may take a lot of exposure or multiple

culprits to trigger a flush response, but once triggered it is a near-

immediate phenomenon -- and that's not just from food, from any

source (environmental, medication, etc).

Once flushed, of course, we rosaceans can *continue* the flush for

hours or days... <g>

> So, my question about contributing to a more pronounced " background

> flush " is that general diet (if healthy) does not make the overall

> condition worse because of a few, regular problem items one eats?

> This is my understanding from the post, at least.

I would agree with that. Food intolerances are quite common, but the

singular manifestation of background redness on the face doesn't fit

in with even the most liberal diagnosis of food intolerance, unless

there are also unexplained chronic GI symptoms (usually diarrhea)

and/or rashes elsewhere on the body.

But even if present, we're not talking about rosacea, this would be a

skin manifestation of a food intolerance, a co-existing second

condition. And there's nothing I'm aware of that would lead us to

anticipate an increased incidence of food intolerances among

rosaceans.

Marjorie

Marjorie Lazoff, MD