Fat, Sick and Nearly Dead is a 2010 documentary which follows the journey of Australian Joe Cross (http://www.fatsickandnearlydead.com). Joe traveled the country during a 60 day juice fast. Nothing but liquid nutrition. His purpose; cure disease, reduce dependence on medications and lose weight. Joe has chronic hives (urticaria). He relies on multiple medications, including oral steroids, to control symptoms. Throughout the trip he undergoes a miraculous transformation. The number of pills and pounds continue to drop. Should everyone expect these results? Probably not. A documentary film is not sound medical evidence. In this film, there is only one subject. There is no comparison group. Most importantly, hives frequently come and go on their own without reason. A German study published in 2010 investigated diet manipulation for the treatment of chronic hives. Patients eliminated all processed foods, artificial substances, food additives, dyes, antibiotics, preservatives, phenols and natural foods rich in aromatic compounds such as tomatoes. What is most interesting, patients avoided the majority of Joe’s diet – NO fruit. The results were mixed; 34% benefited from the diet and 24% deteriorated while on the diet. Responders took on average 3 or more weeks to respond. These doctors believe that artificial preservatives and dyes in modern processed foods (and aromatic compounds in some natural foods) act as pseudoallergens, substances causing allergy symptoms via non-allergic mechanisms. These foods trigger the release of histamine and subsequent hives without an allergic immune response. This suggests another possible link, those foods with high levels of histamine (http://chronichives.com/useful-information/histamine-restricted-diet). An Italian group put patients on an oligo-antigenic and histamine-free diet for 21 days. They excluded foods with artificial coloring (esp. tartrazine), fermented foods, benzoates, Butylated hydroxyanisole (BHA) and butylated hydoxytoluene (BHT). Patients in this study had a significant improvement in symptoms. However, there were only 10 patients. Additionally, patients in a similar study out of Canada showed less substantial improvement. Other foods under investigation for chronic urticaria include; MSG, parabens and aspartame. Alcohol and spices both can cause vasodilation (widening of the blood vessels) and hives in patients with chronic urticaria. Unfortunately, hives continue to occur after elimination. Overall, there is little scientific evidence to support elimination diets for the treatment of hives. We do not routinely advise patients to adopt a pseudoallergen free diet. However, there are patients who do not respond well to medications, who require multiple medications or are experiencing significant side effects. For this group, there is little risk in trying an elimination diet. Patients should be motivated. Patients should eliminate a large group of foods; although foods can be added one at a time (after hives have resolved), it is unlikely to help if they are removed one at a time. Most important, prolonged diet changes require the supervision of a doctor or nutritionist.