China spice syndrome T78.1

Intolerance reaction after ingestion of food to which L-monosodium glutamate (MSG) has been added as a flavour enhancer.

It is suspected that exogenously supplied as well as endogenously produced glutamate (threshold dose of 1.5-3 g) leads to a stimulation of nitrate synthesis with consecutive stimulation of the so-called "nitric oxide (NO)-mediated eurotransmission pathway" and causes the described sensations in sensitive individuals. Sensitivity to MSG may be genetically determined.

Burning, tingling, feeling of stiffness, heat, pressure and tightness, flushing in the face, neck, upper thorax, shoulders and upper arms 15-25 minutes after consumption of MSG-containing foods, mostly (but not exclusively) of Chinese cuisine dishes. Duration of symptoms 2-3 hours, spontaneously reversible. Inconstant symptoms are headache, sweating, nausea and vomiting.

In case of atopic disposition provocation of bronchial asthma, possibly life-threatening asthma attacks, which can occur up to 12 hours later.

1. Geha RS et al (2000) Review of alleged reaction to monosodium glutamate and outcome of a multicenter double-blind placebo-controlled study. J Nutr 130(4S Suppl): 1058S-1062S
2. Ho Man Kwok R (1968) Chinese restaurant syndrome. N Engl J Med 278: 796
3. Kenney RA (1986) The Chinese restaurant syndrome. An anecdote reviseted. Fd Chem Toxic 24: 351-354
4. Rutten EP et al (2003) The effect of a glutamate load on symptoms of the Chinese restaurant syndrome. Clin Nutr 22: S27