However, consumption of MSG in high concentration without solid food (as in soups) was found to be associated with higher incidence of headache and other symptoms. A systematic review by Obayashi and Nagamura evaluating causal relationship between MSG and headache was inconclusive and suggested the need of more blinded studies. The delay of uvular swelling for > 8 h such as in our patient can be explained by the time taken for the synthesis and release of hormonal factors from the hypothalamic-pituitary region. The exact etiology of the “Chinese restaurant syndrome” is not known but, animal studies have shown neurotoxic and neuroexcitatory properties of MSG in the hypothalamic region of the central nervous system. This syndrome was first described by Kwok in 1968.
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Even free glutamate that exists in tomatoes, mushrooms, and parmesan Chinese is responsible for Chinese restaurant syndrome. Large amount of MSG is used in Japanese, Chinese, and South Asian food preparation. Precipitation of severe bronchial asthma following MSG intake has been reported in two patients.
It is prepared by fermentation of carbohydrate sources, such as sugar beet molasses by acid hydrolysis, by the action of micrococcus glutamicus on a carbohydrate and subsequent partial neutralization, or by hydrolysis of vegetative proteins. MSG is monosodium salt of L-glutamic acid. Many deaths can be avoided with timely diagnosis and treatment. Angioedema of the uvula after ingestion of MSG can be fatal unless patients and physicians are aware of unusual reaction to MSG. In addition to MSG, many other food additives, including preservatives such as meta-bisulfate, soya sauce, coloring agents, such as, carmoisine, sunset yellow, tartrazine, scombroidosis, and seafood may stimulate allergic reactions. In a graded challenge, MSG alone produced angioedema, 16 h after ingestion, as reported from Australia. Ĭhinese food contains MSG as the main additive ingredient and flavor enhancer. 2 days from admission, the uvula and surrounding structures including the palate returned to normal and he could swallow solids. On the following day, there was a gradual reduction in the size of the uvula and surrounding inflammation. At 16 h after the initiation of treatment, he started normal oral communication and was able to swallow liquid. On account of raised leukocyte count with neutrophilia, the patient was treated with oral Amoxycillin with clavulinate. His throat looked angry around the uvula and surrounding. The patient no longer had drooling of saliva and was able to speak a few words. The swelling of the uvula and surroundings gradually regressed. There was no improvement over half an hour, so 0.30 mg of adrenaline was administered as a deep intramuscular injection over the lateral side of the thigh. The patient was admitted and given intravenous crystalline solution of 40mg methyl prednisolone and was monitored continuously for oxygen saturation. The hemoglobin was 14 mg/dl, white cell count 13,000 per cu mm (normal 5000–10,000), eosinophils 1% (normal 1–9), neutrophils 90.9%, random blood sugar 135 mg/dl (normal 70–140), and serum IgE 917.021 IU/ml (normal 3–188). There was no history of allergy or bronchial asthma. He communicated with his family with hand gestures regarding his inability to speak and swallow. Two hours earlier he had woken up due to difficulty in swallowing and speaking out a few words. Within an hour of eating, he had giddiness, sweating, and itching all over the body which subsided without any medication.
The patient said that he ate only Chinese triple fried rice for dinner the previous night 10 hours earlier. His extremities were warm, the electrocardiograph was within normal limits, and SpO 2 was 98% on ambient air. His blood pressure was 120/80 mmHg pulse was 88 beats/min and regular. He was weighing 80 kg, conscious cooperative and well oriented. On arrival, swelling of the uvula and surrounding tissues, almost closing the entry to the pharynx, touching the base of floor of the mouth.
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