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Multiple food allergen sensitisation and chronic spontaneous urticaria: case report A 39-year-old woman developed multiple food allergen sensitisations and chronic spontaneous urticaria (CSU) during treatment with dimethyl fumarate for multiple sclerosis (MS). The woman, who had a history of allergic rhinitis and atopic dermatitis, was diagnosed with MS at the age of 17 years. From the age of 31–38 years, she had received interferon-β without clinical relapses. In August 2018, she became pregnant, and therefore, her interferon-β was discontinued. One month after her delivery, she decided to stop breast-feeding after consultation with her neurologist, and thereafter, she started receiving oral dimethyl fumarate for multiple sclerosis [dosage not stated]. She experienced recurrent episodes of urticaria occurring prevalently after the meal, during the first 6 weeks of dimethyl fumarate treatment without identifying a specific culprit food. She never reported food allergy previously. She had allergic episodes without link with histaminerich foods. Her first episode of urticaria occurred two weeks after initiation of dimethyl fumarate treatment. Her blood work showed elevated level of IgE with 973 KUA/L and a marked eosinophilia 1600/µL. The woman’s allergic episodes were treated with unspecified antihistaminic drugs and unspecified steroids for 2 weeks. One day after treatment withdrawal, she had a multifocal giant urticaria, indicating a differential diagnosis of food allergy, drug allergy, or in alternative acute episodes of spontaneous urticaria/angioedema. Following an in vitro immunoassay, high levels of specific food serum-specific IgE-antibodies (sIgE) were found against wheat, albumen, milk, tomato, while low positivity emerged for apple, soy, peanuts, corn, and nuts. She was negative for multiple parasitic stool examination. She received a hypoallergenic diet excluding eggs and milk together. Simultaneously, she started receiving cetirizine and prednisone. Treatment with prednisone was progressively tapered until discontinuation in 2 weeks. Her dimethyl fumarate therapy was then stopped. Despite the restrictions and the ongoing treatment, she experienced two more urticarial episodes, requiring an adjustment of anti-allergic therapy. Based on the clinical picture, a diagnosis of CSU and transient food allergen sensitisation were made. She did not develop any other allergic reaction during the following weeks. Her sIgE decreased after one month, indicating a possible regulatory mechanism over time. The allergic reactions had no strict temporal correlation with dimethyl fumarate as two of the urticaria episodes developed after discontinuation of dimethyl fumarate. The woman’s dimethyl fumarate was restarted, and the dose of dimethyl fumarate was progressively increased to 240mg twice per day without any exacerbation of urticarial episodes. Avoided foods were progressively reintroduced. The unspecified antihistaminic drugs were stopped 6 months later. In the next 9 months, no recurrence of CSU was reported. G