chinese food and soups contain monosodium glutamate ( msg ) as the main addictive ingredient . a sensitive
individual may suffer from headache , giddiness , sweating , abdominal pain , and urticaria within a few hours of consumption of msg .
angioedema may be delayed up to 816 h after the consumption of msg and it may persist for 24 h. this delayed life - threatening effect in the form of angioedema makes diagnosis difficult .
a 23-year - old male was brought to the general hospital at mahad , with complaints of difficulty in speaking , inability to swallow saliva , and continuous spitting .
he strongly rejected taking sips of water and was afraid of water like a hydrophobic patient .
the posterior pharynx could not be visualized , even after repeated attempts with depression of the tongue with a spatula .
the uvula was touching the base of the tongue [ figure 1 ] . on arrival , swelling of the uvula and surrounding tissues , almost closing the entry to the pharynx , touching the base of floor of the mouth .
his blood pressure was 120/80 mmhg ; pulse was 88 beats / min and regular .
his extremities were warm , the electrocardiograph was within normal limits , and spo2 was 98% on ambient air .
the patient said that he ate only chinese triple fried rice for dinner the previous night 10 hours earlier . within an hour of eating , he had giddiness , sweating , and itching all over the body which subsided without any medication .
two hours earlier he had woken up due to difficulty in swallowing and speaking out a few words .
he communicated with his family with hand gestures regarding his inability to speak and swallow .
the hemoglobin was 14 mg / dl , white cell count 13,000 per cu mm ( normal 500010,000 ) , eosinophils 1% ( normal 19 ) , neutrophils 90.9% , random blood sugar 135 mg / dl ( normal 70140 ) , and serum ige 917.021 iu / ml ( normal 3188 ) .
the patient was admitted and given intravenous crystalline solution of 40 mg methyl prednisolone and was monitored continuously for oxygen saturation .
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 no longer had drooling of saliva and was able to speak a few words .
his throat looked angry around the uvula and surrounding . on account of raised leukocyte count with neutrophilia ,
the patient was treated with oral amoxycillin with clavulinate . at 16 h after the initiation of treatment , he started normal oral communication and was able to swallow liquid . on the following day
, there was a gradual reduction in the size of the uvula and surrounding inflammation .
2 days from admission , the uvula and surrounding structures including the palate returned to normal and he could swallow solids [ figure 2 ] .
chinese food contains msg as the main additive ingredient and flavor enhancer . in a graded challenge ,
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 .
angioedema of the uvula after ingestion of msg can be fatal unless patients and physicians are aware of unusual reaction to msg .
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 .
large amount of msg is used in japanese , chinese , and south asian food preparation .
even free glutamate that exists in tomatoes , mushrooms , and parmesan chinese is responsible for chinese restaurant syndrome .
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 . 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 .
a systematic review by obayashi and nagamura evaluating causal relationship between msg and headache was inconclusive and suggested the need of more blinded studies .
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 .
severe reaction to msg , a common active ingredient in chinese cooking may result in fatal outcome if not treated in time . delayed occurrence of serious symptoms are to be expected .
 in india , eating chinese food has become very popular . 
 we hereby report a case who presented with angioneurotic edema of the uvula and the surrounding structures , after eating chinese food , which resulted in severe difficulty in swallowing saliva and inability to speak . 
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