Excretion of urinary histamine and N-tele methylhistamine in patients with gastrointestinal food allergy compared to non-allergic controls during an unrestricted diet and a hypoallergenic diet

Abstract

BackgroundPatients with gastrointestinal food allergy are characterised by increased production of mast cell derived mediators upon allergen contact and present often with unspecific symptoms. The aim of this study was to evaluate urinary histamine and methylhistamine excretion in patients with food allergy and to compare their values with food-tolerant controls.MethodsIn a retrospective case control study the urinary excretion parameters were analysed from 56 patients (40.9, 19 – 58 years) in whom later food challenge tests confirmed food allergy. During their diagnostic work-up urine was collected during a 12-h period under an unrestricted diet with staple foods and a hypoallergenic potato-rice-diet (each 2 days). Healthy controls underwent the same diet types to define normal excretion parameters. Urinary histamine and n-methylhistamine were determined by ELISA or tandem mass spectrometry, respectively, and were expressed as median (25 – 75% range, μg/mmol creatinine x m2BSA).ResultsDuring unrestricted diet urinary histamine was significantly higher in gastrointestinal food allergy than healthy controls (1.42, 0.9 – 2.7 vs 0.87, 0.4 – 1.3; p < 0.0001), while the difference between both groups became marginal during potato-rice diet (1.30, 0.7 – 2.1 vs 1.05, 0.5 – 1.5; p = 0.02).N-methylhistamine was found to be significantly elevated in gastrointestinal food allergy both during unrestricted diet (7.1, 5.0 – 11.2) and potato-rice diet (5.7, 3.7 – 8.7) compared to controls (p < 0.0001). Interestingly, urinary methylhistamine excretion (p < 0.004) and clinical symptom score (p < 0.02) fell significantly when the diet was switched from unrestricted to hypoallergenic food, but was not correlated with symptom scores.ConclusionsIn gastrointestinal food allergy significantly higher levels of urine histamine and methylhistamine excretion were found under unrestricted diet, reflecting an increased secretion of histamine due to offending foods. Measurement of urinary n-methylhistamine levels may help to find out patients with increased histamine production and/or food-allergen induced clinical symptoms, respectively.

Mechanistic insights into the attenuation of intestinal inflammation and modulation of the gut microbiome by krill oil using in vitro and in vivo models

“…Moreover, a significant correlation of Nmethylhistamine excretion with clinical disease activity is established [41]. Significantly higher levels of urine histamine and methylhistamine have been detected in people with gastrointestinal food allergy under unrestricted diets [42]. Further, histamine drives severity of innate inflammation via H4R in experimental colitis models.…”

Gastrointestinally mediated food allergy causing Spondyloarthritis-like disease

“…abdominal pain and loose or soft stools. The modifi ed symptom score for GMA showed 9 and 15 points [2,10], while during allergen-free diet containing rice, turkey or fi sh scores were normal.…”

“…Before performing ileo-colonoscopy for local IgE detection from lavage fl uid, further evidence for ongoing intestinal allergic reaction was obtained from elevated urinary methylhistamine excretion. During an unrestricted diet with ingestion of all staple foods Urinary Methylhistamine (UM) levels were clearly elevated (9.2μg/mmol creatinine×m 2 body surface area (BSA); normal <6.5), while during an oligoantigenic elimination diet (2 days) with potato, rice and water UM decreased to 6.2μg/ mmol creatinine×m 2 BSA [3,10].…”

Idiopathic Mast Cell Activation Syndrome With Associated Salicylate Intolerance

“…<8.1 pg/mL) as well as significantly enhanced excretion of methylhistamine (17.8 µg/mmol crea/m 2 BSA; ref. value <6.5 µg/mmol crea/m 2 BSA) in a 24 h urine sample indicating a state of high endogenous histamine production ( 1 ). The endoscopic evaluation macroscopically showed nodular hyperplastic spots particularly in the gastric antrum and terminal ileum (Figure 1 ).…”