Histamine intolerance: lack of reproducibility of single symptoms by oral provocation with histamine: A randomised, double-blind, placebo-controlled cross-over study

Komericki, Peter; Klein, Georg; Reider, Norbert; Hawranek, Thomas; Strimitzer, Tanja; Lang, Roland; Kranzelbinder, Bettina; Aberer, Werner

doi:10.1007/s00508-010-1506-y

Cited by 58 publications

(45 citation statements)

References 16 publications

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“…12,27 Second, the severity of symptoms was not assessed by a severity standard, as recommended by Komericki et al by lack of reproducibility of single symptoms following oral provocation with histamine in a randomized, DBPC experimental setting. 28 Taken together, our results suggest that histamine intolerance should be considered in patients visiting allergy clinics. Serum DAO activity measurements and DAO supplementation represent important tools to consolidate the diagnosis, reduce the level of uncertainty of this condition, and provide a causal treatment for the patients' symptoms and signs.…”

Section: Discussionsupporting

confidence: 52%

Serum diamine oxidase activity in patients with histamine intolerance

Manzotti

Breda²,

Gioacchino

et al. 2015

Int J Immunopathol Pharmacol

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Introduction: Intolerance to various foods, excluding bona fide coeliac disease and lactose intolerance, represents a growing cause of patient visits to allergy clinics.Histamine intolerance is a long-known, multifaceted clinical condition triggered by histamine-rich foods and alcohol and/or by drugs that liberate histamine or block diamine oxidase (DAO), the main enzyme involved in the metabolism of ingested histamine. Histamine limitation diets impose complex, non-standardized restrictions that may severely impact the quality of life of patients. Methods: We retrospectively evaluated 14 patients who visited allergy outpatient facilities in northern Italy with a negative diagnosis for IgE-mediated food hypersensitivity, coeliac disease, conditions related to gastric hypersecretion, and systemic nickel hypersensitivity, and who previously underwent a histamine limitation diet with benefits for their main symptoms. Serum diamine oxidase levels and the clinical response to diamine oxidase supplementation were investigated. Results: We found that 10 out of 14 patients had serum DAO activity <10 U/mL, which was the threshold suggested as a cutoff for probable histamine intolerance. Moreover, 13 out of 14 patients subjectively reported a benefit in at least one of the disturbances related to food intolerances following diamine oxidase supplementation. The mean value (± SD) of diamine oxidase activity in the cohort of patients with histamine intolerance symptoms was 7.04 ± 6.90 U/mL compared to 39.50 ± 18.16 U/mL in 34 healthy controls (P = 0.0031). Conclusion:In patients with symptoms triggered by histamine-rich food, measuring the serum diamine oxidase activity can help identify subjects who can benefit from a histamine limitation diet and/or diamine oxidase supplementation.Properly designed, controlled studies investigating histamine intolerance that include histamine provocation are indispensable for providing insights into the area of food intolerances, which are currently primarily managed with nonscientific approaches in Italy.

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Section: Discussionsupporting

confidence: 52%

Serum diamine oxidase activity in patients with histamine intolerance

Manzotti

Breda²,

Gioacchino

et al. 2015

Int J Immunopathol Pharmacol

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“…It has been published that even in patients with overt histamine intolerance oral provocation was positive in only 50% of those tested [14]. Very recently a multicenter study on the nonreliability of blinded oral histamine provocation to confirm histamine intolerance has been published [16]. Obviously oral histamine provocation test thus cannot be considered a gold standard in HIT.…”

Section: Discussionmentioning

confidence: 99%

Histamine 50-Skin-Prick Test: A Tool to Diagnose Histamine Intolerance

Kofler¹,

Ulmer

Kofler³

2011

ISRN Allergy

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Background. Histamine intolerance results from an imbalance between histamine intake and degradation. In healthy persons, dietary histamine can be sufficiently metabolized by amine oxidases, whereas persons with low amine oxidase activity are at risk of histamine toxicity. Diamine oxidase (DAO) is the key enzyme in degradation. Histamine elicits a wide range of effects. Histamine intolerance displays symptoms, such as rhinitis, headache, gastrointestinal symptoms, palpitations, urticaria and pruritus. Objective. Diagnosis of histamine intolerance until now is based on case history; neither a validated questionnaire nor a routine test is available. It was the aim of this trial to evaluate the usefullness of a prick-test for the diagnosis of histamine intolerance. Methods. Prick-testing with 1% histamine solution and wheal size-measurement to assess the relation between the wheal in prick-test, read after 20 to 50 minutes, as sign of slowed histamine degradation as well as history and symptoms of histamine intolerance. Results. Besides a pretest with 17 patients with HIT we investigated 156 persons (81 with HIT, 75 controls): 64 out of 81 with histamine intolerance(HIT), but only 14 out of 75 persons from the control-group presented with a histamine wheal ≥3 mm after 50 minutes (P < .0001). Conclusion and Clinical Relevance. Histamine-50 skin-prickt-test offers a simple tool with relevance.

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“…The so-called histamine intolerance is more likely a “complex of symptoms that can be attributed to histamine only in individual cases” than an isolated clinical picture exclusively triggered by ingested histamine [27]. That would explain why it is often not possible to reproduce symptoms following small quantities of histamine in the patient history [27, 28]. It is possible that symptoms only appear in the presence of concomitant factors (see above).…”

Section: Diagnostic Work-up For Adverse Reactions To Ingested Histaminementioning

confidence: 99%

“…In this context, an alteration in small intestinal permeability as a prerequisite of symptom onset may be of relevance. However, the study conducted by Komericki and coworkers [27, 28] raises the question of whether symptoms can be affected by orally administered histamine at all. The intake of the histamine-degrading enzyme DAO was described to reduce symptoms irrespective of whether or not histamine was administered [28].…”

Section: Diagnostic Work-up For Adverse Reactions To Ingested Histaminementioning

confidence: 99%

German guideline for the management of adverse reactions to ingested histamine

Reese¹,

Ballmer‐Weber

Beyer

et al. 2017

Allergo J Int

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Adverse food reactions are far more often perceived than objectively verified. In our scientific knowledge on non-allergic adverse reactions including the so called histamine intolerance, there are large deficits. Due to the fact that this disorder is increasingly discussed in the media and the internet, more and more people suspect it to be the trigger of their symptoms. The scientific evidence to support the postulated link between ingestion of histamine and adverse reactions is limited, and a reliable laboratory test for objective diagnosis is lacking. This position paper by the “Food Allergy” Working Group of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Association of Allergologists (AeDA), the Society for Pediatric Allergology and Environmental Medicine (GPA), and the Swiss Society for Allergology and Immunology (SGAI) reviews the data on the clinical picture of adverse reactions to ingested histamine, summarizes important aspects and their consequences, and proposes a practical diagnostic and therapeutic approach.

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Histamine intolerance: lack of reproducibility of single symptoms by oral provocation with histamine: A randomised, double-blind, placebo-controlled cross-over study

Cited by 58 publications

References 16 publications

Serum diamine oxidase activity in patients with histamine intolerance

Serum diamine oxidase activity in patients with histamine intolerance

Histamine 50-Skin-Prick Test: A Tool to Diagnose Histamine Intolerance

German guideline for the management of adverse reactions to ingested histamine

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