Histamine Intolerance Originates in the Gut

Abstract

Histamine intolerance (HIT) is assumed to be due to a deficiency of the gastrointestinal (GI) enzyme diamine oxidase (DAO) and, therefore, the food component histamine not being degraded and/or absorbed properly within the GI tract. Involvement of the GI mucosa in various disorders and diseases, several with unknown origin, and the effects of some medications seem to reduce gastrointestinal DAO activity. HIT causes variable, functional, nonspecific, non-allergic GI and extra-intestinal complaints. Usually, evaluation for HIT is not included in differential diagnoses of patients with unexplained, functional GI complaints or in the here-listed disorders and diseases. The clinical diagnosis of HIT is challenging, and the thorough anamnesis of all HIT-linked complaints, using a standardized questionnaire, is the mainstay of HIT diagnosis. So far, DAO values in serum have not been established to correlate with DAO activity in the gut, but the diagnosis of HIT may be supported with determination of a low serum DAO value. A targeted dietary intervention, consisting of a histamine-reduced diet and/or supplementation with oral DAO capsules, is helpful to reduce HIT-related symptoms. This manuscript will present why histamine should also be taken into account in the differential diagnoses of patients with various diseases and disorders of unknown origin, but with association to functional gastrointestinal complaints. In this review, we discuss currently increasing evidence that HIT is primarily a gastrointestinal disorder and that it originates in the gut.

The Missing Link: A Case of Severe Adverse Reaction to Histamine in Food and Beverages

“…Freshness, preparation, and storage all affect an ARH. Certain food additives, beverages, drugs, and other biogenic amines can also cause problems [ 14 ]. Careful surveillance was indispensable [ 15 ].…”

Role of the nuclear receptor subfamily 4a in mast cells in the development of irritable bowel syndrome

“…In this sense, MCs play an important role in the activation of enteric neurons in the gut and maintain the hyperexcitability of nociceptors in the development of IBS. In addition, more recently, a role of MCs has also been hypothesized in relation to IBS-like disorders, such as gluten sensitivity and adverse reaction to foods with a high nickel content [24] , [25] .…”

Guideline on management of suspected adverse reactions to ingested histamine - Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Medical Association

“…For a long time, the condition was postulated to affect only adults and, in particular, patients with chronic spontaneous urticaria and other skin symptoms [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Lately, gastrointestinal symptoms have been increasingly observed [ 10 , 11 , 12 ], and also reports of affected children are available [ 13 , 14 ]. Merely the suspicion of histamine intolerance often leads to extensive dietary restrictions that affect not only diversity of diet but also social life.…”