Circadian profiling reveals higher histamine plasma levels and lower diamine oxidase serum activities in 24% of patients with suspected histamine intolerance compared to food allergy and controls

T C Pinzer, E Tietz, E Waldmann, M Schink, M F Neurath, Y Zopf, T C Pinzer, E Tietz, E Waldmann, M Schink, M F Neurath, Y Zopf

Abstract

Background: Histamine intolerance is thought to trigger manifold clinical symptoms after ingesting histamine-rich food due to reduced activity of diamine oxidase (DAO). No study has hitherto systematically assessed daily fluctuations of histamine levels and DAO activities in symptomatic patients. The aim of the study was to investigate the presence of histamine intolerance, to therefore establish day profiles of histamine levels and DAO activities, and to compare the results between patients with suspected histamine intolerance, food allergy and healthy controls.

Methods: We determined day profiles of histamine plasma levels and DAO serum activities in 33 patients with suspected histamine intolerance, in 21 patients with proven food allergy and in 10 healthy control patients. Clinical symptoms, food intolerances and further clinical and laboratory chemical parameters were evaluated.

Results: Twenty-four percent (8 of 33) suspected histamine-intolerant patients showed elevated histamine levels during the day. That might be caused by constantly and significantly reduced DAO activities in these patients compared to food-allergic and control patients. The remaining 25 patients presented normal histamine levels and DAO activities, but an increased prevalence of multiple food intolerances compared to the other subgroup of suspected histamine-intolerants. There was no correlation between subjective complaints and serological histamine parameters in patients with suspected histamine intolerance.

Conclusions: We determined by daily profiling that decreased DAO activities correlated with elevated histamine levels in a subgroup of suspected histamine-intolerants. This finding discriminates these patients from food intolerant individuals with similar clinical symptoms and strongly suggests the presence of histamine intolerance.

Trial registration: ClinicalTrials.gov NCT02293343.

Keywords: day profile; diamine oxidase activities; food allergy; histamine intolerance; histamine levels.

© 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Figures

Figure 1
Figure 1
Day profiles of histamine plasma levels and diamine oxidase serum activities. For both histamine plasma levels and DAO serum activities, mean values, 95% confidence intervals and reference levels to be regarded as healthy (maximum histamine level: 0.35 ng/mL/m² BSA; minimum DAO activity: 5.73 U/mL/m² BSA) are illustrated. A, Histamine‐intolerant patients, B, food‐hypersensitive patients, C, food‐allergic patients and D, healthy control patients. DAO, diamine oxidase; BSA, body surface area; 95% CI, 95% confidence intervals [Color figure can be viewed at http://www.afsjournals.org/.]
Figure 2
Figure 2
Comparison of histamine plasma levels and diamine oxidase serum activities. P‐values of Wilcoxon signed‐rank test for (A) histamine plasma levels: n.s., and (B) diamine oxidase serum activities: histamine‐intolerant patients – food‐hypersensitive patients: P = .002; histamine‐intolerant patients – food‐allergic patients: P < .001; histamine‐intolerant patients – healthy control patients: P < .001. DAO, diamine oxidase; BSA, body surface area [Color figure can be viewed at http://www.afsjournals.org/.]
Figure 3
Figure 3
Prevalence of food intolerances. Relative frequencies of single and multiple food intolerances against fructose, lactose and sorbitol are shown
Figure 4
Figure 4
Subtype distribution of irritable bowel syndrome based on the Rome III criteria. Proportions of patients are displayed. A, histamine‐intolerant patients, B, food‐hypersensitive patients and C, food‐allergic patients. IBS, irritable bowel syndrome [Color figure can be viewed at http://www.afsjournals.org/.]

References

    1. Skypala I, Vlieg‐Boerstra B. Food intolerance and allergy: increased incidence or contemporary inadequate diets? Curr Opin Clin Nutr Metab Care. 2014;17:442‐447.
    1. Bohn L, Storsrud S, Tornblom H, Bengtsson U, Simren M. Self‐reported food‐related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108:634‐641.
    1. Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy. 2010;65:933‐945.
    1. Zopf Y, Baenkler HW, Silbermann A, Hahn EG, Raithel M. The differential diagnosis of food intolerance. Dtsch Arztebl Int. 2009;106:359‐369.
    1. Kanny G, Moneret‐Vautrin DA, Flabbee J, Beaudouin E, Morisset M, Thevenin F. Population study of food allergy in France. J Allergy Clin Immunol. 2001;108:133‐140.
    1. Langen U, Schmitz R, Steppuhn H. Prevalence of allergic diseases in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:698‐706.
    1. Litschauer‐Poursadrollah M, El‐Sayad S, Wantke F, Fellinger C, Jarisch R. Abdominal spasms, meteorism, diarrhea: fructose intolerance, lactose intolerance or IBS? Wien Med Wochenschr. 2012;162:506‐512.
    1. Jarisch R, Götz M, Hemmer W, Missbichler A, Raithel M, Wantke F. Histamin‐Intoleranz. Histamin und Seekrankheit. (Histamine Intolerance. Histamine and Motion Sickness.). 2 ed Stuttgart, NY: Georg Thieme Verlag; 2004. (in German)
    1. Bieganski T. Biochemical, physiological and pathophysiological aspects of intestinal diamine oxidase. Acta Physiol Pol. 1983;34:139‐154.
    1. Music E, Korosec P, Silar M, Adamic K, Kosnik M, Rijavec M. Serum diamine oxidase activity as a diagnostic test for histamine intolerance. Wien Klin Wochenschr. 2013;125:239‐243.
    1. Sattler J, Lorenz W, Kubo K, Schmal A, Sauer S, Luben L. Food‐induced histaminosis under diamine oxidase (DAO) blockade in pigs: further evidence of the key role of elevated plasma histamine levels as demonstrated by successful prophylaxis with antihistamines. Agents Actions. 1989;27:212‐214.
    1. Sattler J, Hafner D, Klotter HJ, Lorenz W, Wagner PK. Food‐induced histaminosis as an epidemiological problem: plasma histamine elevation and haemodynamic alterations after oral histamine administration and blockade of diamine oxidase (DAO). Agents Actions. 1988;23:361‐365.
    1. Wantke F, Gotz M, Jarisch R. The red wine provocation test: intolerance to histamine as a model for food intolerance. Allergy Proc. 1994;15:27‐32.
    1. Wantke F, Hemmer W, Haglmuller T, Gotz M, Jarisch R. Histamine in wine. Bronchoconstriction after a double‐blind placebo‐controlled red wine provocation test. Int Arch Allergy Immunol. 1996;110:397‐400.
    1. Rosell‐Camps A, Zibetti S, Perez‐Esteban G, Vila‐Vidal M, Ferres‐Ramis L, Garcia‐Teresa‐Garcia E. Histamine intolerance as a cause of chronic digestive complaints in pediatric patients. Rev Esp Enferm Dig. 2013;105:201‐206.
    1. Wohrl S, Hemmer W, Focke M, Rappersberger K, Jarisch R. Histamine intolerance‐like symptoms in healthy volunteers after oral provocation with liquid histamine. Allergy Asthma Proc. 2004;25:305‐311.
    1. Lessof MH, Gant V, Hinuma K, Murphy GM, Dowling RH. Recurrent urticaria and reduced diamine oxidase activity. Clin Exp Allergy. 1990;20:373‐376.
    1. Sampson HA, Jolie PL. Increased plasma histamine concentrations after food challenges in children with atopic dermatitis. N Engl J Med. 1984;311:372‐376.
    1. Curtis MJ, Pugsley MK, Walker MJ. Endogenous chemical mediators of ventricular arrhythmias in ischaemic heart disease. Cardiovasc Res. 1993;27:703‐719.
    1. Reese I, Ballmer‐Weber B, Beyer K, Fuchs T, Kleine‐Tebbe J, Klimek L, et al. German guideline for the management of adverse reactions to ingested histamine: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Association of Allergologists (AeDA), and the Swiss Society for Allergology and Immunology (SGAI). Allergo J Int. 2017;26:72‐79.
    1. Wantke F, Proud D, Siekierski E, Kagey‐Sobotka A. Daily variations of serum diamine oxidase and the influence of H1 and H2 blockers: a critical approach to routine diamine oxidase assessment. Inflamm Res. 1998;47:396‐400.
    1. Maintz L, Benfadal S, Allam JP, Hagemann T, Fimmers R, Novak N. Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema. J Allergy Clin Immunol. 2006;117:1106‐1112.
    1. Wantke F, Gotz M, Jarisch R. Histamine‐free diet: treatment of choice for histamine‐induced food intolerance and supporting treatment for chronic headaches. Clin Exp Allergy. 1993;23:982‐985.
    1. Komericki P, Klein G, Reider N, Hawranek T, Strimitzer T, Lang R, et al. Histamine intolerance: lack of reproducibility of single symptoms by oral provocation with histamine: a randomised, double‐blind, placebo‐controlled cross‐over study. Wien Klin Wochenschr. 2011;123:15‐20.
    1. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377‐1390.
    1. Drossman DA. Rome III: the new criteria. Chin J Dig Dis. 2006;7:181‐185.
    1. R Core Team . R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2016. Available at: .
    1. Manzotti G, Breda D, Di Gioacchino M, Burastero SE. Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol. 2015;29:105‐111.
    1. Giera B, Straube S, Konturek P, Hahn EG, Raithel M. Plasma histamine levels and symptoms in double blind placebo controlled histamine provocation. Inflamm Res. 2008;57(suppl 1):S73‐S74.
    1. Kleine‐Tebbe J, Wassmann‐Otto A, Monnikes H. Food Allergy and Intolerance: Distinction, Definitions and Delimitation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59:705‐722.
    1. Boeckxstaens G. Mast cells and inflammatory bowel disease. Curr Opin Pharmacol. 2015;25:45‐49.
    1. Enko D, Meinitzer A, Mangge H, Kriegshauser G, Halwachs‐Baumann G, Reininghaus EZ, et al. Concomitant Prevalence of Low Serum Diamine Oxidase Activity and Carbohydrate Malabsorption. Can J Gastroenterol Hepatol. 2016;2016:4893501.
    1. Gibson PR, Shepherd SJ. Evidence‐based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25:252‐258.
    1. Gibson PR, Shepherd SJ. Personal view: food for thought–western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Aliment Pharmacol Ther. 2005;21:1399‐1409.
    1. Adeyemo MA, Spiegel BM, Chang L. Meta‐analysis: do irritable bowel syndrome symptoms vary between men and women? Aliment Pharmacol Ther. 2010;32:738‐755.
    1. Pardanani A. Systemic mastocytosis in adults: 2017 update on diagnosis, risk stratification and management. Am J Hematol. 2016;91:1146‐1159.
    1. Deutsche Gesellschaft für Ernährung (DGE), Österreichische Gesellschaft für Ernährung (ÖGE), Schweizerische Gesellschaft für Ernährung (SGE) . Referenzwerte für die Nährstoffzufuhr. 2. Auflage, 2. aktualisierte Ausgabe. Bonn; (2016). . Accessed February 5, 2017.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅