Histamine intolerance

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Classification according to ICD-10
T78.1 Other food intolerance, not elsewhere classified
ICD-10 online (WHO version 2019)

Under a histamine intolerance ( Histaminosis ) refers to the incompatibility of histamine , which is taken with food. The cause of the intolerance is a deficiency of the histamine-degrading enzymes diamine oxidase (DAO) and / or histamine-N-methyltransferase (HNMT) or a disproportion between supply and degradation of histamine. This theory was developed in the 1980s as part of research into biogenic amines . According to some authors, histamine intolerance is not congenital, but an acquired disease that affects almost 1% of the European population. 80% of the sick patients are middle-aged women. The symptoms of the disease may go away during pregnancy, but reappear after pregnancy.

Controlled individual studies and a comprehensive meta-analysis from 2003 have so far not been able to find any scientific evidence for the postulated food intolerance due to biogenic amines such as histamine.

If histamine intolerance exists, it is assumed that it occurs neither as an allergy nor as a non-immunological food intolerance , but as a breakdown disorder. It could possibly be the result or companion of other intolerances or allergies.

Symptoms

Possible symptoms after eating food rich in histamine are:

Pathomechanism

Histamine is broken down extracellularly in the body by the enzyme diamine oxidase (DAO) and intracellularly by histamine N-methyltransferase (HNMT) and aldehyde oxidases (AOX1). In the case of histamine intolerance, the activity of the DAO is said to be restricted, and histamine that is absorbed through food and formed in the body can only be partially broken down. When eating food containing histamine (e.g. red wine or hard cheese), the body experiences a pseudo-allergic reaction . How histamine passes through the intestinal wall during absorption and enters the blood without coming into contact with the aldehyde oxidases and histamine N-methyltransferases expressed in intestinal cells has not been clarified. The explanatory approach of insufficient intercellular tight junctions cannot be maintained due to the maintained osmosis gradient between the chyme and blood serum. Active or passive exposure to tobacco smoke is suspected to promote histamine intolerance, but has not yet been adequately investigated.

Potentially intolerable foods

Various hard cheeses

Histamine is produced in foods fermented with bacteria or fungi, such as:

  • smoked meat , salami , ham , offal, pork
  • many fish products, especially canned fish
  • seafood
  • Matured cheeses ("hard cheese"), the higher the degree of ripeness, the higher the histamine content
  • sauerkraut
  • Beer : Mainly top-fermented , cloudy, colored.
  • Vinegar , products containing vinegar such as mustard, and pickled foods (e.g. pickled vegetables)
  • Red wine , the higher the degree of ripeness, the higher the histamine content. Dry white wines contain practically no histamine, and sparkling wine is also recommended. R. Jarisch, on the other hand, warns against French champagne with its 670 µg / l histamine (champagne is partly made from red grapes).
  • Chocolate : Although chocolate does not contain histamine, it does contain the other biogenic amines tyramine and phenylethylamine. These amines come from cocoa. When minimizing the histamine absorption through food, cocoa drinks and chocolate (in various desserts) should also be avoided.
  • Mushrooms, including molds (e.g. noble mold on various types of cheese)

But also fresh foods like

  • In addition, there should be foods (such as pineapples, papayas, nut and cocoa products) and drugs that delay the breakdown of histamine, or so-called histamine liberators (e.g. certain food additives ), which release more histamine in the body .
  • Alcohol consumption increases the permeability of the cell membrane and thus lowers the histamine tolerance limit, which is why extremely strong reactions can occur, especially when mixing alcohol and food rich in histamine (e.g. red wine and cheese).

Drug intolerance

  • Intolerance to anti-inflammatory and analgesic drugs in people with histamine intolerance:
Anti- inflammatory / analgesic drugs that increase the allergen-specific histamine release in allergy sufferers are incompatible :
Excerpt from the list on p. 125 in:
Active substance Medicines with the active substance
Mefenamic acid Parkemed
Diclofenac Dedolor, Deflamat, Diclo B, Diclobene, Diclomelan, Diclostad, Diclovit, Dolo-Neurobion, Neurofenac, Tratul, Voltaren
Indomethacin Flexidin, Indorben, Indocid, Indohexal, Indomelan, Idometacin, Indoptol, Luiflex, Ralicid
Acetylsalicylic acid aspirin
Anti- inflammatory / analgesic drugs that inhibit the allergen-specific release of histamine in allergy sufferers are compatible :
Excerpt from the list on p. 126 in:
Active substance Medicines with the active substance
Fenbufen Lederfen
Levamisole Ergamisole
Ibuprofen Avallone, Brufen, Dismenol neu, Dolgit, Ibudol, Ibumetin, Ibupron, Ibuprofen Genericon, Kratalgin, Nurofen, Tabcin, Ubumetin, Urem

These pain relievers (analgesics, antipyretics, anti-inflammatory drugs) inhibit prostaglandin synthesis and can therefore lead to the formation of edema as a side effect. Conversely, if edema is present, the intake of fenbufen, levamisole or ibuprofen should be avoided. In addition to drug side effects, other causes such as venous weakness, renal insufficiency or heart failure should also be considered in the case of edema.

  • X-ray contrast agent allergy:

R. Jarisch writes that a contrast medium intolerance is wrongly called an allergy. And since contrast media contain iodine, it is almost always incorrectly specified as an iodine allergy. “Contrast agents release histamine. The reason why nothing happens when contrast agents are given in most cases is that most patients are not histamine intolerant. But if they are affected, anaphylactic shock is inevitable. ”Therefore, for safety reasons, people with histamine intolerance should always be given an antihistamine with an X-ray contrast medium before the examination. In addition, it is advisable to adhere to a histamine-free diet 24 hours before X-ray examinations with contrast media to minimize the histamine exposure. P. 127/128 in

diagnosis

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

Anamnesis (taking a history) is important for the diagnosis . But since many complaints such as For example, headaches, migraines, bronchial asthma, hypotension, cardiac arrhythmias and dysmenorrhea can also have causes other than histamine intolerance, it is not surprising that half of the suspected diagnoses are not confirmed.

The diagnosis is usually made by provocation. However, since histamine can trigger potentially life-threatening conditions, the following procedure is recommended: Before and after a 14-day diet, blood is taken to determine the histamine and diamine oxidase level and compared. Instead of adding histamine, the diet removes histamine. This procedure does not endanger the patient, on the contrary: If there is a histamine intolerance, the symptoms are improved or have completely disappeared. At the same time, the histamine level halves and the DAO increases (both significantly). If there is no histamine intolerance, the blood values ​​do not change and neither do the symptoms. At the same time, food allergies , cross-reactions with pollen , fructose malabsorption , lactose intolerance and celiac disease must be ruled out.

The scientific evidence for the postulated relationships is limited, and there is no reliable laboratory determination for a definitive diagnosis.

therapy

Treatment is based on reducing dietary histamine by following a low-histamine diet. A maximum variant is the "potato-rice diet", which has been used successfully by dermatologists for decades in urticaria , ie only potatoes, rice, salt, sugar and water. In addition, foods (e.g. citrus fruits) and certain drugs (e.g. morphine ) that contain little or no histamine themselves, but release histamine stored in the body ( histamine liberation ) should also be avoided .

When the consumption of foods containing histamine cannot be avoided, antihistamines and cromoglicic acid can be effective. Taking diamine oxidase (DAO) in capsule form with meals may reduce symptoms of histamine intolerance.

As a therapy for very high levels of glutamic acid (glutamate) in the blood, as it is e.g. May occur as eczema and / or histamine intolerance, recommends Reinhart Jarisch a vitamin B6 -Gabe. This also promotes the body's own synthesis of DAO and thus combats the causal effects of histamine intolerance. The reference ranges (normal values) for blood glutamic acid are 20–107 in infants, 18–65 in children and 28–92 µmol / ml in adults.

literature

  • Abbot, Lieners, Mayer, Missbichler, Pfisterer, Schmutz: Food intolerance (histamine intolerance) . HSC, Mauerbach 2006, ISBN 3-9502287-0-5 .
  • Reinhart Jarisch: histamine intolerance, histamine and seasickness. Thieme 2004, ISBN 3-13-105382-8 .
  • Nadja Schäfers: Cooking with low histamine levels - vegetarian. pala-Verlag, Darmstadt 2009, ISBN 978-3-89566-263-8 .
  • Anja Völkel: Healthy cuisine: enjoy consciously - tasty & delicious. AVA-Verlag, 2013, ISBN 978-3-944321-13-4 .
  • I. Reese: Controversial issue of histamine intolerance. (CME certified advanced training) In: Der der dermatologist , 65, 2014, pp. 559-566, doi: 10.1007 / s00105-014-2815-2 .

Web links

Individual evidence

  1. ↑ J. Sattler et al .: Food-induced histaminosis as an epidemiological problem. In: Inflammation research. Basel 23.1988, pp. 361–365. doi: 10.1007 / BF02142588 ISSN  1023-3830 (English).
  2. ↑ L. Maintz et al .: The different faces of histamine intolerance. Consequences for practice . In: Deutsches Ärzteblatt , 103.2006, A-3477, B-3027, C-2903.
  3. ↑ L. Maintz, N. Noval: Histamine and histamine intolerance . In: American Journal of Clinical Nutrition. Bethesda MD, 85.2007, pp. 1185-1196. ISSN  0002-9165 (English).
  4. ↑ J. Lüthy, C. Schlatter: Biogenic amines in foods. In: Zeitschrift Lebensm Unters Forsch. Heidelberg 177.1983, pp. 439–443. PMID 6364621 ISSN  1431-4630 .
  5. ↑ G. Kanny et al. a .: Histamine content does not influence the tolerance of wine in normal subjects. In: Allergy & immunology. Paris 31.1999, pp. 45-48. PMID 10219426 ISSN  0397-9148 (English).
  6. ↑ SC, Jansen et al .: Intolerance to dietary biogenic amines, a review. In: Annals of Allergy, Asthma & Immunology , 91.2003, pp. 233-240, PMID 14533654 (English).
  7. ↑ B. Wedi, A. Kapp: Current position determination on the importance of food allergies and intolerances in urticaria . In: The dermatologist . tape 57 , no. 2 , February 1, 2006, ISSN  1432-1173 , p. 101-107 , doi : 10.1007 / s00105-005-1078-3 .
  8. ↑ Tissue expression of HNMT - Summary - The Human Protein Atlas. Retrieved January 6, 2019 .
  9. ^ Tissue expression of AOX1 - Summary - The Human Protein Atlas. Retrieved January 6, 2019 .
  10. ↑ Laura Maintz, Thomas Bieber, Natalija Novak: The different faces of histamine intolerance: consequences for practice . In: Deutsches Ärzteblatt . tape 103 , no. 51-52 , December 25, 2006, pp. A-3477 / B-3027 / C-2903 ( aerzteblatt.de [accessed on February 2, 2015]).
  11. ^ T. Wilhelm: Tobacco smoke is an important source of histamine. Review of 'The Different Faces of Histamine Intolerance'. In: Deutsches Ärzteblatt , 104.2007, p. A 1758.
  12. ↑ Conny Becker: When cheese and wine are no pleasure. In: pharmische-zeitung.de. February 24, 2006, accessed March 5, 2020 .
  13. ↑ a b c d R. Jarisch: Pizza, contrast media, seasickness, biologicals as anti-IgE antibodies. In: Ärztemagazin , 40/2004.
  14. ↑ a b c d e Reinhart Jarisch: Histamine intolerance, histamine and seasickness. Thieme, 2004, ISBN 3-13-105382-8 .
  15. ↑ a b Nadja Schäfers: Cooking with low histamine levels - vegetarian. pala-Verlag, 2009.
  16. ↑ i-med.ac.at .
  17. ↑ Causes & Risk Factors of Edema »Edema» Diseases »Internists on the Net». Retrieved September 23, 2019 .
  18. ↑ Axel Vogelreuter: Food intolerances . S. Hirzel Verlag, Stuttgart 2015, ISBN 978-3-7776-2349-8 , pp. 99-121.
  19. ↑ Study on histamine intolerance .
  20. ↑ Reinhart Jarisch: Histamine intolerance, histamine and seasickness. 2nd Edition. Thieme Verlag, Stuttgart / New York 2004, ISBN 3-13-105382-8 , p. 151.
  21. ↑ Helmut Greiling, AM Gressner: Textbook of clinical chemistry and pathobiochemistry. Schattauer Verlagsgesellschaft, 1987, ISBN 3-7945-0949-8 .