Symptoms of pseudoallergy and histamine metabolism disorders
Joanna Kacik, Agata Wawrzyniak, Magda Rakowska, Bolesław Kalicki
Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland. Head of the Department: Associate Professor Bolesław Kalicki, MD, PhD
Correspondence: Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland, tel.: +48 261 817 236, fax: +48 22 515 05 85, e-mail: firstname.lastname@example.org
Histamine intolerance is a poorly investigated type of hypersensitivity responsible for a number of often serious symptoms, erroneously interpreted as food allergy. Endogenous histamine originates from the histidine amino acid with the help of the histidine decarboxylase enzyme. Apart from the endogenous production histamine may be supplied to the body with food. Slow-maturing and fermenting products are characterised by particularly high levels of histamine. Some food products stimulate excessive release of histamine from stores in the body as well as containing significant amounts of it. These products include spices, herbs, dried fruits and a large group of food additives. Histamine intolerance is considered to be a condition in which the amount of histamine in the body exceeds its tolerance threshold, which leads to the development of adverse reactions. These reactions primarily include skin symptoms (pruritus, urticaria, skin reddening, acne lesions), angioedema, respiratory symptoms (nasal obstruction and watery discharge, sneezing, coughing, wheezing), gastrointestinal symptoms (abdominal cramps, diarrhoea, bloating), nervous system symptoms (headaches, fatigue, irritability, anxiety, panic attacks), cardiovascular symptoms (tachycardia, hypotension, chest pain), primary dysmenorrhoea and many more. It is estimated that nearly 1% of society is susceptible to histamine intolerance. The diagnosis of this disorder is based on observing at least two characteristic symptoms and their disappearance or improvement following histamine-free diet. A new, although not easily accessible diagnostic tool is assay for serum diamine oxidase activity, which correlates to a significant extent with symptoms of histamine intolerance. Normal activity of diamine oxidase is considered to be the amount of >80 HDU/mL, decreased activity – 40–80 HDU/mL and severely decreased activity – <40 HDU/mL. Currently the option of diamine oxidase supplementation is being considered as prevention for patients with the decreased activity of this substance.