Is There a Diet for Histamine Intolerance?
2014; Elsevier BV; Volume: 114; Issue: 11 Linguagem: Inglês
10.1016/j.jand.2014.09.009
ISSN2212-2680
Autores Tópico(s)Food Allergy and Anaphylaxis Research
ResumoThe incidence of food allergies and intolerances appears to be increasing in the United States in both children and adults. The American Academy of Allergy, Asthma, and Immunology defines a food intolerance (or sensitivity) as an event that affects the digestive system after eating a particular food.1American Academy of Allergy, Asthma, and Immunology. Food Intolerance. http://www.aaaai.org/conditions-and-treatments/conditions-dictionary/food-Intolerance.aspx. Accessed August 6, 2014.Google Scholar A food allergy, in comparison, involves the immune system, produces a repeatable response, and can be confirmed with a series of tests. Although there is no specific diagnostic test at this time to aid in the clinical diagnosis of a histamine intolerance, also known as enteral histaminosis, the use of a skin-prick test and double-blind placebo-controlled histamine food challenges have been proposed.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 6Hoffman K.M. Gruber E. Deutschmann A. Jahnel J. Hauer A.C. Histamine intolerance in children with chronic abdominal pain [letter].Arch Dis Child. 2013; 98: 832-833Crossref PubMed Scopus (19) Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar However, the span of time it takes for histamine to build up in the body is usually longer than what is allowed during testing.5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar The prevalence of histamine intolerance is estimated to be 1% of the population, and it has typically presented more often in people who are middle-aged.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar Symptoms can vary or seem similar to an allergic reaction, and affect multiple organs and/or systems in the body, thus making its diagnosis difficult.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 6Hoffman K.M. Gruber E. Deutschmann A. Jahnel J. Hauer A.C. Histamine intolerance in children with chronic abdominal pain [letter].Arch Dis Child. 2013; 98: 832-833Crossref PubMed Scopus (19) Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar The reports of ailments have ranged from itching or hives to sneezing, watery eyes, asthma, headaches, abdominal pain, flatulence, diarrhea, tachycardia, and hypotension, among others.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 6Hoffman K.M. Gruber E. Deutschmann A. Jahnel J. Hauer A.C. Histamine intolerance in children with chronic abdominal pain [letter].Arch Dis Child. 2013; 98: 832-833Crossref PubMed Scopus (19) Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar Histamine, a biogenic amine, is released from mast cells within the immune system when an allergen is detected by the body.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar, 9American Academy of Allergy, Asthma and Immunology, Histamine. http://www.aaaai.org/conditions-and-treatments/conditions-a-to-z-search/histamine.aspx. Accessed August 1, 2014.Google Scholar A disproportionate amount of histamine is suspected to result from either an allergic response, ingestion of a large quantity of histamine-containing foods or beverages, consumption of foods or other substances that cause histamine to be released, or an impaired ability for enzymes (ie, diamine oxidase [DAO] and histamine N-methyl transferase [HNMT]) in the body to break it down.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 6Hoffman K.M. Gruber E. Deutschmann A. Jahnel J. Hauer A.C. Histamine intolerance in children with chronic abdominal pain [letter].Arch Dis Child. 2013; 98: 832-833Crossref PubMed Scopus (19) Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar After food allergies have been ruled out, a low-histamine diet is often recommended, and a favorable response to it can help aid in the diagnosis of a histamine intolerance.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 6Hoffman K.M. Gruber E. Deutschmann A. Jahnel J. Hauer A.C. Histamine intolerance in children with chronic abdominal pain [letter].Arch Dis Child. 2013; 98: 832-833Crossref PubMed Scopus (19) Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar Because exposure to histamine exists beyond diet, total avoidance of histamines is not attainable.5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar In some cases, antihistamine medications may be prescribed to help minimize symptoms.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar Dietary sources that are high in histamine include many aged and fermented foods and beverages (eg, cheeses, yogurt, processed meats, alcoholic beverages, sauerkraut, soy2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 6Hoffman K.M. Gruber E. Deutschmann A. Jahnel J. Hauer A.C. Histamine intolerance in children with chronic abdominal pain [letter].Arch Dis Child. 2013; 98: 832-833Crossref PubMed Scopus (19) Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar); some fish, especially frozen, smoked, and canned varieties; fruits, such as strawberries and cherries; vegetables, including spinach, tomatoes, and eggplant; and seasonings, such as chili powder, cinnamon, cloves, and vinegar.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 3Schwelberger H.G. Histamine intolerance: A metabolic disease?.Inflamm Res. 2010; 59: S219-S221Crossref PubMed Scopus (43) Google Scholar, 4Kofler L. Ulmer H. Kofler H. Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.ISRN Allergy. 2011; 2011: 1-5Crossref Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 6Hoffman K.M. Gruber E. Deutschmann A. Jahnel J. Hauer A.C. Histamine intolerance in children with chronic abdominal pain [letter].Arch Dis Child. 2013; 98: 832-833Crossref PubMed Scopus (19) Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar The list is not exhaustive, and the amount of histamine from dietary sources can vary.5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar Foods that are minimally processed are encouraged, since even the removal of skins or peels on produce can increase their histamine content.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar Certain foods, beverages, additives, and drugs are also thought to either aid in the release of histamine or inhibit the enzymes needed to break it down. A few examples of these include citrus fruits, nuts, alcoholic beverages, teas, egg whites, food additives, some preservatives, and medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) or isoniazid and doxycycline.2Rosell-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: 201-207Crossref PubMed Scopus (39) Google Scholar, 5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar, 8Zopf Y. Baenkler H.W. Silbermann A. Hahn E.G. Raithel M. The differential diagnosis of food intolerance.Dtsch Arztebl Int. 2009; 106: 359-370PubMed Google Scholar, 10Centers for Disease Control and Prevention. Marine Toxins. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/marine_toxins/. Accessed August 12, 2014.Google Scholar In addition, bacteria that inhabit the large intestine are able to convert the amino acid histidine found in protein foods into histamine, thereby contributing to internal levels.5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar Similar microorganisms exist in other sources, which is why higher amounts of histamine are found in some spoiled foods, especially fish.5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar, 7Maintz L. Novak N. Histamine and histamine intolerance.Am J Clin Nutr. 2007; 85: 1185-1196Crossref PubMed Scopus (551) Google Scholar Scromboid poisioning, also known as scrombotoxic fish poisoning or histamine toxicity, is the result of ingesting spoiled finfish, such as tuna or mackerel, that contain high amounts of histamine that have been produced from bacterial overgrowth.10Centers for Disease Control and Prevention. Marine Toxins. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/marine_toxins/. Accessed August 12, 2014.Google Scholar Because each person’s level of tolerance to histamine is unique and ever-changing, the approach to reduce dietary sources of histamine needs to be individualized.5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar Rotation diets are considered to be helpful for intolerances that are dose-dependent, although there is a lack of research at this time in support of them.5Vickerstaff Joneja J. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, Chicago, IL2013: 291-304Google Scholar Since the consumption of a variety of foods can be a challenge for patients with food intolerances, a registered dietitian nutritionist (RDN) can assist with the initial trial of a histamine-restricted diet, while ensuring the patient’s total diet remains adequate in all nutrients.
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