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.
Highlights
Chronic and unexplained, functional, gastrointestinal (GI) symptoms impact more than 20% of the population
We discuss currently increasing evidence that Histamine Intolerance (HIT) is primarily a gastrointestinal disorder and that it originates in the gut
With help of published studies, report on the link between reduced gastrointestinal diamine oxidase (DAO) activity and HIT, and why this association demonstrates that HIT originates in the gut
Summary
Functional, gastrointestinal (GI) symptoms impact more than 20% of the population. In histamine intolerance (HIT), the impairment of GI histamine degradation causes functional, nonspecific, non-allergic GI complaints and extra-intestinal complaints [1]. In HIT, the intestinal enzyme diamine oxidase (DAO) has a reduced ability to metabolize and degrade histamine. In association with various different disorders and diseases listed here, several with unknown underlying pathophysiologic mechanisms, the majority reports on additional unexplained, functional GI symptoms. A personalized treatment with the targeted dietary intervention for each patient with HIT, using a histamine-reduced diet and/or oral supplementation with DAO, may help to provide sustained relief [6]. We review various disorders and diseases with unexplained, functional, GI complaints, and their parallels to HIT. Published studies, report on the link between reduced gastrointestinal DAO activity and HIT, and why this association demonstrates that HIT originates in the gut
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