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Histaminosis

Terminology

The term histamine intolerance is most frequently used, when talking about this illness (Latin: intolerantia, from tolerare meaning "to bear", "to endure", with the negating prefix "in"). Histamine intolerance is not solely a food intolerance. In addition to food, there are other "histamine sources" that cause symptoms, such as medication, stress, physical effort or toxines. The terms histaminosis or enteral histaminosis also refer to the same illness ("enteral" = uptake via the digestive tract). Some people also speak of an intolerance to biogenic amines: Biogenic amines intolerance (BAI).

To talk about a "histamine allergy" is medically incorrect, as the immune system is not involved. Nevertheless, it may be easier for afflicted people to say that they have an "allergy" rather than to explain in detail why having to give up so many food items. The term "allergy" is universally understood and it is generally known and accepted that an allergic person must absolutely avoid the allergen. (In restaurants in particular, the staff will take a sufferer more seriously when mentioning an allergy rather than intolerance.)

Abbreviations

Common abbreviations are HIT and HI (for Histamine Intolerance) or more recently sometimes BAI (Biogenic amines intolerance). Which of these abbreviations should be given preference? Since LI is used for lactose intolerance and FI for fructose intolerance, HI would make the most sense. However, this can be confused with the illness caused by the HI-virus (HIV). The acronym HIT also has other meanings; it sometimes stands for heparin-induced thrombocytopenia. The abbreviation BAI is actually the most appropriate, because with histamine intolerance, it is not histamine alone that causes problems, but a variety of biogenic amines, of which histamine is the most prominent. But to date BAI is too rarely used. We therefore remain with the commonly used HIT.

Definition of histamine intolerance

There are different points of view about what is a histamine intolerance and what is not:

Enzyme disorder of the DAO

In the strictest sense, HIT is defined as an acquired or congenital loss of activity of the enzyme diamine oxidase (DAO), resulting in a slower degradation of ingestedhistamine and other biogenic amines.

Histamine degradation disorder

More broadly speaking, HIT may be a fault somewhere in the various degradation pathways involved in the breakdown of histamine (ingested or released) and other biogenic amines.

Histamine related disorder

In the broadest sense of the word, HIT can be understood as any disorder of the histamine metabolism leading to increased histamine levels or to an increased effect of histamine. Histamine-mediated symptoms may be caused by an increased histamine supply (by food intake, intestinal flora, release of endogenous histamine, biosynthesis by histidine decarboxylase), a decrease in histamine degradation rate (enzyme inhibition, enzyme defect), or a change in the body's histamine receptor density or sensitivity. The problem of this wide definition is that it includes also independent diseases like mast cell disorders, which can be clearly distinguished from HIT.

Additional information: page Histaminose (German)

Classification

in the medical classification system ICD-10, histamine intolerance cannot be classified satisfactorily. Might this reflect the low attention and recognition of this disease by the medical community? Here are some suggestions:

"T78.1, other food intolerance, not elsewhere classified"

Alternatively, diagnosis can be limited to certain symptoms of histaminosis. For example G44.0 "cluster headache" ("histamine headache").

In T61 "Toxic effects by intake of harmful substances from seafood" there is the sub-item T61.1 "Scombroid fish poisoning, histamine-like syndrome".

Frequency (Prevalence)

Although numerous opinions can be found, the most commonly indicated percentage of the population affected by HIT is given as 1 % (though, to date, we were not able to find the primary source of this frequently quoted information). However, before we talk about and believe in any numbers, we must ask ourselves whether it is possible to clearly separate people into "affected" and "not affected" categories and where should the line between the affected and the unaffected part of the population be drawn? Some difficulties for categorisation arise from the following:

Suspected high number of unreported cases

HIT often remains undiagnosed or is incorrectly diagnosed as something else, such as Irritable Bowel Syndrome (IBS). Some of the reasons for this are: selection of inappropriate methods, misinterpretation of test results, refusal to believe in HIT existence by still a large number of doctors, lack of knowledge regarding HIT by doctors, etc. Furthermore, amongst healthcare professionals only the HIT type caused by a lack of DAO is currently discussed. Other disturbances and malfunctions of the histamine metabolism are not yet acknowledged. We suspect a high number of unreported cases.

Different degrees of severity

With HIT there are different degrees of severity; from only the slightly affected people (who notice it on a low level and only sporadically), to highly sensitive people (where even the smallest mistake in diet can have severe consequences). So there is a smooth transition between "affected" and "not affected". Actually, everybody can be regarded as histamine-intolerant in comparison to the amount tolerated by scavengers such as lions or hyenas. Above a certain threshold histamine is toxic for every human being but a "healthy" person only notices this when extraordinarily large amounts of histamine are consumed or released (e.g. a meal of hard cheeses with lots of red wine, tomatoes and strawberries after taking medication that block DAO).

Influence of external factors

The degree of severity also depends on current environmental factors and "achievements of civilisation" (eating habits, stress, drugs, environmental pollutants, etc.).

Some are affected only temporarily

Only a part is affected since birth. Histamine intolerance is mostly acquired and certain forms are even reversible, e.g. intestinal infections, abuse of medication or alcohol, consumption of drugs etc.

So how can the persons concerned and the non concerned be separated properly?

Nevertheless, here some sources where the prevalence is quantified:

• "Entsprechend den Daten einer französischen Studie, bei der 33.000 Personen nach Nahrungsmittel-Unverträglichkeiten befragt wurden, kann die Prävalenz der Histamin-Intoleranz mit knapp 1 % der Gesamt-Bevölkerung angenommen werden. Da 80 % der erkrankten Patienten weiblichen Geschlechts sind und sich insbesondere in der Altersgruppe um 40 Jahre befinden, liegt ein Zusammenhang mit der Abnahme von weiblichen Geschlechtshormonen nahe." [Jarisch 2004]
• "Exakte Daten zur Prävalenz der Histaminintoleranz gibt es kaum, schätzungsweise sind 3 – 4% der Bevölkerung davon betroffen. Noch weniger verlässliche Daten gibt es derzeit zur Prävalenz der Histaminintoleranz im Kinder- und Jugendalter." [Kofler et al. 2009]
• "Von 500 solchen Patienten mit inhalativen Beschwerden (Asthma-Anfälle, Rhinitis, Anm.) haben zehn Prozent eine echte Nahrungsmittel-Allergie, weitere zehn Prozent eine Lactose- und Fructose-Intoleranz, 40 Prozent haben Kreuzallergien zu Pollen etc. und weitere 40 Prozent eine Histamin-Intoleranz. Letzteres betrifft ein Prozent der Gesamtbevölkerung." [Wurzinger 2007]
• "2-5% der erwachsenen Bevölkerung" [Schleip 2006]

Some numbers about incompatibilities in general:

"Nahrungsmittelunverträglichkeiten beeinträchtigen mehr als 20 % der Bevölkerung der Industrieländer. Der Hauptanteil der nicht immunologisch bedingten Formen macht 15 bis 20 % aller Nahrungsmittelunverträglichkeiten aus. Diese Gruppe reicht von den pseudoallergischen Reaktionen über die Enzymopathien bis zu chronischen Infektionen und psychosomatischen Reaktionen, die mit Unverträglichkeitsreaktionen assoziiert werden. Die Prävalenz der Nahrungsmittelallergie, der immunologisch bedingten Unverträglichkeitsreaktion, beträgt nur 2 bis 5 %." [Zopf 2009]

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histaminosis > histamine metabolism

References and bibliography

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