Cited by 41Mast cells and histaminePolyamine Metabolism and ApplicationsGastrointestinal motility and disorders

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Basal Serum Diamine Oxidase Levels as a Biomarker of Histamine Intolerance: A Retrospective Cohort Study

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Abstract

Background: Histamine Intolerance (HIT) is a multifaceted pseudoallergic disorder possibly due to defective histamine metabolism. Diamine oxidase (DAO) contributes to histamine degradation and can be measured in the serum. The role of DAO measurement in the diagnostic work-up of HIT still remains unclear, and conflicting results have been reported in the literature. Therefore, we aimed to evaluate the possible clinical usefulness and consistency of DAO value ranges as provided by the assay manufacturer and verify whether they could predict the response to treatment. Methods: We retrospectively analyzed 192 outpatients with HIT symptoms and measured serum DAO values at baseline. Patients were prescribed either with low-histamine diet and/or enzymatic supplementation according to symptom severity and re-evaluated six to eight months later. Patients were stratified into three groups according to DAO levels: <3 U/mL, 3–10 U/mL, and >10 U/mL. HIT severity was assessed on a scale of 1 to 5 before and after treatment. Results: A total of 146 patients completed the study. Gastrointestinal and cutaneous symptoms, often associated with headache, were more frequent in subjects with DAO < 10 U/mL. Symptom severity and DAO ranges were correlated. Patients with intermediate DAO levels (3–10 U/mL) showed a more complex clinical phenotype but also a more significant improvement in symptom severity (score reduction 50%, interquartile range (IQR) = 33–60%) when compared to patients with low DAO (40%, IQR = 20–60%; p = 0.045) or high DAO (33%, IQR = 0–50%; p < 0.001). Complex clinical phenotypes were also more frequent in patients with intermediate DAO levels. Conclusions: HIT is characterized by typical symptoms and low levels of DAO activity. Symptom severity was associated with the degree of DAO deficiency. Patients with DAO values between 3 and 10 U/mL show the best response to treatment (low-histamine diet and/or DAO supplementation). DAO value could arguably be considered as a predictor of clinical response to treatment. Prospective studies are needed to confirm these data.

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  1. Astier, 2017, Histamine intolerance or false food allergy with histamine mechanism, Rev. Fr. D’allergologie, 57, 24

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Authors
Cucca, V., Ramirez, G. A., Pignatti, P., Asperti, C., Russo, M., Della-Torre, E., Breda, D., Burastero, S. E., Dagna, L., & Yacoub, M.-R.
Affiliations
  • Vita-Salute San Raffaele University (IT)
  • Istituti Clinici Scientifici Maugeri (IT)
  • Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, 20132 Milan, Italy
  • IRCCS Ospedale San Raffaele (IT)
Corresponding author
Yacoub, Mona-Rita
Venue
Nutrients
Publisher
MDPI AG
Published
2022-04-05
Volume
14
Issue
7
Pages
1513
ISSN
2072-6643 (ISSN-L)
OpenAlex
W4223477378
Cited by
41
References
50
Citations by year
2026: 7 · 2025: 8 · 2024: 11 · 2023: 10 · 2022: 5
FWCI
3.24
Type
journal article
Language
en
Open access
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion, cc-by)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Polyamine Metabolism and Applications
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
histamine intolerance, diamine oxidase, biomarkers, histamine metabolism, low-histamine diet, treatment response prediction, symptom severity, clinical phenotype, headache, gastrointestinal symptoms, cutaneous manifestations
MeSH terms
Headache, Amine Oxidase (Copper-Containing), Histamine, Humans, Retrospective Studies, Biomarkers

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