Maintz Laura, Novak Natalija
Department of Dermatology, University of Bonn, Bonn, Germany.
Am J Clin Nutr. 2007 May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185.
Histamine intolerance results from a disequilibrium of accumulated histamine and the capacity for histamine degradation. Histamine is a biogenic amine that occurs to various degrees in many foods. In healthy persons, dietary histamine can be rapidly detoxified by amine oxidases, whereas persons with low amine oxidase activity are at risk of histamine toxicity. Diamine oxidase (DAO) is the main enzyme for the metabolism of ingested histamine. It has been proposed that DAO, when functioning as a secretory protein, may be responsible for scavenging extracellular histamine after mediator release. Conversely, histamine N-methyltransferase, the other important enzyme inactivating histamine, is a cytosolic protein that can convert histamine only in the intracellular space of cells. An impaired histamine degradation based on reduced DAO activity and the resulting histamine excess may cause numerous symptoms mimicking an allergic reaction. The ingestion of histamine-rich food or of alcohol or drugs that release histamine or block DAO may provoke diarrhea, headache, rhinoconjunctival symptoms, asthma, hypotension, arrhythmia, urticaria, pruritus, flushing, and other conditions in patients with histamine intolerance. Symptoms can be reduced by a histamine-free diet or be eliminated by antihistamines. However, because of the multifaceted nature of the symptoms, the existence of histamine intolerance has been underestimated, and further studies based on double-blind, placebo-controlled provocations are needed. In patients in whom the abovementioned symptoms are triggered by the corresponding substances and who have a negative diagnosis of allergy or internal disorders, histamine intolerance should be considered as an underlying pathomechanism.
组胺不耐受是由于组胺积累与组胺降解能力失衡所致。组胺是一种生物胺，在许多食物中都不同程度地存在。在健康人群中，膳食中的组胺可被胺氧化酶迅速解毒，而胺氧化酶活性低的人则有组胺中毒的风险。二胺氧化酶（DAO）是摄入组胺代谢的主要酶。有人提出，DAO作为一种分泌蛋白，在介质释放后可能负责清除细胞外组胺。相反，组胺N-甲基转移酶是另一种使组胺失活的重要酶，它是一种胞质蛋白，只能在细胞内空间将组胺转化。基于DAO活性降低导致的组胺降解受损以及由此产生的组胺过量，可能会引发许多类似过敏反应的症状。摄入富含组胺的食物、酒精或释放组胺或阻断DAO的药物，可能会在组胺不耐受患者中引发腹泻、头痛、鼻结膜炎症状、哮喘、低血压、心律失常、荨麻疹、瘙痒、潮红及其他病症。症状可通过无组胺饮食减轻，或用抗组胺药消除。然而，由于症状的多面性，组胺不耐受的存在一直被低估，需要基于双盲、安慰剂对照激发试验进行进一步研究。对于上述症状由相应物质引发且过敏或内科疾病诊断为阴性的患者，应将组胺不耐受视为潜在的发病机制。
