Department of Family Medicine, Semmelweis University, Budapest, Hungary.
Hungarian Angioedema Center of Reference and Excellence, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.
Am J Case Rep. 2022 Mar 6;23:e934212. doi: 10.12659/AJCR.934212.
BACKGROUND Adverse reaction to histamine found in food and beverages is still a debated entity. It presents with a diverse, multisystemic clinical picture and lacks objective diagnostic criteria. CASE REPORT We report a case of severe adverse reaction to histamine in food and beverages. The 36-year-old White man had diet-dependent problems for 17 years that involved periodic erythematous rash, fever, headaches, nausea, and upper respiratory symptoms. The symptoms developed in the same chronologic order each time. The course of the disease could be divided into a first (prodromal, gastrointestinal), a second (acute, dermal), and a third (subacute, respiratory) phase. The symptoms occurred every 3-6 weeks and lasted for 10-14 days. The differential diagnosis was time-consuming and very detailed. Family history, genetic testing, and oral histamine provocation testing supported the diagnosis of an adverse reaction to histamine in food and beverages. A low-histamine diet resulted in a symptom-free state. Follow-up lasted longer than 24 months. CONCLUSIONS This presentation of an adverse reaction to histamine in food and beverages can serve as a textbook example where a chronological, syndrome-like order of symptom appearance is described. To the best of our knowledge, this is the first report of a severe adverse reaction to histamine in food and beverages, where symptoms are described in 3 distinct recurring phases.
食物和饮料中组胺的不良反应仍然是一个有争议的实体。它表现出多样化、多系统的临床特征，缺乏客观的诊断标准。
我们报告了一例食物和饮料中组胺严重不良反应的病例。这名 36 岁的白人男性有 17 年的饮食依赖性问题，涉及周期性红斑、发热、头痛、恶心和上呼吸道症状。每次症状的出现都按相同的时间顺序进行。疾病的过程可以分为三个阶段：第一阶段（前驱期、胃肠道）、第二阶段（急性、皮肤）和第三阶段（亚急性、呼吸道）。症状每 3-6 周出现一次，持续 10-14 天。鉴别诊断耗时且非常详细。家族史、基因检测和口服组胺激发试验支持食物和饮料中组胺不良反应的诊断。低组胺饮食可使症状消失。随访时间超过 24 个月。
这种食物和饮料中组胺不良反应的表现可以作为一个教科书式的例子，其中描述了症状出现的按时间顺序、综合征样的顺序。据我们所知，这是首例食物和饮料中组胺严重不良反应的报告，其中症状描述为 3 个不同的反复出现阶段。
