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Excretion of urinary histamine and N-tele methylhistamine in patients with gastrointestinal food allergy compared to non-allergic controls during an unrestricted diet and a hypoallergenic diet.

Raithel M, Hagel A, Albrecht H, Zopf Y, Naegel A, Baenkler HW, Buchwald F, Schultis HW, Kressel J, Hahn EG, Konturek P - BMC Gastroenterol (2015)

Bottom Line: Urinary histamine and n-methylhistamine were determined by ELISA or tandem mass spectrometry, respectively, and were expressed as median (25 - 75% range, μg/mmol creatinine x m(2)BSA).In gastrointestinal food allergy significantly higher levels of urine histamine and methylhistamine excretion were found under unrestricted diet, reflecting an increased secretion of histamine due to offending foods.Measurement of urinary n-methylhistamine levels may help to find out patients with increased histamine production and/or food-allergen induced clinical symptoms, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany. martin.raithel@uk-erlangen.de.

ABSTRACT

Background: Patients with gastrointestinal food allergy are characterised by increased production of mast cell derived mediators upon allergen contact and present often with unspecific symptoms. The aim of this study was to evaluate urinary histamine and methylhistamine excretion in patients with food allergy and to compare their values with food-tolerant controls.

Methods: In a retrospective case control study the urinary excretion parameters were analysed from 56 patients (40.9, 19 - 58 years) in whom later food challenge tests confirmed food allergy. During their diagnostic work-up urine was collected during a 12-h period under an unrestricted diet with staple foods and a hypoallergenic potato-rice-diet (each 2 days). Healthy controls underwent the same diet types to define normal excretion parameters. Urinary histamine and n-methylhistamine were determined by ELISA or tandem mass spectrometry, respectively, and were expressed as median (25 - 75% range, μg/mmol creatinine x m(2)BSA).

Results: During unrestricted diet urinary histamine was significantly higher in gastrointestinal food allergy than healthy controls (1.42, 0.9 - 2.7 vs 0.87, 0.4 - 1.3; p < 0.0001), while the difference between both groups became marginal during potato-rice diet (1.30, 0.7 - 2.1 vs 1.05, 0.5 - 1.5; p = 0.02). N-methylhistamine was found to be significantly elevated in gastrointestinal food allergy both during unrestricted diet (7.1, 5.0 - 11.2) and potato-rice diet (5.7, 3.7 - 8.7) compared to controls (p < 0.0001). Interestingly, urinary methylhistamine excretion (p < 0.004) and clinical symptom score (p < 0.02) fell significantly when the diet was switched from unrestricted to hypoallergenic food, but was not correlated with symptom scores.

Conclusions: In gastrointestinal food allergy significantly higher levels of urine histamine and methylhistamine excretion were found under unrestricted diet, reflecting an increased secretion of histamine due to offending foods. Measurement of urinary n-methylhistamine levels may help to find out patients with increased histamine production and/or food-allergen induced clinical symptoms, respectively.

No MeSH data available.


Related in: MedlinePlus

A large number of patients with functional adverse food reactions were identified as carbohydrate malassimilation with/without small intestinal bowel overgrowth (SIBO), while a minority had non-allergic food intolerance or Irritable Bowel Syndrome (IBS). Among the remaining 225 patients an allergic disease could be excluded definitively, while 153 had strong clinical suspicion of gastrointestinally mediated allergy (GMA) and were scheduled for confirmatory food challenge tests. However, only in 56 patients completed diagnostics was obtained and this group with confirmation of allergy is further described as study group GMA.
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Fig1: A large number of patients with functional adverse food reactions were identified as carbohydrate malassimilation with/without small intestinal bowel overgrowth (SIBO), while a minority had non-allergic food intolerance or Irritable Bowel Syndrome (IBS). Among the remaining 225 patients an allergic disease could be excluded definitively, while 153 had strong clinical suspicion of gastrointestinally mediated allergy (GMA) and were scheduled for confirmatory food challenge tests. However, only in 56 patients completed diagnostics was obtained and this group with confirmation of allergy is further described as study group GMA.

Mentions: During the study period (2007 – 2011) 2816 individuals were identified with functional food reactions (Figure 1). Following diagnoses were confirmed in these patients, carbohydrate malassimilation, and/or small intestinal bacterial overgrowth, non-allergic intolerances and IBS or somatoforme diseases, respectively. Patients with prompt resolution of symptoms after diet or therapy were excluded from further allergy testing.Figure 1


Excretion of urinary histamine and N-tele methylhistamine in patients with gastrointestinal food allergy compared to non-allergic controls during an unrestricted diet and a hypoallergenic diet.

Raithel M, Hagel A, Albrecht H, Zopf Y, Naegel A, Baenkler HW, Buchwald F, Schultis HW, Kressel J, Hahn EG, Konturek P - BMC Gastroenterol (2015)

A large number of patients with functional adverse food reactions were identified as carbohydrate malassimilation with/without small intestinal bowel overgrowth (SIBO), while a minority had non-allergic food intolerance or Irritable Bowel Syndrome (IBS). Among the remaining 225 patients an allergic disease could be excluded definitively, while 153 had strong clinical suspicion of gastrointestinally mediated allergy (GMA) and were scheduled for confirmatory food challenge tests. However, only in 56 patients completed diagnostics was obtained and this group with confirmation of allergy is further described as study group GMA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389952&req=5

Fig1: A large number of patients with functional adverse food reactions were identified as carbohydrate malassimilation with/without small intestinal bowel overgrowth (SIBO), while a minority had non-allergic food intolerance or Irritable Bowel Syndrome (IBS). Among the remaining 225 patients an allergic disease could be excluded definitively, while 153 had strong clinical suspicion of gastrointestinally mediated allergy (GMA) and were scheduled for confirmatory food challenge tests. However, only in 56 patients completed diagnostics was obtained and this group with confirmation of allergy is further described as study group GMA.
Mentions: During the study period (2007 – 2011) 2816 individuals were identified with functional food reactions (Figure 1). Following diagnoses were confirmed in these patients, carbohydrate malassimilation, and/or small intestinal bacterial overgrowth, non-allergic intolerances and IBS or somatoforme diseases, respectively. Patients with prompt resolution of symptoms after diet or therapy were excluded from further allergy testing.Figure 1

Bottom Line: Urinary histamine and n-methylhistamine were determined by ELISA or tandem mass spectrometry, respectively, and were expressed as median (25 - 75% range, μg/mmol creatinine x m(2)BSA).In gastrointestinal food allergy significantly higher levels of urine histamine and methylhistamine excretion were found under unrestricted diet, reflecting an increased secretion of histamine due to offending foods.Measurement of urinary n-methylhistamine levels may help to find out patients with increased histamine production and/or food-allergen induced clinical symptoms, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine 1, Functional Tissue Diagnostics, Gastroenterology, University Hospital Erlangen, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany. martin.raithel@uk-erlangen.de.

ABSTRACT

Background: Patients with gastrointestinal food allergy are characterised by increased production of mast cell derived mediators upon allergen contact and present often with unspecific symptoms. The aim of this study was to evaluate urinary histamine and methylhistamine excretion in patients with food allergy and to compare their values with food-tolerant controls.

Methods: In a retrospective case control study the urinary excretion parameters were analysed from 56 patients (40.9, 19 - 58 years) in whom later food challenge tests confirmed food allergy. During their diagnostic work-up urine was collected during a 12-h period under an unrestricted diet with staple foods and a hypoallergenic potato-rice-diet (each 2 days). Healthy controls underwent the same diet types to define normal excretion parameters. Urinary histamine and n-methylhistamine were determined by ELISA or tandem mass spectrometry, respectively, and were expressed as median (25 - 75% range, μg/mmol creatinine x m(2)BSA).

Results: During unrestricted diet urinary histamine was significantly higher in gastrointestinal food allergy than healthy controls (1.42, 0.9 - 2.7 vs 0.87, 0.4 - 1.3; p < 0.0001), while the difference between both groups became marginal during potato-rice diet (1.30, 0.7 - 2.1 vs 1.05, 0.5 - 1.5; p = 0.02). N-methylhistamine was found to be significantly elevated in gastrointestinal food allergy both during unrestricted diet (7.1, 5.0 - 11.2) and potato-rice diet (5.7, 3.7 - 8.7) compared to controls (p < 0.0001). Interestingly, urinary methylhistamine excretion (p < 0.004) and clinical symptom score (p < 0.02) fell significantly when the diet was switched from unrestricted to hypoallergenic food, but was not correlated with symptom scores.

Conclusions: In gastrointestinal food allergy significantly higher levels of urine histamine and methylhistamine excretion were found under unrestricted diet, reflecting an increased secretion of histamine due to offending foods. Measurement of urinary n-methylhistamine levels may help to find out patients with increased histamine production and/or food-allergen induced clinical symptoms, respectively.

No MeSH data available.


Related in: MedlinePlus