Hypersensitivity to biogenic aminesBiogenic amines include, for example:
- Histamine (most important representative, especially in cheese, wine, fish, smoked meat products, spinach and tomatoes – when these foods spoil, their histamine content increases).
- Cadaverine (contained mainly in cereal sprouts and sauerkraut).
- Feruloylputrescine (found in grapefruit).
- Phenylethylamine
- Putrescine* (especially in cereal sprouts and sauerkraut).
- Serotonin (in migraine patients, serotonin together with tyramine is often responsible for headache attacks; mainly contained in walnuts, pineapple, bananas and tomatoes).
- Spermidine (in cereal sprouts).
- Spermine (in cereal seedlings)
- Synephrine (found in tangerines and oranges).
- Tryptamine
- Tyramine* (increases blood pressure by releasing norepinephrine; especially in yeast, fish, sausage, cheese, raspberries, sauerkraut).
* The biogenic amines putrescine and tyramine are competitive inhibitors of DAO (diamine oxidase; synonym: histaminase).Biogenic amines are nitrogenous waste and conversion products of amino acids and can be formed mainly by chemical reactions, effects of enzymes and microorganisms in the metabolism of many plants and animals, but also in the human body. Finally, biogenic amines are present in foods in both small and large quantities as a result of microbial spoilage and microbial processing (fermentation) and the addition of enzyme preparations. Fermented foods, such as hard and semi-hard cheeses, sauerkraut or wine, may contain particularly high amine concentrations, with histamine and tyramine predominating in terms of quantity.The amines are absorbed directly from food in the intestine. Alcohol can increase the rate of absorption.Individuals with non-immunologically mediated hypersensitivity to biogenic amines lack the enzyme necessary for amine degradation (diamine oxidase (DAO) concentration in the intestinal tract and histamine methyltransferase in the liver) or have an enzyme defect. Since biogenic amines are vaso- or psychoactive, even low amine concentrations in foods trigger complaints in very sensitive people – individual irritation threshold.Both special diseases (especially functional disorders of the intestinal mucosa or liver with a negative effect on aminooxidase activity) and drugs can influence the irritation threshold. This explains why reactions to amine-rich foods vary in severity.In particular, drugs and psychological factors (for example, stress) can lead to addition effects.Hypersensitivity to biogenic amines – frequencyIn particular, patients with chronic urticaria often exhibit intolerance to histamine due to a defect in diamino-oxidase. According to studies, chronic urticaria was induced in 64% of patients after duodenal application of 120 mg histamine. In comparison, the control group remained asymptomatic.Enzyme activity is also decreased in patients with atopic eczema. Hypersensitivity to biogenic amines-symptoms.
- Bronchial asthma
- Atopic eczema (neurodermatitis)
- Respiratory distress
- Chronic headache
- Chronic urticaria – often accompanied by wheals and severe itching.
- Diarrhea
- Vomiting
- Skin redness
- Itching
- Migraine attacks
- Nausea
Attention!Alcohol decreases the enzyme activity of DAO (diamine oxidase) and increases the absorption of histamine! This simultaneously leads to a non-IgE-mediated release of histamine from mast cells and basophilic granulocytes.Drugs that are inhibitors of DAO:
- Acetylcysteine (ACC)
- Ambroxol
- Aminoglycosides (framycetin, neomycin, paromomycin)
- Aminophylline
- Amitriptyline
- Chloroquine
- Clavulanic acid
- Dihydralazine
- Gelatin (plasma expander)
- Metoclopramide (MCP)
- N-acetylcysteine (NAC)
- Isoniazid
- Pentamidine
- Pirenzepine
- Promethazine
- Verapamil
Patients treated with the drugs listed above should avoid histamine-containing foods (see list above: biogenic amines) because histamine is not sufficiently cleared due to DAO inhibition.Non-steroidal analgesics or anti-inflammatory drugs listed below may additionally lead to histamine release in individuals with an allergic disposition, so that an increased histamine effect may occur:
- Acetylsalicylic acid (ASA).
- Diclofenac
- Indometacin
- Flurbiprofen
- Ketoprofen
- Meclofenamic acid
- Mefenamic acid
- Naproxen
For allergy sufferers suitable analgesic or antiphlogistic drugs that inhibit allergen-specific histamine release are:
- Fenbufen
- Levamisole
- Ibuprofen
