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Dr.

Fawzia abo ali


Prof. of internal medicine & immunology
Ain shams faculty of medicine
Food Allergy and Food
Food Allergy and Food
Intolerance:
Intolerance:
What is the Difference?
Food Allergy:
A response of the
immune system
involving
antigen consisting of
protein or a molecule
linked to a protein
Food Intolerance
A non immunologically
mediated event
usually triggered by small
molecular weight
chemical substances and
biologically active
components of foods
Histamine in Food Allergy

!istamine" is a physiologic protein only


active for a short time released by mast
cells & other granulocytes.

#he main function of histamines is to protect


the body against invaders such as allergens
bacteria and viruses. !istamines also
promote wakefulness and alertness.
Histamine & food Intolerance
!istamine is a biologically active derivative of an amino
acid $histidine%via histidine decarbo&ylase $!D'%
(s present in many foods and beverages
!igh doses are to&ic to all humans " levels of )*.+
mg,kg body weight cause-histamine poisoning.
(ndividual tolerance determines reactivity to small
/uantities.
Individual Intolerance of Histamine
'ause is most likely a defect in the catabolism of
histamine.
(n humans enzymatic inactivation of histamine
occurs by two pathways"
0&ogenous histamine is metabolised predominantly
via o&idative deamination by DA1
0ndogenous histamine is metabolised more via ring 23
methylation by histamine 23methyltransferase
Mechanism of Histamine
Sensitivity
4ymptoms develop when"

0&cessive amounts of histamine e&ceed


the enzymes5 capacity to break it down

#here is a lowered enzyme capacity for


histamine breakdown

Drugs inhibit enzyme action $e.g.


isoniazid%
Theory of Histamine !cess
6.!istamine from dietary sources and from the
activity of intestinal microorganisms will normally
be catabolized before gaining access to
circulation.
*. (f enzyme activity is reduced histamine will gain
access to blood and augment the level of plasma
histamine from endogenous sources.
Symptoms of Histamine Excess
4ymptoms of !istamine 0&cess

Pruritis $skin eyes ears nose%

7rticaria

Angioedema

!ypotension

#achycardia

-Panic attack.

'hest pain

2asal congestion

wheezes

!eadache

Fatigue confusion irritability

Abdominal pain
Sources of Histamine in Foods
6. !istidine can be decarbo&ylated to
histamine $histidine decarbo&ylase %by
intestinal bacteria

8ay develop in fish 9especially tuna and


mackerel that have been improperly
processed and refrigerated.

(n shellfish where intestine is not


removed
6. !istamine is produced by microbial action
in manufacture of foods such as cheese
wine beers vinegar yeast e&tract.
4ources of !istamine in Foods
:. 4ome foods contain high levels of histamine
naturally especially spinach and eggplant
;. Plant foods may produce histamine during the
ripening process e.g. tomato
<. 4ome foods may release histamine by a non3
immunologically mediated mechanism which is
presently unknown. 4uch foods include"

0gg white

4trawberry

Alcohol $ethanol%

'itrus fruits
"ther Food Sources of Histamine

4ome food additives appear to release


histamine"
Tartra#ine and other a#o dyes
Sul$hites
%en#oates

0gg white $ovalbumin% has been implicated


in
histamine release by an unknown mechanism
(nhibitors of DA1 and !8#
Drugs that inhi&it en#ymes involved in
histamine
&rea'do(n result in histamine e!cess:
HMT inhi&itors:

Antimalarial drugs

Anticancer drugs $pyrimidine analogs%


DA" inhi&itors:

'opper3chelating agents .

'arbonyl group reagents $aminoguanidine%

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Signs of *ossi&le Histamine Intolerance
6. 4kin tests"
-8ildly positive. to multiple allergens
>arge reaction wheal to histamine control
*. 7nusually sensitive to alcoholic beverages
:. 4ensitive to fermented foods cheese&vinegar
;. 4ensitive to benzoate3containing food.
<. Dermatographia
?. (ndicators of reduced histamine metabolism"
0levated plasma histamine $)* ng,ml%
@educed DA1 activity $AB.+ nkat,>%
+. 2ormal serum (g0.
C. Positive family history
Histamine $oisoning
!istamine poisoning results from the
consumption of foods typically certain types
of fish and cheeses that contain unusually
high levels of histamine. 4poiled fish of the
families 4combridae $e.g. tuna mackerel
bonito% termed -scombroid fish poisoning.
cheeses especially 4wiss cheese can be
implicated in histamine poisoning.
The sym$toms of histamine $oisoning
include :
6.nausea vomiting diarrhea
*.oral burning sensation or peppery taste
:. hives itching red rash and hypotension.
;.#he onset of the symptoms usually occurs within
a few minutes after ingestion of the implicated
food and the duration of symptoms ranges from
a few hours to *; h.
<.Antihistamines can be used effectively to treat
this into&ication.
Management of Histamine Intolerance
Management of Histamine
Intolerance
+, Avoidance of foods that:
6. 'ontain high levels of histamine naturally"
#omato 4pinach
0ggplant !istamine3rich fruits
6. 'ontain histamine as a conse/uence of
manufacture"
Fermented foods and beverages
'heese Alcoholic beverages
Dinegars Fermented sausages
6. 'ontain histamine as a result of microbial
activity "2on3gutted fish4hellfish
*. @elease histamine"Eenzoates#artrazine .
-, Histamine Degrading %acteria

'ertain species of bacteria produce


diamine o&idase"
>actobacillus sp. 3 4arcina sp.

'apable of degrading food sources of


histamine
3 8ay reduce total histamine load
3 Possible role in probioticsF
!istame is the first product worldwide that
regulates histamine levels that can cause food
intolerance by replenishing the body5s
digestive enzyme Diamine o&idase or DA1.
!istame is not effective with immune system3
based food allergies

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