Spectrum, Time Course, Stages, and a Proposal for the Diagnosis of Histamine Intolerance in General Practice: A Nonrandomized, Quasi-Experimental Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Establishment of a HIT Symptom Frequency Score
2.3. Analysis of Doctor–Patient Meetings Involving Upper Respiratory Symptoms
3. Results
3.1. Formation and Symptom Frequency of HIT and Non-HIT Patient Groups
3.2. Analysis of Predictors for HIT
3.3. Analysis of the Second Questionnaire Data
3.4. General Trends Based on the Food and Symptom Diaries
3.5. Upper Respiratory Symptoms Among HIT Patients
4. Discussion
4.1. Symptom Spectrum of HIT
4.2. Severe Symptoms Associated with HIT
4.3. Proposed Diagnostic Steps for HIT
4.4. Limitations of This Study
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BMI | body mass index |
CI | confidence interval |
DAO | diamine oxidase |
HIT | histamine intolerance |
HNMT | histamine N-methyltransferase |
IBS | irritable bowel syndrome |
ICD-10 | International Classification of Diseases, 10th Revision |
MCA | mast cell activation |
MCAD | mast cell activation disorder |
MCAS | mast cell activation syndrome |
References
- Jochum, C. Histamine Intolerance: Symptoms, Diagnosis, and Beyond. Nutrients 2024, 16, 1219. [Google Scholar] [CrossRef] [PubMed]
- Sánchez-Pérez, S.; Comas-Basté, O.; Costa-Catala, J.; Iduriaga-Platero, I.; Veciana-Nogués, M.T.; Vidal-Carou, M.C.; Latorre-Moratalla, M.L. The Rate of Histamine Degradation by Diamine Oxidase Is Compromised by Other Biogenic Amines. Front. Nutr. 2022, 9, 897028. [Google Scholar] [CrossRef] [PubMed]
- Reese, I.; Ballmer-Weber, B.; Beyer, K.; Dölle-Bierke, S.; Kleine-Tebbe, J.; Klimek, L.; Lämmel, S.; Lepp, U.; Saloga, J.; Schäfer, C.; et al. Guideline on management of suspected adverse reactions to ingested histamine: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA) as well as the Swiss Society for Allergology and Immunology (SGAI) and the Austrian Society for Allergology and Immunology (ÖGAI). Allergol. Sel. 2021, 5, 305–314. [Google Scholar]
- Yuan, H.; Silberstein, S.D. Histamine and Migraine. Headache 2018, 58, 184–193. [Google Scholar] [CrossRef]
- de Mora, F.; Messlinger, K. Is calcitonin gene-related peptide (CGRP) the missing link in food histamine-induced migraine? A review of functional gut-to-trigeminovascular system connections. Drug Discov. Today 2024, 29, 103941. [Google Scholar] [CrossRef] [PubMed]
- Chen, J.; Chen, X.; Xie, Y.; Sun, Y.; Wang, X.; Hesketh, T. Irritable bowel syndrome and migraine: Evidence from Mendelian randomization analysis in the UK Biobank. Expert. Rev. Gastroenterol. Hepatol. 2021, 15, 1233–1239. [Google Scholar] [CrossRef] [PubMed]
- Wongtrakul, W.; Charoenngam, N.; Ungprasert, P. Increased prevalence of irritable bowel syndrome in migraine patients: A systematic review and meta-analysis. Eur. J. Gastroenterol. Hepatol. 2022, 34, 56–63. [Google Scholar] [CrossRef]
- Ferretti, A.; Gatto, M.; Velardi, M.; Di Nardo, G.; Foiadelli, T.; Terrin, G.; Cecili, M.; Raucci, U.; Valeriani, M.; Parisi, P. Migraine, Allergy, and Histamine: Is There a Link? J. Clin. Med. 2023, 12, 3566. [Google Scholar] [CrossRef] [PubMed]
- Wei, C.C.; Lin, C.L.; Shen, T.C.; Chen, A.C. Children with allergic diseases have an increased subsequent risk of migraine upon reaching school age. J. Investig. Med. 2018, 66, 1064–1068. [Google Scholar] [CrossRef] [PubMed]
- Wang, L.; Deng, Z.R.; Zu, M.D.; Zhang, J.; Wang, Y. The Comorbid Relationship Between Migraine and Asthma: A Systematic Review and Meta-Analysis of Population-Based Studies. Front. Med. 2020, 7, 609528. [Google Scholar] [CrossRef] [PubMed]
- Bin Abdulrahman, K.A.; Alenazi, N.S.; Albishri, S.B.; Alshehri, F.F. Association of Migraine and Irritable Bowel Syndrome in Saudi Arabia: A Nationwide Survey. Biomed. Res. Int. 2022, 2022, 8690562. [Google Scholar] [CrossRef]
- Blitshteyn, S. Dysautonomia, Hypermobility Spectrum Disorders and Mast Cell Activation Syndrome as Migraine Comorbidities. Curr. Neurol. Neurosci. Rep. 2023, 23, 769–776. [Google Scholar] [CrossRef] [PubMed]
- Afrin, L.B.; Butterfield, J.H.; Raithel, M.; Molderings, G.J. Often seen, rarely recognized: Mast cell activation disease—A guide to diagnosis and therapeutic options. Ann. Med. 2016, 48, 190–201. [Google Scholar] [CrossRef]
- Valent, P.; Akin, C.; Bonadonna, P.; Hartmann, K.; Brockow, K.; Niedoszytko, M.; Nedoszytko, B.; Siebenhaar, F.; Sperr, W.R.; Oude Elberink, J.N.G.; et al. Proposed Diagnostic Algorithm for Patients with Suspected Mast Cell Activation Syndrome. J. Allergy Clin. Immunol. Pract. 2019, 7, 1125–1133.e1. [Google Scholar] [CrossRef]
- Valent, P.; Akin, C.; Nedoszytko, B.; Bonadonna, P.; Hartmann, K.; Niedoszytko, M.; Brockow, K.; Siebenhaar, F.; Triggiani, M.; Arock, M.; et al. Diagnosis, Classification and Management of Mast Cell Activation Syndromes (MCAS) in the Era of Personalized Medicine. Int. J. Mol. Sci. 2020, 21, 9030. [Google Scholar] [CrossRef] [PubMed]
- Afrin, L.B.; Ackerley, M.B.; Bluestein, L.S.; Brewer, J.H.; Brook, J.B.; Buchanan, A.D.; Cuni, J.R.; Davey, W.P.; Dempsey, T.T.; Dorff, S.R.; et al. Diagnosis of mast cell activation syndrome: A global “consensus-2”. Diagnosis 2021, 8, 137–152. [Google Scholar] [CrossRef]
- Valent, P.; Hartmann, K.; Bonadonna, P.; Gülen, T.; Brockow, K.; Alvarez-Twose, I.; Hermine, O.; Niedoszytko, M.; Carter, M.C.; Hoermann, G.; et al. Global Classification of Mast Cell Activation Disorders: An ICD-10-CM-Adjusted Proposal of the ECNM-AIM Consortium. J. Allergy Clin. Immunol. Pract. 2022, 10, 1941–1950. [Google Scholar] [CrossRef] [PubMed]
- Valent, P.; Hartmann, K.; Bonadonna, P.; Niedoszytko, M.; Triggiani, M.; Arock, M.; Brockow, K. Mast Cell Activation Syndromes: Collegium Internationale Allergologicum Update 2022. Int. Arch. Allergy Immunol. 2022, 183, 693–705. [Google Scholar] [CrossRef]
- Molderings, G.J.; Haenisch, B.; Bogdanow, M.; Fimmers, R.; Nothen, M.M. Familial occurrence of systemic mast cell activation disease. PLoS ONE 2013, 8, e76241. [Google Scholar] [CrossRef]
- Schnedl, W.J.; Lackner, S.; Enko, D.; Schenk, M.; Holasek, S.J.; Mangge, H. Evaluation of symptoms and symptom combinations in histamine intolerance. Intest. Res. 2019, 17, 427–433. [Google Scholar] [CrossRef] [PubMed]
- Moskatel, L.S.; Zhang, N. Migraine and Diet: Updates in Understanding. Curr. Neurol. Neurosci. Rep. 2022, 22, 327–334. [Google Scholar] [CrossRef] [PubMed]
- Vassilopoulou, E.; Konstantinou, G.N.; Dimitriou, A.; Manios, Y.; Koumbi, L.; Papadopoulos, N.G. The Impact of Food Histamine Intake on Asthma Activity: A Pilot Study. Nutrients 2020, 12, 3402. [Google Scholar] [CrossRef] [PubMed]
- Ceren Akgör, M.; Ekizoğlu, E.; Özge, A. Dairy and Headaches: What is the Connection? Curr. Pain Headache Rep. 2024, 28, 1255–1264. [Google Scholar] [CrossRef] [PubMed]
- Gazerani, P. Migraine and Diet. Nutrients 2020, 12, 1658. [Google Scholar] [CrossRef] [PubMed]
- Sanchez-Perez, S.; Comas-Baste, O.; Veciana-Nogues, M.T.; Latorre-Moratalla, M.L.; Vidal-Carou, M.C. Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content? Nutrients 2021, 13, 1395. [Google Scholar] [CrossRef] [PubMed]
- San Mauro Martin, I.; Brachero, S.; Garicano Vilar, E. Histamine intolerance and dietary management: A complete review. Allergol. Immunopathol. 2016, 44, 475–483. [Google Scholar] [CrossRef]
- Komericki, P.; Klein, G.; Reider, N.; Hawranek, T.; Strimitzer, T.; Lang, R.; Kranzelbinder, B.; Aberer, W. Histamine intolerance: Lack of reproducibility of single symptoms by oral provocation with histamine: A randomised, double-blind, placebo-controlled cross-over study. Wien. Klin. Wochenschr. 2011, 123, 15–20. [Google Scholar] [CrossRef]
- Comas-Baste, O.; Sanchez-Perez, S.; Veciana-Nogues, M.T.; Latorre-Moratalla, M.; Vidal-Carou, M.D.C. Histamine Intolerance: The Current State of the Art. Biomolecules 2020, 10, 1181. [Google Scholar] [CrossRef]
- Shulpekova, Y.O.; Nechaev, V.M.; Popova, I.R.; Deeva, T.A.; Kopylov, A.T.; Malsagova, K.A.; Kaysheva, A.L.; Ivashkin, V.T. Food Intolerance: The Role of Histamine. Nutrients 2021, 13, 3207. [Google Scholar] [CrossRef]
- Zhao, Y.; Zhang, X.; Jin, H.; Chen, L.; Ji, J.; Zhang, Z. Histamine Intolerance-A Kind of Pseudoallergic Reaction. Biomolecules 2022, 12, 454. [Google Scholar] [CrossRef] [PubMed]
- Nazar, W.; Plata-Nazar, K.; Sznurkowska, K.; Szlagatys-Sidorkiewicz, A. Histamine Intolerance in Children: A Narrative Review. Nutrients 2021, 13, 1486. [Google Scholar] [CrossRef] [PubMed]
- Schnedl, W.J.; Schenk, M.; Michaelis, S.; Enko, D.; Mangge, H. Functional Abdominal Pain Disorders in Children May Be Associated with Food Intolerance/Malabsorption. Children 2023, 10, 1444. [Google Scholar] [CrossRef] [PubMed]
- Velicky, P.; Windsperger, K.; Petroczi, K.; Pils, S.; Reiter, B.; Weiss, T.; Vondra, S.; Ristl, R.; Dekan, S.; Fiala, C.; et al. Pregnancy-associated diamine oxidase originates from extravillous trophoblasts and is decreased in early-onset preeclampsia. Sci. Rep. 2018, 8, 6342. [Google Scholar] [CrossRef]
- Boehm, T.; Pils, S.; Gludovacz, E.; Szoelloesi, H.; Petroczi, K.; Majdic, O.; Quaroni, A.; Borth, N.; Valent, P.; Jilma, B. Quantification of human diamine oxidase. Clin. Biochem. 2017, 50, 444–451. [Google Scholar] [CrossRef] [PubMed]
- Wöhrl, S.; Hemmer, W.; Focke, M.; Rappersberger, K.; Jarisch, R. Histamine intolerance-like symptoms in healthy volunteers after oral provocation with liquid histamine. Allergy Asthma Proc. 2004, 25, 305–311. [Google Scholar] [PubMed]
- Sánchez-Pérez, S.; Comas-Basté, O.; Duelo, A.; Veciana-Nogués, M.T.; Berlanga, M.; Latorre-Moratalla, M.L.; Vidal-Carou, M.C. Intestinal Dysbiosis in Patients with Histamine Intolerance. Nutrients 2022, 14, 1774. [Google Scholar] [CrossRef] [PubMed]
- Sánchez-Pérez, S.; Comas-Basté, O.; Duelo, A.; Veciana-Nogués, M.T.; Berlanga, M.; Vidal-Carou, M.C.; Latorre-Moratalla, M.L. The dietary treatment of histamine intolerance reduces the abundance of some histamine-secreting bacteria of the gut microbiota in histamine intolerant women. A pilot study. Front. Nutr. 2022, 9, 1018463. [Google Scholar] [CrossRef]
- Mihele, D.M.; Nistor, P.A.; Bruma, G.; Mitran, C.I.; Mitran, M.I.; Condrat, C.E.; Tovaru, M.; Tampa, M.; Georgescu, S.R. Mast Cell Activation Syndrome Update-A Dermatological Perspective. J. Pers. Med. 2023, 13, 1116. [Google Scholar] [CrossRef]
- Afrin, L.B.; Self, S.; Menk, J.; Lazarchick, J. Characterization of Mast Cell Activation Syndrome. Am. J. Med. Sci. 2017, 353, 207–215. [Google Scholar] [CrossRef]
- Tamasi, J.; Balla, Z.; Csuka, D.; Kalabay, L.; Farkas, H. The Missing Link: A Case of Severe Adverse Reaction to Histamine in Food and Beverages. Am. J. Case Rep. 2022, 23, e934212. [Google Scholar] [CrossRef]
- Weinstock, L.B.; Pace, L.A.; Rezaie, A.; Afrin, L.B.; Molderings, G.J. Mast Cell Activation Syndrome: A Primer for the Gastroenterologist. Dig. Dis. Sci. 2021, 66, 965–982. [Google Scholar] [CrossRef] [PubMed]
- Hrubisko, M.; Danis, R.; Huorka, M.; Wawruch, M. Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients 2021, 13, 2228. [Google Scholar] [CrossRef] [PubMed]
- Rentzos, G.; Weisheit, A.; Ekerljung, L.; van Odijk, J. Measurement of diamine oxidase (DAO) during low-histamine or ordinary diet in patients with histamine intolerance. Eur. J. Clin. Nutr. 2024, 78, 726–731. [Google Scholar] [CrossRef] [PubMed]
- Arih, K.; Đorđević, N.; Košnik, M.; Rijavec, M. Evaluation of Serum Diamine Oxidase as a Diagnostic Test for Histamine Intolerance. Nutrients 2023, 15, 4246. [Google Scholar] [CrossRef] [PubMed]
- Zingone, F.; Bertin, L.; Maniero, D.; Palo, M.; Lorenzon, G.; Barberio, B.; Ciacci, C.; Savarino, E.V. Myths and Facts about Food Intolerance: A Narrative Review. Nutrients 2023, 15, 4969. [Google Scholar] [CrossRef] [PubMed]
- Tuck, C.J.; Biesiekierski, J.R.; Schmid-Grendelmeier, P.; Pohl, D. Food Intolerances. Nutrients 2019, 11, 1684. [Google Scholar] [CrossRef] [PubMed]
Baseline Characteristics | All Patients (n = 217) | Patients with HIT (n = 77) | Patients Without HIT (n = 140) | p * |
---|---|---|---|---|
Mean age (years) | 38.4 ± 12.7 (18–73) | 37.8 ± 11.4 (19–68) | 38.7 ± 13.4 (18–73) | NS * |
Males/Females | 29%/71% | 31%/69% | 29%/71% | |
Mean age at symptom onset | 22.4 ± 12.7 | 21.3 ± 11.9 | 23 ± 13.2 | NS * |
Onset of symptoms between the ages of 10 and 35 years | 175/217 (81%) | 63/77 (82%) | 112/140 (80%) | |
Average duration of symptoms from onset | 16.1 ± 13.1 | 16.6 ± 12.1 | 15.9 ± 13.7 | NS * |
Gastrointestinal symptoms | ||
Bloating | 72/77 | 94% |
Diarrhea or loose stools | 59/77 | 77% |
Dyspepsia | 53/77 | 69% |
Abdominal pain | 52/77 | 68% |
Early satiety/discomfort | 51/77 | 66% |
Nausea | 41/77 | 53% |
Abdominal cramping | 37/77 | 48% |
Prone to stomachaches as a child | 29/77 | 38% |
Frequent recurrences of aphthae or herpes | 28/77 | 36% |
Vomiting | 19/77 | 25% |
Neurological symptoms | ||
Headache | 70/77 | 91% |
Fatigue/weakness/weariness | 64/77 | 83% |
Postprandial somnolence | 62/77 | 81% |
Dull, symmetrical headache | 44/77 | 57% |
Migraine or migraine-like (unilateral, throbbing) headache | 41/77 | 53% |
Dizziness | 41/77 | 53% |
Respiratory symptoms | ||
Runny nose | 52/77 | 68% |
Nasal congestion | 46/77 | 60% |
Postnasal drip, throat clearing | 44/77 | 57% |
Sneezing | 39/77 | 51% |
Sore throat | 29/77 | 38% |
Cough | 27/77 | 35% |
Asthma or asthmatic symptoms (cough, wheezing, dyspnea, etc.) | 16/77 | 21% |
Miscellaneous symptoms | ||
Skin symptoms | 67/77 | 87% |
Psychological | 59/77 | 77% |
Muscle twitching | 47/77 | 61% |
Cardiovascular (hypotension, presyncope, palpitations) | 42/77 | 55% |
Food items that caused complaints in patients with histamine intolerance | ||
Wine | 56/77 | 73% |
Champagne | 52/77 | 68% |
Various types of sausages | 45/77 | 58% |
Tomato concentrate | 42/77 | 55% |
Strong spices | 40/77 | 52% |
Dairy products | 39/77 | 51% |
Cheese or aged cheese | 34/77 | 44% |
Onions | 33/77 | 43% |
Citrus fruits | 30/77 | 39% |
Coffee | 29/77 | 38% |
Chocolate | 27/77 | 35% |
Pickles | 26/77 | 34% |
(A) | ||||
---|---|---|---|---|
Symptoms | All Patients (n = 217) | Patients with HIT (n = 77) | Patients Without HIT (n = 140) | p a |
Bloating | 180 (83%) | 72 (94%) | 108 (77%) | 0.001 a |
Diarrhea/loose stools | 153 (71%) | 59 (77%) | 94 (67%) | NS a |
Dyspepsia | 143 (66%) | 53 (69%) | 90 (64%) | NS a |
Nausea | 122 (56%) | 41 (53%) | 81 (58%) | NS a |
Vomiting | 59 (27%) | 19 (25%) | 40 (29%) | NS a |
Abdominal pain | 119 (55%) | 52 (68%) | 67 (48%) | 0.004 a |
Headache | 198 (91%) | 70 (91%) | 128 (91%) | NS a |
Migraine-like headache | 108 (50%) | 41 (53%) | 67 (48%) | NS a |
Dull headache | 133 (61%) | 44 (57%) | 89 (64%) | NS a |
Postprandial somnolence | 170 (78%) | 62 (81%) | 108 (77%) | NS a |
Dizziness | 106 (49%) | 41 (53%) | 65 (46%) | NS a |
Sore throat | 58 (27%) | 29 (38%) | 29 (21%) | 0.006 a |
Runny nose | 129 (59%) | 52 (68%) | 77 (55%) | 0.048 a |
Cough | 79 (36%) | 27 (35%) | 52 (37%) | NS a |
Sneezing | 110 (51%) | 39 (51%) | 71 (51%) | NS a |
Asthmatic complaints | 52 (24%) | 16 (21%) | 36 (26%) | NS a |
Congested nose | 121 (56%) | 46 (60%) | 75 (54%) | NS a |
Postnasal drip | 104 (48%) | 44 (57%) | 60 (43%) | 0.03 a |
Flush | 52 (24%) | 23 (29%) | 29 (21%) | NS a |
Brain fog | 117 (54%) | 43 (56%) | 74 (53%) | NS a |
Muscle twitching | 128 (59%) | 47 (61%) | 81 (58%) | NS a |
Fatigue/weakness | 178 (82%) | 64 (83%) | 114 (81%) | NS a |
Aphtha/herpes labialis | 66 (30%) | 28 (36%) | 38 (27%) | NS a |
(B) | ||||
Average count of complaints | All patients (n = 217) Mean ± SD Median (Q1–Q3) | Patients with HIT (n = 77) Mean ± SD Median (Q1–Q3) | Patients without HIT (n = 140) Mean ± SD Median (Q1–Q3) | p b |
Average count of gastrointestinal complaints (0–18) | 6.3 ± 3 6 (4–8) | 6.8 ± 2.8 7 (5–9) | 6 ± 3 6 (4–8) | 0.024 b |
Average count of neurologic complaints (0–9) | 4.8 ± 1.6 5 (4–6) | 4.9 ± 1.7 5 (4–6) | 4.7 ± 1.6 5 (4–5) | 0.013 b |
Average count of respiratory complaints (0–10) | 3.4 ± 2.3 4 (2–5) | 4.1 ± 2.1 4 (2–5) | 3.6 ± 2.4 4 (2–5) | NS b |
Average count of skin complaints (0–8) | 1.7 ± 1.4 1 (1–3) | 2 ± 1.3 2 (1–3) | 1.5 ± 1.4 1 (0–2) | 0.009 b |
Average count of psychiatric complaints (0–9) | 2.5 ± 2.3 2 (1–4) | 2.8 ± 2.5 2 (1–5) | 2.4 ± 2.2 2 (0.5–4) | NS b |
Average count of cardiovascular complaints (0–3) | 0.8 ± 0.9 1 (0–1) | 0.8 ± 0.1 1 (0–1) | 0.7 ± 0.8 1 (0–1) | NS b |
Average count of not-tolerated foods (0–26) | 6.8 ± 4.8 6 (3–10) | 8.9 ± 5 9 (5–12) | 5.6 ± 4.2 5 (2–7.5) | <0.001 b |
(C) | ||||
Anamnestic data | All patients (n = 217) | Patients with HIT (n = 77) | Patients without HIT (n = 140) | p a |
Feeling more energetic on an empty stomach | 138/217 (64%) | 51/77 (66%) | 87/140 (62%) | NS a |
No symptoms during pregnancy (especially in second and third trimesters) | 67/71 (94%) | 25/26 (96%) | 42/45 (93%) | NS a |
Onset of symptoms can be attributed to meals | 145/217 (67%) | 67/77 (87%) | 78/140 (56%) | <0.001 a |
Onset of symptoms usually in the afternoon or evening | 137/217 (63%) | 48/78 (62%) | 89/140 (63%) | NS a |
Children with similar symptoms | 43/87 (49%) | 18/35 (51%) | 25/52 (48%) | NS a |
Headaches or chronic diarrhea in the family | 144/217 (66%) | 54/77 (70%) | 90/140 (64%) | NS a |
HIT in the family | 27/217 (15%) | 13/77 (17%) | 14/140 (8%) | NS a |
Family member who has taken or is taking medication for reflux | 99/217 (54%) | 39/77 (51%) | 60/140 (33%) | NS a |
(A) | ||||
---|---|---|---|---|
Initial/pre-diet Questionnaire | All Patients (n = 217) Median (Q1–Q3) Mean ± SD | Patients with HIT (n = 77) Median (Q1–Q3) Mean ± SD | Patients Without HIT (n = 140) Median (Q1–Q3) Mean ± SD | p |
Body mass index (kg/m2) (Q1–Q3) | 23.2 (20.6–27) 24.5 ± 5 | 22.6 (20.3–25.7) 23.2 ± 3.9 | 24.3 (21.1–28.3) 25.2 ± 5.4 | 0.008 a |
Histamine intolerance frequency score (0–5) | 3 (3–4) 3.25 ± 1 | 3 (3–4) 3.5 ± 1 | 3 (2–4) 3.1 ± 1 | 0.0025 a |
Histamine intolerance symptom severity score (0–10) | 8 (6–9) 7.4 ± 1.8 | 8 (8–9) 7.5 ± 1.9 | 7 (6–9) 7.3 ± 1.7 | NS a |
DAO concentration (kU/L) | 8 (5.4–10.6) 8.7 ± 5.2 | 7 (5–9) 7.3 ± 3.2 | 8.95 (6.85–17.9) 8.1 ± 7 | 0.015 a |
DAO concentration below the specified limit of 10 kU/L | 37/50 (74%) | 29/35 (81%) | 8/15 (53%) | 0.03 b |
(B) | ||||
Second/post-diet questionnaire | Patients with HIT (n = 77) Median (Q1–Q3) Mean ± SD | p | ||
Histamine intolerance frequency score (0–5) average following dietary adjustments | 2 (1–2.75) 1.75 ± 1.3 | <0.0001 c | ||
Histamine intolerance symptom severity score average (0–10) following dietary adjustments | 3 (1–4.75) 2.9 ± 2.2 | <0.0001 c |
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Tamasi, J.; Kalabay, L. Spectrum, Time Course, Stages, and a Proposal for the Diagnosis of Histamine Intolerance in General Practice: A Nonrandomized, Quasi-Experimental Study. J. Clin. Med. 2025, 14, 311. https://doi.org/10.3390/jcm14020311
Tamasi J, Kalabay L. Spectrum, Time Course, Stages, and a Proposal for the Diagnosis of Histamine Intolerance in General Practice: A Nonrandomized, Quasi-Experimental Study. Journal of Clinical Medicine. 2025; 14(2):311. https://doi.org/10.3390/jcm14020311
Chicago/Turabian StyleTamasi, József, and László Kalabay. 2025. "Spectrum, Time Course, Stages, and a Proposal for the Diagnosis of Histamine Intolerance in General Practice: A Nonrandomized, Quasi-Experimental Study" Journal of Clinical Medicine 14, no. 2: 311. https://doi.org/10.3390/jcm14020311
APA StyleTamasi, J., & Kalabay, L. (2025). Spectrum, Time Course, Stages, and a Proposal for the Diagnosis of Histamine Intolerance in General Practice: A Nonrandomized, Quasi-Experimental Study. Journal of Clinical Medicine, 14(2), 311. https://doi.org/10.3390/jcm14020311