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Zaczerwienienie twarzy – problem interdyscyplinarny. Nietolerancja histaminy w przebiegu niedoboru diaminooksydazy
Klinika Endokrynologii, Centrum Medyczne Kształcenia Podyplomowego, Warszawa
Kierownik Kliniki: prof. dr hab. med. Wojciech Zgliczyński
70-letnia kobieta ze stale występującymi: zaczerwienieniem twarzy, uczuciem parzenia policzków, diagnozowana była przed kilkoma laty w Klinice Endokrynologii z podejrzeniem rakowiaka. Okresowo występowały również bóle głowy, dolegliwości żołądkowe i bóle stawów. Z uwagi na niespecyficzny charakter dolegliwości pacjentka diagnozowana dermatologicznie, reumatologicznie i alergologicznie. W leczeniu stosowano wiele leków, m.in. sterydy, leki antyhistaminowe, antybiotykoterapię, kolchicynę, benzodiazepiny. Podjęto również próbę leczenia krótko działającym analogiem somatostatyny. Pomimo wielokierunkowych badań nie zidentyfikowano podłoża dolegliwości, a stosowane leczenie, często empiryczne, było nieskuteczne. Po kilkunastu latach u pacjentki wykonano oznaczenie poziomu histaminy we krwi, uzyskując istotnie podwyższony poziom. Poszukując przyczyny nadmiaru histaminy, wykonano oznaczenie diaminooksydazy (DAO) – enzymu rozkładającego tę aminę – i stwierdzono obniżoną jego aktywność. Rozpoznano nietolerancję histaminy i zastosowano dietę z ograniczeniem spożycia histaminy z dobrym efektem klinicznym. Nietolerancja histaminy powinna być brana pod uwagę przy diagnostyce niespecyficznych dolegliwości takich jak zaczerwienienie i pieczenie twarzy. W diagnostyce pomocne jest stwierdzenie obniżonej aktywności DAO we krwi. Continue reading
Petra Wigand, Maria Blettner, Joachim Saloga, Heinz Decker
Institute of Molecular Biophysics of the Johannes Gutenberg University Mainz
Wine is an ancient food product, ubiquitous across cultures all over the world. Its effects on health have been extensively studied, yet there have been only a few case reports of wine intolerance or wine allergy. We studied the prevalence of self-reported wine intolerance in the adult population of Mainz, Germany.
dr nauk biologicznych Patrycja Szachta
Instytut Mikroekologii w Poznaniu
Artykuł ukazał się w czasopiśmie specjalistycznym o żywności i żywieniu „Food Forum” nr 3/2013
Niepożądane reakcje na pokarm kojarzą się przede wszystkim z pojęciem alergii pokarmowej, dość niestety ostatnimi czasy nadużywanym. Częsta jest jednak sytuacja, gdy alergiczne podłoże dolegliwości zostaje wykluczone, tymczasem pacjent nadal czuje się źle po spożyciu pokarmu. Przyczyną takiego stanu rzeczy może być nietolerancja pokarmowa, częstokroć błędnie utożsamiana z alergią, z uwagi na podobieństwo objawów.
Elena García-Martín, MD, PhD; Carmen Martínez, MD, PhD; Mercedes Serrador, MD, PhD; Hortensia Alonso Navarro, MD, PhD; Pedro Ayuso, MD; Francisco Navacerrada, MD; José A. G. Agúndez MD, PhD; Félix Javier Jiménez-Jiménez, MD, PhD
Background.—Histamine has been implicated in the pathogenesis of migraine. We investigated the possible association between functional single nucleotide polymorphisms (SNPs) in the diamine oxidase gene (DAO; chromosome 7q36.1, involved in histamine metabolism) and the risk for migraine.
Methods.—We studied the frequency of the rs2052129, rs10156191, rs1049742, and rs1049793 genotypes and allelic variants in 197 patients with migraine and 245 healthy controls using a TaqMan-based qPCR Assay.
Results.—The DAO SNP rs10156191, which is related to decreased DAO enzyme activity, is associated with the risk of
developing migraine, particularly in women. The odds ratio (OR) for the defect allele positivity is 1.61 (95% confidence interval 1.31-2.37) for overall migraine patients and 2.08 (1.29-3.36) for women suffering from migraine. The association was not influenced by confounders such as the age at onset, the presence of aura, positivity of alcohol as a triggering factor, positive family history of aura, or family history of allergy. Multiple regression analyses did not confirm association with the rest of genetic factors.
Conclusion.—Our findings, which should be framed as hypothesis generating, suggest that DAO genotypes and allelic
variants are associated with the risk for migraine in Caucasian Spanish people, especially in women.
Key words: migraine, genetics, histamine, diamine oxidase gene, risk factor, biomarker
Alergia czy nietolerancja histaminy – podobieństwo kliniczne odmiennych typów nadwrażliwości pokarmowej
Instytut Mikroekologii w Poznaniu
Artykuł ukazał się w czasopiśmie „Dermatologia Praktyczna” nr 1/2014
Stosunkowo niedawno odkrytym typem nadwrażliwości pokarmowej jest nietolerancja aminy biogennej – histaminy. Histamina jest wytwarzana fizjologicznie w ludzkim organizmie oraz przyjmowana z żywnością. O nietolerancji histaminy mówimy, gdy ilość opisywanej aminy w organizmie przekroczy próg tolerancji. Wynika to najczęściej ze zmniejszenia ilości bądź aktywności enzymu rozkładającego histaminę – oksydazy diaminowej (diamine oxidase – DAO), przy jednoczesnej wysokiej zawartości histaminy spożywanej w pokarmach. Objawy nietolerancji histaminy są zróżnicowane i mogą występować z różnym nasileniem, aż do sytuacji zagrożenia życia (wstrząs anafilaktyczny). Do typowych objawów zaliczamy wodnisty katar lub zaczerwienienie i świąd skóry, przypominające reakcję alergiczną. Równie często opisywana nadwrażliwość objawia się migrenami, zaburzeniami rytmu serca, bolesnymi menstruacjami, pokrzywką oraz dolegliwościami ze strony przewodu pokarmowego (biegunka, bóle brzucha). Objawy nietolerancji histaminy u pacjenta wyzwala nie tylko spożycie pokarmów bogatych w aminę, ale również inhibitorów DAO bądź stymulatorów produkcji aminy. Są to przede wszystkim produkty przetworzone, przeznaczone do dłuższego przechowywania i dojrzewające, podsuszane wędliny, sery, ryby i owoce morza oraz wybrane owoce i warzywa. Bogatym źródłem histaminy są napoje alkoholowe, szczególnie czerwone wino. Zdiagnozowanie nietolerancji histaminy jest trudne, gdyż towarzyszące jej reakcje sugerują występowanie alergii pokarmowej. Osoba nietolerująca histaminy musi stosować się do wytycznych niskohistaminowej diety eliminacyjnej bądź przyjmować suplementy diety zawierające egzogenną oksydazę diaminową, uzupełniając tym samym niedobory enzymatyczne w organizmie.