Clinical diagnosis of Histamine Intolerance

    The heterogenous nature of the aetiology, pathophysiology and clinical presentation of histamine intolerance and the variability of the validity and clinical information provided by commonly utilised assessment strategies are essential considerations in the accurate clinical diagnosis and effective clinical management of histamine intolerance.

-Histamine skin prick test: Determines presence of IgE-mediated ‘histamine wheal’ 50 minutes after exposure and IgE-sensitisation caused by food allergy.

-Whole blood histamine: Measures serum histamine and 1-methylhistamine levels.

-Serum tryptase: Presence of systemic mastocytosis.

-Urine methylhistamine: Indicates general dietary intake levels of histamine (and protein).

-DAO enzyme activity Serum: measures blood DAO activity.

-Intestinal biopsy: measures local DAO activity.

-Genetic:  measures genetic DAO deficiency polymorphisms.

-MCAS markers: Determine presence of inflammatory mediators released by mast cells (tryptase, histamine, prostaglandins, leukotrienes, DAO, and IgE).