The clinical labyrinth: ruling out real allergies and hidden pathologies

The investigation of histamine imbalance requires, firstly, the ruling out of structural or primary immunological causes. 

Joint guidelines established by the German Society of Allergology and Clinical Immunology and the Swiss Society of Allergology ^[1] emphasise the need to differentiate non-allergic hypersensitivity from IgE-mediated reactions, the classic allergies. For this, specific antibody tests are the mandatory initial step to ensure the food safety of the person being analysed.

In addition to true food allergies, it is vital to distinguish enzymatic imbalance from diseases of the mast cell itself. Researchers and world consortia, according to the journal Diagnosis ^[2], propose rigorous diagnostic algorithms to exclude Mast Cell Activation Syndrome and Systemic Mastocytosis. In these cases, serum tryptase measurement is often used, a marker that is usually elevated in mast cell proliferation pathologies, but which remains normal in histamine sensitivity.

Only after negative results for true allergies, coeliac disease and structural mast cell disorders does clinical suspicion fall on a deficiency in the processing and degradation of histamine.

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References:

[1] Allergo Journal International, 2017

[2] Diagnosis, 2021

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