Summary:
Histamine intolerance (HIT) is associated with impaired histamine breakdown, often due to diamine oxidase (DAO) deficiency. While HIT is well known for gastrointestinal and systemic symptoms, oral manifestations have not been previously described. Oral manifestations may include burning sensations in the mouth, sensitivity to acidic or histamine-rich foods, small red slightly raised patches on the tongue or oral mucosa, and general oral discomfort such as mild pain, tingling, or irritation. This study is a case series of five patients evaluated between 2022 and 2024 for persistent oral symptoms. Patients underwent detailed oral examinations and dietary assessments, focusing on the consumption of histamine-rich foods. All patients experienced oral burning, sensitivity to acidic foods, and raised patches on the tongue or oral mucosa. Symptoms were triggered by histamine-containing foods and improved with dietary restriction and antihistamines. Differential diagnoses considered included food allergies, plasma cell mucositis, fungal infections, lupus, and oral lichen planus. One case suggested a familial link, indicating a potential genetic component of DAO deficiency. These findings suggest that oral lesions may represent a previously unrecognized manifestation of HIT. Recognizing these signs could improve diagnosis in patients with unexplained oral symptoms. Further research is needed to establish diagnostic criteria and inform management strategies.
Abstract:
Background: Histamine intoxication, initially described as scombroid fish poisoning, is now recognized as histamine intolerance (HIT), a condition associated with impaired histamine metabolism, often due to diamine oxidase (DAO) deficiency. HIT presents with nonspecific gastrointestinal and systemic symptoms, frequently overlooked in clinical practice. While extraintestinal manifestations are well-documented, oral findings have not been previously described. Objective: This short communication presents the first reported cases of HIT diagnosed through oral lesions, providing a brief review of this emerging condition. Materials and methods: Five patients (2022-2024) were evaluated based on clinicopathological findings and dietary anamnesis, focusing on histamine-rich food intake. A thorough oral examination was conducted, and diagnostic criteria and differential diagnoses were reviewed. Results: All cases exhibited persistent oral burning, sensitivity to acidic foods, and erythematous velvety macules on oral mucosa. Symptoms correlated with histamine intake and improved with dietary restriction and antihistamines. Differential diagnoses included food allergies, plasma cell mucositis, fungal infections, lupus, and oral lichen planus. A familial case suggests a genetic component of DAO deficiency. Conclusions: Recognizing oral lesions as potential HIT manifestations may improve diagnostic accuracy in patients with unexplained mucosal symptoms. Further research is needed to establish standardized diagnostic criteria and optimize clinical management.
Article Publication Date: 24/04/2025
DOI: 10.1111/odi.15363
