Mirna Šitum

Histamine intolerance - Dermatologic sequels

Autoimmune bullous diseases are a group of intraand subepidermal disorders with different course and prognosis. Most of them are serious diseases which have to be treated for longer period and controlled by experienced dermatologist. Pemphigus group of diseases is characterized by acantholysis in the epithelium of mucous membranes or / and the skin. These diseases can have significant morbidity and morality as a result of complications of the disease or side-effects of the therapy. Mainstay of the therapy of pemphigus are corticosteroids. Usually together with corticosteroids, steroid-sparing agents i.e. azathioprine or mycophenate mofetil are introduced to reduce side-effects of corticosteroids and to make remision periods longer. Patients who do not respond to these therapies should be treated with intravenous immunoglobulins, cyclophosphamide or rituximab.Histamine intolerance (HIT) develops as a result of an impaired diamine oxidase (DA0) activity due to gastrointestinal disease or through DA0 inhibition, as well as through a genetic predis-position which was proven in a number of patients. The intake of histamine- rich foods as well as alcohol or drugs which cause either the release of histamine or the blocking of DA0 can lead to various disorders in many organs (gastrointestinal system, skin, lungs, cardiovascular system and the brain), depending on the expression of histamine receptors. Dermatologic sequels can be rashes, itch, urticaria, angioedema, dermatitis, eczema and even acne, rosacea, psoriasis and other. The recognizing of symptoms due to HIT is especially important in treating such patients. Because of the possibility of symptoms affecting numerous organs, a detailed history of symptoms following the intake of histamine rich foods or drugs that interfere with histamine metabolism is essential for making a diagnosis of HIT. Considering that such symptoms ran be a result of multiple factors, the existence of HIT is usually underestimated, 5 expectations are being made from the future studies.