Histamine intolerance as a cause of chronic digestive complaints in pediatric patients.

INTRODUCTION: histamine intolerance (HI) is a poorly described disease in gastroenterology that may present with predominant digestive complaints. The goals of this study include a report of two cases diagnosed in a pediatric gastroenterology clinic. MATERIAL AND METHODS: observational, retrospective study of patients diagnosed with HI from September 2010 to December 2011 at the pediatric gastroenterology clinic of a tertiary hospital.They were deemed to have a diagnosis of HI in the presence of 2 or more characteristic digestive complaints, decreased diamino oxidase (DAO) levels and/or response to a low histamine diet with negative IgE-mediated food allergy tests. RESULTS: sixteen patients were diagnosed. Males predominated versus females (11/5). Mean age at symptom onset was 4 years (6 months vs. 13 years and 6 months) and mean age at diagnosis was 6 years and 6 months (17 months vs. 13 years and 11 months), with an interval of 2 years and 1 month between symptom onset and diagnosis (5 months vs. 4 years). Predominant symptoms included diffuse abdominal pain (16/16), intermittent diarrhea (10/16), headache (5/16), intermittent vomiting (4/16), and skin rash (2/16). The diagnosis was established by measuring plasma diamino oxidase levels, which were below 10 kU/L (normal > 10 kU/L) in 14 cases, and symptom clearance on initiating a low histamine diet. In two patients DAO levels were above 10 kU/L but responded to diet. Treatment was based on a diet low in histamine-contaning food, and antihistamines H1 y H2 had to be added for two cases. CONCLUSIONS: histamine intolerance is a little known disease with a potentially relevant incidence. Predominant complaints include diffuse abdominal pain, diarrhea, headache, and chronic intermittent vomiting. Its diagnosis is based on clinical suspicion, plasma DAO measurement, and response to a low histamine diet. Management with the latter provides immediate improvement.

Intolerancia a la histamina como causa de síntomas digestivos crónicos en pacientes pediátricos / Histamine intolerance as a cause of chronic digestive complaints in pediatric patients

Introducción: la intolerancia a la histamina (IH) es una patología poco descrita en gastroenterología y que puede tener una sintomatología digestiva predominante. Los objetivos de este estudio son describir los casos diagnosticados en una consulta de gastroenterología pediátrica. Material y métodos: estudio observacional y retrospectivo analizando los pacientes diagnosticados de IH desde septiembre de 2010 a diciembre de 2011 en la consulta de gastroenterología pediátrica de un hospital terciario. Se consideraron con diagnóstico de IH al presentar 2 o más síntomas digestivos característicos, determinación de diaminooxidasa disminuida y/o respuesta a la dieta baja en histamina con pruebas de alergia IgE-mediada a alimentos negativos. Resultados: se han diagnosticado 16 pacientes. Hubo un predominio de niños (11/5) frente a las niñas. La edad media al inicio de los síntomas fue de 4 años (6 meses vs. 13 años y 6 meses) y la edad media al diagnóstico fue de 6 años y 6 meses (17 meses vs. 13 años y 11 meses). Los síntomas predominantes fueron dolor abdominal difuso (16/16), diarrea intermitente (10/16), cefalea (5/16) y vómitos intermitentes (4/16). Conclusiones: la intolerancia a la histamina es una patología poco conocida pero con una incidencia que puede ser relevante. Los síntomas predominantes son dolor abdominal difuso, diarrea, cefalea y vómitos de aparición crónica e intermitente. El diagnóstico se realiza por sospecha clínica, determinación de diaminooxidasa plasmática y respuesta a dieta baja en histamina. Con el tratamiento de dieta baja en histamina presentan una mejoría inmediata (AU)

Introduction: histamine intolerance (HI) is a poorly described disease in gastroenterology that may present with predominant digestive complaints. The goals of this study include a report of two cases diagnosed in a pediatric gastroenterology clinic. Material and methods: observational, retrospective study of patients diagnosed with HI from September 2010 to December 2011 at the pediatric gastroenterology clinic of a tertiary hospital. They were deemed to have a diagnosis of HI in the presence of 2 or more characteristic digestive complaints, decreased diamino oxidase (DAO) levels and/or response to a low histamine diet with negative IgE-mediated food allergy tests. Results: sixteen patients were diagnosed. Males predominated versus females (11/5). Mean age at symptom onset was 4 years (6 months vs. 13 years and 6 months) and mean age at diagnosis was 6 years and 6 months (17 months vs. 13 years and 11 months), with an interval of 2 years and 1 month between symptom onset and diagnosis (5 months vs. 4 years). Predominant symptoms included diffuse abdominal pain (16/16), intermittent diarrhea (10/16), headache (5/16), intermittent vomiting (4/16), and skin rash (2/16). The diagnosis was established by measuring plasma diamino oxidase levels, which were below 10 kU/L (normal > 10 kU/L) in 14 cases, and symptom clearance on initiating a low histamine diet. In two patients DAO levels were above 10 kU/L but responded to diet. Treatment was based on a diet low in histamine-contaning food, and antihistamines H1 y H2 had to be added for two cases. Conclusions: histamine intolerance is a little known disease with a potentially relevant incidence. Predominant complaints include diffuse abdominal pain, diarrhea, headache, and chronic intermittent vomiting. Its diagnosis is based on clinical suspicion, plasma DAO measurement, and response to a low histamine diet. Management with the latter provides immediate improvement (AU)

Modelo de coparticipación de los facultativos en la gestión clínica eficiente de las pruebas subcontratadas / Multidisciplinary model in the efficient clinical management of requested tests

Introducción. El uso del laboratorio es inadecuado (excesivo o innecesario) y es preciso controlarlo. Material y métodos. Elaborar una estrategia para gestionar, según criterios de medicina basada en la evidencia, la derivación de pruebas subcontratadas y comparar los resultados entre dos años consecutivos. Resultados. La demanda se ha reducido un 6,56% y los costes un 26,9%. Es de destacar que solo el 1,9 % de los peticionarios a los que se les ha denegado alguna prueba contacta con el laboratorio para reclamar o mostrar su disconformidad. Conclusiones. El profesional del laboratorio clínico debe implicarse como consultor clínico para mejorar la eficiencia de las pruebas de laboratorio (AU)

Introduction. The use of the laboratory is inadequate and it is necessary to control it. Materials and methods. To elaborate a strategy to manage, according to evidence-based medicine criteria, the origin of requested tests and to compare the results between two consecutive years. Results. The demand has reduced by 6.56% and the costs by 26.9%. It is worth emphasizing that only 1.9% of the requesters, for which some test has been refused, contacts the laboratory to show disapproval. Conclusions. The professionals of the clinical laboratory must be involved in their function as clinical consultant to improve the efficiency of laboratory tests (AU)