Introduction: Diamine oxidase (DAO) catabolizes and inactivates histamine, a key player in a wide range of invalidating conditions, such as migraine and chronic spontaneous urticaria (CSU). The highest expression of DAO occurs in the gastrointestinal tract, possibly to control the burden of histamine intake from food. Methods: Here, we tested the hypothesis that a 30-day oral supplementation with DAO (1 capsule b.i.d., 15 min before a meal) could reduce the severity of CSU as estimated by the 7-Day Urticaria Activity Score (UAS-7). The study was designed as a double-blind, placebo-controlled, crossover investigation of 22 patients with CSU incompletely controlled by first-line antihistamine therapy. Results: Twenty patients completed the study. Supplemental therapy with DAO caused a 3.8 ± 1.2 point mean ± SEM UAS-7 score reduction in patients with low serum DAO levels at time 0 (p = 0.041 compared to placebo). The degree of UAS-7 improvement was inversely correlated with the levels of basal DAO (p = 0.019). Patients receiving DAO supplementation were able to slightly reduce their daily antihistamine dose (p = 0.049). Conclusion: These data suggest that DAO may be involved in the pathogenic cascade of CSU and that DAO supplementation could be effective for symptom relief in patients with low DAO levels in serum.

Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al: The EAACI/GA(2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy 2014; 69: 868–887.
Wernersson S, Pejler G: Mast cell secretory granules: armed for battle. Nat Rev Immunol 2014; 14: 478–494.
Garcia-Martin E, Martinez C, Serrador M, Alonso-Navarro H, Ayuso P, Navacerrada F, Agundez JA, Jimenez-Jimenez FJ: Diamine oxidase rs10156191 and rs2052129 variants are associated with the risk for migraine. Headache 2015; 55: 276–286.
Maintz L, Benfadal S, Allam JP, Hagemann T, Fimmers R, Novak N: Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema. J Allergy Clin Immunol 2006; 117: 1106–1112.
Shamji MH, Layhadi JA, Scadding GW, Cheung DK, Calderon MA, Turka LA, Phippard D, Durham SR: Basophil expression of diamine oxidase: a novel biomarker of allergen immunotherapy response. J Allergy Clin Immunol 2015; 135: 913–921. e919.
Naila A, Flint S, Fletcher GC, Bremer PJ, Meerdink G, Morton RH: Prediction of the amount and rate of histamine degradation by diamine oxidase (DAO). Food Chem 2012; 135: 2650–2660.
Stein J, Scheuermann EH, Yazdi R, Lembcke B, Caspary WF: Reduced postheparin plasma diamine oxidase activity in patients with chronic renal failure. Z Gastroenterol 1994; 32: 236–239.
Maintz L, Yu CF, Rodriguez E, Baurecht H, Bieber T, Illig T, Weidinger S, Novak N: Association of single nucleotide polymorphisms in the diamine oxidase gene with diamine oxidase serum activities. Allergy 2011; 66: 893–902.
Manzotti G, Breda D, Di Gioacchino M, Burastero SE: Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol 2016; 29: 105–111.
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