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The relationship between biogenic amines and human pathologies has been known for many years. Biogenic amines are involved in carcinogenesis and tumor invasion (ornithine-derived polyamines and histamine), allergy and immune response in general (histamine), and neurological disorders such as Parkinson s disease, Alzheimer s disease, and depression (serotonin, dopamine, histamine). Pathological disorders mainly related to histamine are cancer, oxidative stress, and allergy (218 222). Tyramine is involved in migraine,
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hypertension, Parkinson s disease, and depression (223). Polyamines are involved in neural injury, muscular dystrophy, Alzheimer s disease, and cancer (224 227). The biogenic amine content of various foods has been widely studied because of their potential toxicity. Food poisoning may occur especially in conjunction with potentiating factors such as monoamine oxidase inhibiting (MAOI) drugs, alcohol, gastrointestinal diseases, and other amines. Only histamine has legal limits established for food but some countries have regulated the maximum amounts of other biogenic amines in different foods. Tyramine and 2-phenylethylamine have been proposed as the initiators of hypertensive crisis in certain patients and of dietary-induced migraine. Aged cheeses are the most frequently reported food and most serious of the case reports. The phenomenon is the so-called cheese reaction caused by high amounts of tyramine in cheese. McCabe et al. recently published a critical review on tyramine in foods and MAOI drugs (227). Table 3.2.9 summarizes the percentage of published values of foods by categories that have been found to contain clinically signi cant amounts of tyramine. The presence of 6-mg tyramine in one or two usual servings is thought to be suf cient to cause a mild adverse event, while 10 25 mg will produce a severe adverse event in those using MAOI drugs (228, 229). For unmedicated adults, 200 800 mg of dietary tyramine is needed to induce a mild rise (30 mm Hg) in blood pressure (230). Histamine intoxication, also called scombrotoxicosis, is still one of the most common seafood intoxications. Histamine poisoning is usually related to the consumption of scombroid sh such as tuna, mackerel, and sardines (231 235). However, reliable statistics about its incidence do not exist because the poisoning incidents are often unreported because of the mild nature of the
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TABLE 3.2.9 Percentage of food analyzed for tyramine that had clinically signi cant (>6 mg) quantities. Number with clinical signi cant levels Number 18 12 20 5 4 % 25 30 27 24 12
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Food Cheese Asian dishes (fermented) Meat/meat products Sauces ( sh, shrimp, soy) Tap beer
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Data from Reference 227.
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Total number of published values 71 37 74 21 34
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TABLE 3.2.10 Outbreaks of HFP in the United States, the United Kingdom, and Australia. Country United States United Kingdom Australia Period 1990 2000 1992 1999 1990 2000 Number of outbreaks 103 47 10 Percentage of all seafood outbreaks 43 31 Total ill 680 28
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Data from Reference 242.
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illness, lack of adequate systems for reporting foodborne diseases, or ignorance by medical personnel who misdiagnose histamine poisoning as a food allergy (236, 237). Japan, the United States (238), and the United Kingdom (239) are the countries with the highest number of reported incidents, although this possibly re ects better reporting systems. Frequent incidents have been reported all over the world (240, 241). Table 3.2.10 shows the outbreaks of histamine sh poisoning (HFP) in some countries. Putrescine, spermine, spermidine, and cadaverine have no adverse health effects, but they may react with nitrite to form carcinogenic nitrosoamines especially in meat products that contain nitrite and nitrate salts as curing agents (51, 243). Determination of the exact toxicity threshold of biogenic amines in individuals is extremely dif cult since the toxic dose strongly depends on the ef ciency of the detoxi cation mechanisms of each individual.
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The biogenic amine content of various foods has been widely studied because of their potential toxicity. Biogenic amines in foods are not necessarily hazardous. In healthy individuals, low amounts of biogenic amines are easily metabolized in the gut to physiologically less active degradation products during the food intake process. This intestinal detoxifying system includes speci c enzymes such as MAO, DAO, and HNMT. However, upon intake of high amounts of biogenic amines in foods, the detoxi cation system is unable to eliminate these amines suf ciently or when it is genetically de cient (244). Moreover, the amine metabolism could be inhibited by simultaneous ingestion of alcoholic beverages, certain drugs, or MAO inhibitors. The biogenic amines are categorized primarily as either vasoactive or psychoactive. The physiological effects of vasoactive amines (mainly tyramine) include peripheral vasoconstriction, increased cardiac output, increased respiration, elevated blood glucose, and release of norepinephrine. Histamine poisoning symptoms include headache, nausea, vomiting, diarrhea, itching, oral burning sensation, red rash, and hypotension (14). Polyamines, such as
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