La intolerancia a la histamina y el síndrome de HANA

Qué es HANA o Histaminosis Alimentaria No Alérgica? 

En España, un grupo investigador ha descrito, además de la intolerncia a la
histamina, otro tipo de cuadro, la histaminosis alimentaria no alérgica o HANA. En
este cuadro se considera que lo que sucede es que se produce una liberación de
un exceso de histamina por las células del organismo, por un mecanismo que no
es mediado por una alergia. Los síntomas serían parecidos a los de una
intolerancia a la histamina, pero no tendrían que ver con el contenido de la
histamina en un alimento, sino con la reacción que un alimento produce en el
individuo, sin que sea una alergia como tal.
Alimentos de consumo cotidiano que se toman con frecuencia y en cantidad
abundante, como la leche y los lácteos, seguidos del trigo y el huevo, se
relacionan en un alto porcentaje con el "síndrome de histaminosis alimentaria no
alérgica" (HANA), un mecanismo de intolerancia alimentaria. Es un cuadro clínico
complejo por la heterogeneidad de las manifestaciones clínicas y mejora solo con
una dieta en la que se elimina el alimento que genera altas dosis de histamina en
el organismo. De esta manera, se consigue bajar el contenido de histamina en los
tejidos de las personas afectadas de histaminosis; la mejor forma de liberarse de
los síntomas. El tratamiento, aunque parece sencillo, es complejo, ya que los
alimentos más problemáticos son los de consumo más frecuente entre la
población general y, por ende, también entre los afectados.
Los síntomas pueden aparecer hasta varios días luego de consumidos los
alimentos liberadores de histamina..
La intolerancia a la histamina o el HANA podrían ser la causante de sus
síntomas?

Síntomas más frecuentes:
 erupciones, urticaria o eczema;
 dolores de cabeza o migrañas;
 diarrea;
 presión arterial baja;
 picazón en los ojos, goteo nasal, congestión;
 cólicos o dolores de cabeza premenstruales.

Estos son síntomas muy generales que tienen muchas causas posibles, pero una
posibilidad que no se discute a menudo es una condición llamada intolerancia a la
histamina.

¿Qué es la histamina?
La histamina es un compuesto que se encuentra en todas las células del cuerpo, y
es un componente natural de muchos alimentos. También es un componente
importante tanto del sistema inmunológico como del sistema neurológico, y está
implicada en el proceso de inflamación. La histamina causa una variedad de
síntomas, que varían dependiendo de dónde se la libera y a qué receptores se
une.

¿Qué es la intolerancia a la histamina?
El verdadero mecanismo de la intolerancia a la histamina (IH) se encuentra bajo
investigación, pero se cree que está relacionado con la acumulación de histamina.
En un individuo sano, la histamina se descompone regularmente con la ayuda de
dos enzimas: DAO y HNMT. Se piensa que el mecanismo de la intolerancia a la
histamina se debe a la presencia de una disfunción genética o adquirida en una de
estas dos enzimas. La enzima DAO se produce en el intestino, por lo que si la
función intestinal se encuentra comprometida puede que no haya suficiente
enzima para degradar la histamina de manera normal.
Cuando se produce una acumulación de histamina, aparecen los síntomas. Una
disminución en la producción de la enzima DAO puede ser la razón por la que la
intolerancia a la histamina parece ser más común en personas que tienen
trastornos gastrointestinales tales como la enfermedad inflamatoria intestinal, el
síndrome del intestino irritable, la enfermedad celíaca y el sobrecrecimiento
bacteriano intestinal (SIBO, por sus siglas en inglés).  La producción de la enzima
DAO también puede verse inhibida ante ciertos medicamentos.
Algunos médicos cuestionan si verdaderamente la intolerancia a la histamina es
una enfermedad. En Europa, la intolerancia a la histamina es aceptada más
ampliamente como una condición verdadera.  En 2012, la Sociedad Alemana de
Alergología e Inmunología Clínica la reconoció como una enfermedad verdadera
cuya fisiopatología aún no ha sido determinada.

¿Cuáles son algunos de los síntomas de la intolerancia a la histamina?
 diarrea;
 dolor de cabeza;
 sofocones;
 sarpullido, urticaria (ronchas), eczema;
 arritmia (latido irregular del corazón);
 presión arterial baja: debido a la vasodilatación causada por la histamina;

 sibilancia;
 goteo nasal;
 ojos llorosos;
 angioedema: hinchazón de cara, manos, labios;
 acidez gástrica: debido al aumento de producción de ácido;
 picazón: normalmente de la piel;
 síndrome premenstrual: dolores de cabeza durante el ciclo menstrual o
cólicos dolorosos debido a contracciones producidas por la histamina en
relación con los niveles hormonales.

Puede tener correlación con otros problemas de salud
La intolerancia a la histamina parece darse más frecuentemente cuando hay
presente una disfunción gastrointestinal, como en la enfermedad inflamatoria
intestinal, la enfermedad celíaca, el síndrome del intestino irritable, etc. Dados los
pocos datos que se tienen en cuanto a la incidencia real de la intolerancia a la
histamina, los datos sobre su correlación con otros problemas de salud son
también escasos.
No es lo mismo que una alergia alimentaria

Con la intolerancia a la histamina, los síntomas pueden aparecer cuando se
consumen ciertos alimentos, pero el mecanismo es diferente al de una alergia
alimentaria. Algunos de los síntomas son similares a los de una verdadera
reacción alérgica, pero en la intolerancia a la histamina no está implicada la
inmunoglobulina E (IgE), por lo que las pruebas cutáneas y de alergias darán
negativo.  Se piensa que la intolerancia a la histamina se produce debido a una
acumulación de histamina, en vez de una liberación excesiva de histamina. Debido
a esto, los síntomas pueden no ser inmediatos. Los síntomas pueden presentarse
cada vez que se alcanza un cierto límite, lo que dificulta identificar un alimento en
particular como el culpable.
Por ejemplo, es posible que usted haya consumido alimentos ricos en histamina
en la mañana, y en la tarde haya consumido una comida baja en histamina. Pero,
es posible que la comida de la tarde sea suficiente para hacer sobrepasar su nivel
de tolerancia, por lo que usted tendría síntomas en la tarde. Usted podría pensar
que sus síntomas se debieron a la comida de la tarde, pero en realidad los
alimentos de la mañana fueron el factor más importante, tambi´ne peuede suceder
esto mismo luego de uno o dos días de ingerido el alimento causante de los
síntomas.

Qué debe hacer si piensa que la histamina es un problema para usted

Si usted cree que puede tener intolerancia a la histamina, hable con su médico
para evaluar otras condiciones posibles “parecidas”, tales como alergias,
trastornos de mastocitos o trastornos digestivos subyacentes. Una vez que estas
posibilidades se hayan evaluado y tratado, se podrá comenzar una dieta de
eliminación para ver si los síntomas mejoran. En este caso, llevar un diario de
alimentos es esencial. Se deben corregir primero cuestiones subyacentes para
optimizar la mejora. Debido a que la dieta es restrictiva, sobre todo si se añade a
un plan de alimentación ya restringido, consulte con un profesional para asegurar
una ingesta nutricional adecuada.
Cómo se diagnostica la intolerancia a la histamina
En este momento no hay pruebas comprobadas para diagnosticar la intolerancia a
la histamina más allá de la dieta de eliminación. Si bien es posible medir la
actividad de la enzima DAO en la sangre (una de las enzimas mencionadas
anteriormente), así como los niveles de histamina en la sangre y la orina, estos
resultados no parecen correlacionarse significativamente con los síntomas. Las
pruebas cutáneas o las pruebas típicas de sangre para detectar alergias no
pueden dar positivo, ya que la inmunoglobulina E (IgE) no está implicada en la
intolerancia a la histamina (como es en el caso de las verdaderas alergias).
Es importante recordar que, mientras se considere la intolerancia a la histamina
como causa de síntomas, se deben evaluar otros trastornos relacionados como las
alergias, los trastornos de mastocitos, la enfermedad inflamatoria intestinal, la
enfermedad celíaca, la malabsorción de fructosa, el sobrecrecimiento bacteriano
intestinal, la colitis, etc.
Después de realizar una evaluación de los trastornos relacionados, se podrá
comenzar una dieta que elimine los alimentos altos en histamina y ños que
produzcan más frecuentemente liberación de histamina. Si los síntomas mejoran
al reducir o eliminar la histamina de la dieta o los alimentos que estimulan su
liberación, es posible que usted tenga intolerancia a la histamina o el síndrome de
HANA.

El tratamiento para la intolerancia a la histamina
¡No se trata solo de seguir una dieta! Trate primero cualquier otro problema
subyacente, ya que solo eso podría mejorar la tolerancia a la histamina.
En general, me gusta concentrarme en los tratamientos alimentarios ya que
prefiero hacer todo lo posible en cuanto a la dieta en lugar de usar medicación.
Pero, la intolerancia a la histamina requiere en verdad un enfoque integrador, ya que a menudo se produce junto a otros trastornos que necesitan un tratamiento
que vaya más allá de las modificaciones que se puedan hacer en la dieta.
Dieta: una dieta baja en histamina es el tratamiento de elección (podrá ver listas
de alimentos abajo), pero puede ser difícil de seguir si la persona ya está haciendo
una dieta restringida como la dieta sin gluten o baja en FODMAPs, y debe hacerse
bajo supervisión médica para asegurar una ingesta nutricional apropiada. La
tolerancia a la histamina varía de persona a persona, y la cantidad de histamina
tolerada debe deducirse por ensayo y error. Algunas personas solo pueden tolerar
cantidades muy pequeñas, y otras más grandes.
Lo importante de destacar es que la tolerancia a la histamina parece mejorar
cuando se tratan los problemas subyacentes.  Por ejemplo, cuando se tratan el
síndrome del intestino irritable o el sobrecrecimiento bacteriano intestinal (SIBO),
las reacciones a la histamina a menudo disminuyen. Es de suma importancia tratar
los trastornos subyacentes junto con cambios en la dieta. Una vez que se
completa la dieta de eliminación, se debe evaluar individualmente la tolerancia a
determinados alimentos, y agrandar la dieta según la tolerancia que usted tenga
para lograr una nutrición y estilo de vida óptimos.
Sueño: De siete a ocho horas por noche ayuda mucho
Ejercicio: cualquier ejercicio es beneficioso. Trate de hacer de treinta a sesenta
minutos diarios. No se sienta mal si solo puede hacer quince minutos de ejercicio;
¡todo ayuda!
Relajación: los beneficios de las técnicas de relajación son más que importantes.
Los ejercicios de respiración o relajación muscular progresiva son fáciles, gratis y
pueden hacerse en cualquier lugar.  El yoga y la meditación son excelentes
también. La relajación también puede significar para usted leer un libro, pasar
tiempo con amigos o tocar música.
Medicamentos: antihistamínicos, cremas/ esteroides tópicos, esteroides orales,
cremas homeopáticas o de origen vegetal tópicas y lociones para las erupciones.
Alimentos que se pueden comer en una dieta baja
en histamina
 En lo posible, coma alimentos frescos.
 Carne y pescado frescos (evitar la carne y el pescado en conserva).
 Fruta fresca, excepto fresas y cítricos.
 Verduras frescas, excepto tomates, espinaca y col.
 Cereales: arroz, maíz, mijo, avena, sorgo.
 Aceites: la mayoría de los aceites de cocina.
Vea abajo una lista de alimentos con alto contenido de histamina y de
medicamentos que deben utilizarse con precaución si usted piensa que la
intolerancia a la histamina puede ser un problema para usted.

Alimentos con alto contenido de histamina

Esto es motivo de controversia, ya que el contenido de histamina de los alimentos
varía en función de su tiempo de almacenamiento, madurez, cocción y
procesamiento. Ciertos alimentos también, si bien no contienen niveles altos de
histamina, son ricos en compuestos conocidos como liberadores de histamina que
pueden desencadenar síntomas similares al aumentar los niveles de histamina. La
siguiente lista, que no es exhaustiva en absoluto, contiene alimentos comúnmente
reconocidos por ser ricos en histamina o ser liberadores de histamina.  Las listas
de alimentos que se encuentran disponibles varían, y es difícil encontrar
información consistente en cuanto al contenido de histamina de los alimentos. El
punto que sí parece ser aceptado por todos es que los alimentos fermentados y
añejados suelen ser los más culpables de todos.
 alcohol: champagne, vino tinto, cerveza, vino blanco;
 carnes o pescados fermentados o ahumados: salame, sardina, caballa,
arenque, atún;
 alimentos enlatados o encurtidos: chucrut, pepinillos en vinagre, salsa de
pepinillos, salsa de      soja;
 productos lácteos fermentados: yogur, kéfir, suero de leche;
 quesos añejos: parmesano, gouda, suizo, cheddar;
 frutas: frutas secas, fresas, cítricos;
 verduras: tomates y productos de tomate, espinaca;
 legumbres: garbanzos, granos de soja, cacahuetes;
 otros: canela, chocolate;
 cereales: trigo;
 liberadores de histamina: cítricos, papaya, piña, nueces, fresas, claras de
huevo, aditivos;
 bloqueadores de la enzima DAO: alcohol, té negro y verde.
Medicaciones para usar con precaución si la intolerancia a
la histamina es un problema
Estas medicaciones inhiben la enzima DAO:
 la acetilcisteína;
 el ambroxol;
 la amilorida;
 la aminofilina;
 la amitriptilina;
 la aspirina;
 el cefotiam;
 la cefuroxima;
 la ciclofosfamida;
 la cimetidina (Tagamet);
 el ciprofloxacino;

 la codeína/ los opioides;
 el diazepam (Valium);
 el haloperidol (Haldol);
 los medios de contraste;
 el metamizol;
 la metoclopramida (Reglan);
 el naproxeno (Aleve);
 el narcótico tiopental (medicamento intravenoso para las cirugías);
 la noscapina;
 el pancuronio;
 la prilocaína.

Alimentos que pueden producir el síndrome de HANA
Leche y lácteos, los alimentos más problemáticos
El componente que da síntomas con mayor frecuencia es el grupo de las proteínas lácteas,
quizá porque la leche y los lácteos son los alimentos que se consumen con más frecuencia y
en mayor cantidad. Otros alimentos implicados son el trigo (las proteínas del cereal) y el
huevo. Estos son en general los alimentos más comunes en esta patología.
Los alimentos más problemáticos son los de mayor presencia en la dieta
cotidiana
La  histaminosis  por trigo corresponde a las proteínas del trigo, y no en exclusiva a la gliadina,
que es la proteína del gluten que resulta tóxica en caso de celiaquía o intolerancia al gluten.
Esto es lo que desde el punto de vista clínico distingue un HANA de una celiaquía; los
mecanismos fisiopatológicos son distintos.
Si se atiende a que los alimentos más problemáticos son los de mayor presencia en la dieta
cotidiana de la mayoría de la población es fácil entender que "las personas afectadas tengan
auténticas dificultades para hacer la compra porque los componentes básicos están muy
mezclados". Cuando a una persona afectada se le recomienda que no tome proteínas lácteas,
estos componentes los encuentra no solo en la leche y los productos lácteos, sino que se
añaden como aditivos en diversidad de productos de repostería y confitería, panes (de molde,
tostados), galletas, cereales de desayuno, masas para tartas o pizzas, e incluso, salsas
(pueden ir mezcladas con leche, nata), caldos deshidratados y margarinas que no
especifiquen que son 100% vegetales, por lo que se limitan mucho sus posibilidades
alimentarias.

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