Abstract
Background: Asthma is a complex chronic inflammatory disorder, with many
factors influencing its prevalence. Diet’s impact on the symptoms of the
disease is still controversial, although various dietary patterns or
specific nutrients have been studied. Objective: The objective of this
crossover, randomised, two-period study was to examine the potential of
controlling dietary histamine intake and, through this, alter asthma
symptoms in children with mild intermittent asthma. Methods: Children
with mild intermittent asthma were randomly assigned to either a high-
(HH) or low- histamine (LH) diet, based on the Mediterranean pattern,
for 4 weeks (t0). This was followed by a 2-week washout period (t1)
before patients crossed to the alternative diet (t2) for an additional 4
weeks. Children were assessed at baseline and after the completion of
each diet phase. They also recorded symptoms and peak flow throughout
the intervention. Adherence to the dietary intervention was assessed via
four random 24-hour recalls for each intervention period and comparison
of selected qualitative and quantitative indices, i.e. histidine, food
choices, energy, macro- and micronutrients intake. Results: Eighteen
children (10 boys), with mean age 11,5±3,1years were recruited and
completed the study. A trend for prolonged and more severe symptoms was
observed during HH. There was good adherence to the diet during
remission periods, but lower compliance during symptomatic periods,
particularly for the HH group. The mean actual intake differed
significantly between the two diets, not only in the histamine content
but also in energy, sugar and various micronutrients, including sodium.
Conclusions & Clinical Relevance: Diet may have an active and direct
impact on asthma symptoms. A diet deviating from the Mediterranean
standard in terms of high energy, histamine, and salt has been
associated with asthma worsening. Dietary interventions in asthmatic
patients should be prospectively evaluated for a longer period and with
proper nutritional education.