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Allergic Predisposition, Histamine and Histamine Receptor Expression (H1r, H2r) Are Associated With Complicated Courses of Sigmoid Diverticulitis
Burkhard H. Von Rahden*1, Martin Grimm1, Stefan Kircher2, Maria Lazariotou1, Matthias Jung1, Christoph-Thomas Germer1
1Department of Surgery, University Hospital Wuerzburg, Wuerzburg, Germany; 2Department of Pathology, University Hospital Wuerzburg, Wuerzburg, Germany

Background: We aimed to evaluate the hypothesis that allergic predisposition and expression of histamine receptors might contribute to complicated courses of sigmoid diverticulitis.Methods: Expression of histamine and histamine receptors (H1R, H2R) were analyzed on protein (IHC/ IF) as well as mRNA (RT-PCR) level in surgical specimen (n=101) of patients with complicated (n=57) and uncomplicated (chronically-recurrent, n=44) sigmoid diverticulitis. Results were correlated with clinical parameters.Results: The mean number of comorbid diseases per patient was 1.76 ± 1.25. Thirty-nine of 100 patients (39%) exhibited allergic predisposition (grass poll, food, drug, pets, etc.). Comorbid diseases were significantly associated with complicated diverticulitis (p=0.027). Complicated sigmoid diverticulitis was significantly associated with high H1R and H2R expression, in comparison to uncomplicated types (p=0.0304). Furthermore, an association of complicated diverticulitis with allergic preconditions was found (OR= 3.2; 95% confidence interval: 1.3271-7.8239, p=0.0097). IF double-labelling experiments showed a strong correlation of increased histamine expression on H1R as well as H2R expressing intestinal enterocytes (histamine/H1R, rho=0.841, p<0.0001 and Histamine/H2R, rho=0.806, p<0.0001). The results of increased H1R and H2R expression in complicated sigmoid diverticulitis were confirmed on mRNA-level (RT-PCR, p=0.009).Conclusions: Our findings suggest that allergic predisposition is another important risk factor for complicated courses of acute sigmoid diverticulitis and linked with histamine receptor expression. Supportive therapies with antihistaminic drugs might also become an option. Allergic predisposition might be worth considering (similar to immunosuppression and steroid intake) when indicating surgery for sigmoid diverticulitis.


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