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26198 N-Methylhistamine, Urine (NMHR)

N-Methylhistamine, Urine (NMHR)
Test Code: NMHRSO
Synonyms/Keywords

​1-Methylhistamine
Histamine Metabolites
Urinary N-Methylhistamine

Test Components

​N-Methylhistamine, Random

Creatinine, Random, U

Useful For

Screening for and monitoring of mastocytosis and disorders of systemic mast-cell activation, such as anaphylaxis and other forms of severe systemic allergic reactions using random urine specimens

Monitoring therapeutic progress in conditions that are associated with secondary, localized, low-grade persistent, mast-cell proliferation and activation such as interstitial cystitis

Specimen Requirements
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Urine​Sterile Container​5 mL​3 mL
Collection Processing Instructions

​Patient must not be taking monoamine oxidase inhibitors (MAOIs) or aminoguanidine as these medications increase N-methylhistamine (NMH) levels.

1. Collect a random urine specimen within a few hours of symptom onset.

2. No preservative.

Specimen Stability Information
Specimen TypeTemperatureTime
​Urine​Refrigerated (preferred)​28 days
​Ambient​14 days
​Frozen​28 days
Rejection Criteria

​All specimens will be evaluated at Mayo Clinic Laboratories for test suitability. 

Interference

While an average North American diet has no effect on urinary N-methylhistamine (NMH) levels, mild elevations (around 30%) may be observed on very histamine-rich diets. This problem is more pronounced if random-urine specimens are used and collected following a histamine-rich meal.

NMH levels may be depressed in individuals who have an alteration in the histamine-N-methyl transferase gene, which encodes the enzyme that catalyzes NMH formation. This alteration results in an amino acid change that decreases the rate of NMH synthesis.

When N-acetylcysteine is administered at levels sufficient to act as an antidote for the treatment of acetaminophen overdose, it may lead to falsely decreased creatinine results.

Performing Laboratory Information
Performing LocationDay(s) Test PerformedAnalytical TimeMethodology/Instrumentation
​Mayo Clinic Laboratories​Tuesday, Thursday; 10 am​3 days

​NMHR1: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

CRETR: Enzymatic Colorimetric Assay

Reference Lab
Reference Range Information
Performing LocationReference Range
​Mayo Clinic Laboratories

0-5 years: 120-510 mcg/g creatinine

6-16 years: 70-330 mcg/g creatinine

>16 years: 30-200 mcg/g creatinine

Interpretation

​Increased concentrations of urinary N-methylhistamine (NMH) are consistent with urticaria pigmentosa (UP), systemic mastocytosis, or mast-cell activation. Because of its longer half-life, urinary NMH measurements have superior sensitivity and specificity than histamine, the parent compound. However, not all patients with systemic mastocytosis or anaphylaxis will exhibit concentrations outside the reference range and healthy individuals may occasionally exhibit values just above the upper limit of normal.

The extent of the observed increase in urinary NMH excretion is correlated with the magnitude of mast-cell proliferation and activation, UP patients, or patients with other localized mast-cell proliferation and activation, show usually only mild elevations, while systemic mastocytosis and anaphylaxis tend to be associated with more significant rises in NMH excretion (2-fold or more). There is, however, significant overlap in values between UP and systemic mastocytosis, and urinary NMH measurements should not be relied upon alone in distinguishing localized from systemic disease.

Up to 25% variability in random-urine excreted levels may be observed, making 24-hour urine collections preferable for cases with borderline results.

Children have higher NMH levels than adults. By the age of 16, adult levels have been reached. 

Outreach CPTs
CPTModifier
(if needed)
QuantityDescriptionComments
​82542​1
82570​​1
Synonyms/Keywords

​1-Methylhistamine
Histamine Metabolites
Urinary N-Methylhistamine

Test Components

​N-Methylhistamine, Random

Creatinine, Random, U

Ordering Applications
Ordering ApplicationDescription
​Centricity

​N-Methylhist. Rand, U (NMHR)

COM​​N-Methylhist. Random, U
​Cerner​N-Methylhist. Rand, U (NMHR)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Urine​Sterile Container​5 mL​3 mL
Collection Processing

​Patient must not be taking monoamine oxidase inhibitors (MAOIs) or aminoguanidine as these medications increase N-methylhistamine (NMH) levels.

1. Collect a random urine specimen within a few hours of symptom onset.

2. No preservative.

Specimen Stability Information
Specimen TypeTemperatureTime
​Urine​Refrigerated (preferred)​28 days
​Ambient​14 days
​Frozen​28 days
Rejection Criteria

​All specimens will be evaluated at Mayo Clinic Laboratories for test suitability. 

Interference

While an average North American diet has no effect on urinary N-methylhistamine (NMH) levels, mild elevations (around 30%) may be observed on very histamine-rich diets. This problem is more pronounced if random-urine specimens are used and collected following a histamine-rich meal.

NMH levels may be depressed in individuals who have an alteration in the histamine-N-methyl transferase gene, which encodes the enzyme that catalyzes NMH formation. This alteration results in an amino acid change that decreases the rate of NMH synthesis.

When N-acetylcysteine is administered at levels sufficient to act as an antidote for the treatment of acetaminophen overdose, it may lead to falsely decreased creatinine results.

Useful For

Screening for and monitoring of mastocytosis and disorders of systemic mast-cell activation, such as anaphylaxis and other forms of severe systemic allergic reactions using random urine specimens

Monitoring therapeutic progress in conditions that are associated with secondary, localized, low-grade persistent, mast-cell proliferation and activation such as interstitial cystitis

Test Components

​N-Methylhistamine, Random

Creatinine, Random, U

Reference Range Information
Performing LocationReference Range
​Mayo Clinic Laboratories

0-5 years: 120-510 mcg/g creatinine

6-16 years: 70-330 mcg/g creatinine

>16 years: 30-200 mcg/g creatinine

Interpretation

​Increased concentrations of urinary N-methylhistamine (NMH) are consistent with urticaria pigmentosa (UP), systemic mastocytosis, or mast-cell activation. Because of its longer half-life, urinary NMH measurements have superior sensitivity and specificity than histamine, the parent compound. However, not all patients with systemic mastocytosis or anaphylaxis will exhibit concentrations outside the reference range and healthy individuals may occasionally exhibit values just above the upper limit of normal.

The extent of the observed increase in urinary NMH excretion is correlated with the magnitude of mast-cell proliferation and activation, UP patients, or patients with other localized mast-cell proliferation and activation, show usually only mild elevations, while systemic mastocytosis and anaphylaxis tend to be associated with more significant rises in NMH excretion (2-fold or more). There is, however, significant overlap in values between UP and systemic mastocytosis, and urinary NMH measurements should not be relied upon alone in distinguishing localized from systemic disease.

Up to 25% variability in random-urine excreted levels may be observed, making 24-hour urine collections preferable for cases with borderline results.

Children have higher NMH levels than adults. By the age of 16, adult levels have been reached. 

For more information visit:
Performing Laboratory Information
Performing LocationDay(s) Test PerformedAnalytical TimeMethodology/Instrumentation
​Mayo Clinic Laboratories​Tuesday, Thursday; 10 am​3 days

​NMHR1: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

CRETR: Enzymatic Colorimetric Assay

Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPTModifier
(if needed)
QuantityDescriptionComments
​82542​1
82570​​1
For most current information refer to the Marshfield Laboratory online reference manual.