Tyramine in foods and monoamine oxidase inhibitor drugs: A crossroad where medicine, nutrition, pharmacy, and food industry converge

Since identification of the “cheese reaction” hypertensive crisis induced by dietary tyramine with monoamine oxidase inhibitors (MAOIs) drugs, numerous articles have addressed the biogenic amine (BA) content of foods. The objective of this review is to explain why many published analyses are no longer valid. Clinically significant BA levels from literature published between 1945 and 2003 were reviewed and compiled and are presented in common units. Clinical recommendations based on newer reports about foods and drugs are offered. Reliance on case reports without chemical analyses led to unnecessary dietary restrictions. Extrapolation of analysis from one food to a similar food led to lengthy lists of banned foods. Early analyses are no longer valid for several reasons: better methods to accurately identify these amines, better packaging methods, recognition of critical processing points in prevention of BA formation, better storage and handling procedures, and substitution of cultures less likely to form amines have reduced the risks of these Food–drug interactions. New generations of MAOIs and different administration routes allow smaller effective dosage and lower risks for interactions. This review of BAs illustrates variability of food components over time, progress of food industry toward a safer food supply, development of better drugs, and the necessity for medicine, nutrition, pharmacy, and food industry to work together.