A review of biogenic amines in fermented foods: Occurrence and health effects.

Biogenic amines (BAs) are low-molecular decarboxylation products of amino acids formed during microbial fermentation. Several fermented foods may contain BAs such as histamine, tyramine, and/or phenylethylamine, at levels above documented toxic doses. Dietary exposure to foods containing high levels of BAs is associated with many adverse health effects, such as migraines, elevated blood pressure, and tachycardia. BA-mediated toxicity may occur at levels a hundred times below regulatory and suggested toxic doses, depending on an individual's sensitivity and factors such as alcohol consumption and certain medications. Although BAs occur in a wide variety of fermented foods, food safety and public health professionals are not well informed about the potential health risks and control strategies in these foods. In this review, we highlight the health risks and symptoms linked to BA exposures, the BA levels found in different fermented foods, regulatory and suggested toxic doses, and risk mitigation strategies to inform food industry and public health professionals' practice.