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Editor—We read with interest the excellent review article on fish odour syndrome (trimethylaminuria) by Rehman.1 However the author does not address the clinical relevance of trimethylaminuria (TMA-uria) well beyond the intermittent unpleasant body odour. TMA-uria is caused by the deficiency of the flavin-containing mono-oxygenase isoform 3 (FMO3).2 3 TheFMO3 gene has been described, and disease causing mutations have been reported.2 3 In addition to TMA this enzyme is required for detoxification of many substances including endogenous amines, tyramine, nicotine, and drugs (for example, tricyclic antidepressants, ranitidine).4 Zschockeet al have followed up patients with mild TMA-uria, and have examined the FMO3 gene in them.5 The …
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