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Histamine intolerance happens when there's too much histamine in the body and the body fails to break it down. Histamine is a chemical in many foods, and many people have the enzymes to break it down. The main enzyme that metabolizes histamine is calleddiamine oxidase (DAO).
In people with low levels of this enzyme, histamine can build up and cause allergy-like symptoms, such as headaches, diarrhea, skin rashes, or difficulty breathing. Alcohol, certain foods and medications can worsen histamine intolerance.
Histamine intolerance is a controversial issue. According to the American Academy of Allergy and Immunology, the condition is notscientifically substantiated.
Because histamine receptors arepresent across the body, histamine intolerance can affect several body systems.
In the intestine, it can cause bloating, abdominal discomfort, gas, diarrhea, or constipation. In the respiratory tract, histamine intolerance can cause a runny nose, nasal congestion, shortness of breath, and sneezing. Meanwhile, histamine receptors in the skin can manifest symptoms like itchy skin, flushing, dermatitis, and swelling.
Histamine intolerance is challenging to diagnose because the symptoms can also be indicative of other conditions.
No, histamine intolerance is not an allergy. Histamine intolerance can cause allergy-like symptoms but it isn’t an allergy.An allergy is an autoimmune response to allergens; histamine intolerance is an inability to digest histamine. Because it can give the impression of an allergy, histamine intolerance has earned the label "pseudo allergy".
Experts disagree that low levels of histamine could cause allergy-like symptoms. Some experts postulate that it’s more likely that other conditions, such as irritable bowel syndrome, cause the symptoms.
Having said that,a 2022 study discusses the issue comprehensively and points to the following factors that can cause histamine intolerance.
Genetic mutations can decrease the effective functioning of DAO enzymes responsible for histamine metabolism.
Medication interference from blood pressure medication, antidepressants, phlegm reducers, and anti-vomiting drugs can reduce or block DAO enzyme production in the body.
Gastrointestinal (GI) disorders such as inflammatory bowel disease (IBD), allergic diseases like celiac disease, intestinal microbiome disorders, and chronic infections are alsoreportedly involved in histamine intolerance.
Dietmay also be a factor. Foods high in histamine, such as aged cheeses can disrupt or reduce the function of DAO enzymes so the histamine doesn't get properly digested. Alcohol can also reduce DAO activity.
Dysbiosis or imbalances in gut flora have also been found in patients with histamine intolerance.
No, there is no cure for histamine intolerance but there are things you can do to reduce your symptoms.
Below we have compiled a list of foods high in histamines. You could exclude them from your diet and when all your symptoms have disappeared, you can add them back into your diet. If your symptoms return, avoid the food henceforth.
To ensure your diet still provides all the nutrients you need to be healthy, consult a dietitian or health provider before you eliminate any foods from your diet.
Your doctor may prescribe antihistamines or mast cell stabilizers to treat your condition.
H1 and H2 antihistamines are medications that block histamine receptors to ease symptoms caused by histamine release. H1 antihistamines target H1 receptors and are prescribed to treat allergic reactions like hay fever, hives, itching, sneezing, or runny nose.
H2 antihistamines target H2 receptors in the stomach lining. They help to reduce acid in the stomach, relieving conditions like acid reflux or stomach ulcers.
Antihistamines are not a permanent solution and won't cure histamine intolerance.
Mast cell stabilizers are medications that help prevent mast cells from releasing histamine and other inflammatory substances. Mast cells are immune cells found in tissues throughout the body. They release histamine when triggered by allergens. Mast cell stabilizers inhibit the release of histamine, thereby preventing or reducing symptoms like itching, swelling, and shortness of breath.
You could consider taking antihistamine supplements. Several studies have found that supplements improve symptoms. Scientists of a 2019 study found thatDAO oral supplements significantly reduce symptoms and their severity.
Areview of several studies came to the same conclusion. Though researchers agreed that more research is necessary to further authenticate these results.
The current advice from health experts is to avoid food that causes excess amounts of histamine in the body. However, there has not been comprehensive research on the subject. A diet that limits histamine intake may help some people with their symptoms but this may not be true for everyone.
Fermented foods and dairy products, such as yogurt and sauerkraut
Dried fruits
Avocados
Eggplant
Spinach
Processed or smoked meats
Preserved fish and shellfish
Aged cheese
Alcohol and other fermented beverages
Citrus fruits
Seafood
Papayas
Tomatoes
Walnuts, cashews, and peanuts
Bananas
Pineapple
Spinach
Chocolate
Strawberries
In asystematic review from 2021 the researchers concluded that although many studies support the benefits of low-histamine diets to manage symptoms, there is no universal agreement on which foods patients should avoid.
In fact, scientists also found that about 32% of foods often recommended on a low-histamine diet, are actually extremely high in histamine.
A low histamine diet doesn't eliminate all histamines from a diet and it's also not the aim of the diet since it could cause malnutrition. The list of foods merely points out the foods that might cause problems. You can try them and see if they cause symptoms, and also eliminate them to see if symptoms disappear.
Here are somefoods that are low in histamine:
Gluten-free grains, such as rice, quinoa, millet like amaranth, arrowroot, buckwheat, and more.
Milk and milk products like butter, ghee, cream, cream cheese, ricotta, mozzarella, and other soft cheeses that have not been aged or fermented. Also, no yogurt.
Fresh meat.
Fresh or flash-frozen salmon.
Non-citrus fruits like apples, blueberries, mangoes, peaches, pomegranates, and more.
Non-dairy milk like almond, coconut, or hemp.
Fresh vegetables except tomato, avocado, eggplant, squash, and spinach.
Olive oil
Coconut oil
Almonds
Flax
Chia
All foods must be as fresh as possible; aging increases histamine levels.
Research has found the following vitamins and minerals may be helpful for histamine intolerance.
DAO enzyme supplements (from pig kidneys) help break down histamine in food. While research on these supplements is limited, early results are promising. Plant-based options are also being researched.
In addition, takingvitamin C and B-6 may increase DAO activity and help with the digestion of histamine.
Quercetin is a natural flavonoid that has antihistamine and anti-inflammatory properties. It can help toinhibit histamine release.
A 2017 study found the following vitamins and micronutrientsboost the body's ability to break down histamine:
Long-chain fatty acids
Saturated fatty acids
Monounsaturated fatty acids
Phosphorus
Calcium
Zinc
Magnesium
Iron
Vitamin B12
While studies indicate that people with Candida infection have worse symptoms, we need more studies to confirm if histamine intolerance can cause histamine intolerance. The thing is, an overgrowth of candida in the gut does trigger the release of histamine which gives rise to overall histamine levels in the body.
Also, Candida has been reported to decrease the breakdown of histamine by inhibiting the activity of DAO enzyme – which is responsible for breaking down excess histamine. But not everyone with Candida infection suffers from histamine intolerance so, we need more studies in this regard.
Physical activity can trigger the release of histamine from mast cells. Mast cells release histamine in response to stimuli such as food, temperature changes, and exercise. The body experiences exercise as a stressor, so it releases cortisol, which then stimulates mast cells, which leads to more histamine release.
Sohistamine levels go up during exercise, but in healthy people, the levels soon drop again.
Yes, antihistamines help histamine intolerance by blocking histamine receptors in the body, but it is not a permanent cure.
Histamine intolerance is thought to be a food intolerance caused by an inability to digest histamine and the resulting accumulation in the body. Although there is greater awareness of histamine intolerance, more research is necessary to fully understand the condition and how to manage it.
At this stage, managing histamine intolerance entails a low-histamine diet, but experts don't agree on what foods to include in a low-histamine diet, or what foods to eliminate.
The problem with histamine intolerance is that it doesn't have specific symptoms – many conditions have similar symptoms. If you don't feel well and have vague symptoms that make you feel as if you might have histamine intolerance, seek medical help to find out exactly what your symptoms indicate and the best way to treat them.