Histamine Intolerance & How Your Histamine Response Influences Your Health & Wellbeing

Histamine intolerance is a relatively obscure yet increasingly recognized condition that can wreak havoc on one's well-being, including one’s mental health (think anxiety + sleep quality). To understand this phenomenon, we first need to grasp the basics of histamine. 

What is Histamine?

Histamine is a chemical that is found naturally in both the body and in many foods that acts a key player in the immune system and is responsible for various physiological processes. Some of the functions of histamine include signaling the immune system to react to an allergen, acting as an inflammatory mediator, as well as  promoting the secretion of stomach acid during digestion [1]. However, when the body struggles to break down histamine efficiently, or when an individual has been exposed to excessive amounts of histamine, it can lead to histamine intolerance, causing a range of seemingly perplexing symptoms.

Symptoms of Histamine Excess

Histamine receptors are found all over the body, meaning symptoms may impact various body systems [2]. Symptoms may develop anywhere from 30 minutes to multiple hours after eating high-histamine foods and may include:

  • Bloating

  • Diarrhea

  • Constipation

  • Nausea

  • Headaches

  • Migraines

  • Low blood pressure

  • Arrhythmia

  • Itchy skin

  • Nasal congestion, and/or rhinitis (runny nose)  

  • Skin flushing 

  • Hives

  • Wheezing

  • Watery eyes

  • PMS / painful cramping or irregular cycles

What Causes an Individual to be Histamine Intolerant?

There are a number of factors that can contribute to histamine intolerance, many of which involve diminished endogenous production of diamine oxidase (DAO), the enzyme that breaks down histamine. Certain foods high in histamine or those that trigger histamine release (often referred to as “histamine liberators”) can exacerbate the condition [4]. Identifying and addressing these root causes is essential for effective management. Potential causes include:

  • Genetics. Certain genetic mutations related to the DAO-encoding gene, such as the AOC1 gene, have been linked to increased risk of developing histamine intolerance.

  • Medications. Certain medications including antidepressants, blood pressure medication, antibiotics, diuretics, antiemetics, antiarrhythmics, and phlegm reducers have been shown to hinder DAO production.

  • Nutrient deficiencies. Deficiencies in certain nutrients related to DAO production and inflammation may lead to histamine intolerance. These nutrients include Vitamin C, Vitamin B6, Vitamin D, Zinc, Copper, and Magnesium. 

  • Heavy metal toxicity. Toxicity of certain heavy metals including aluminum, mercury, lead, and cadmium have been implicated in histamine intolerance as they have been shown to increase histamine production [8].

  • Digestive conditions such as Small Intestinal Bacterial Overgrowth (SIBO), Inflammatory Bowel Disease (IBD), Celiac Disease, Candida, and food allergies. A large percentage of individuals with histamine intolerance also suffer from digestive issues. This is due to the fact that DAO is produced in the intestines, so production is often impeded when GI conditions are present [9]. Additionally, some bacteria are known histamine-producers, so excess bacterial overgrowths can lead to increased histamine levels. In fact, many of our patients at DLW who come in initially for GI concerns later uncover they have histamine intolerance issues as well. 

How Can Histamine Intolerance be Distinguished from Food Allergies?

Histamine intolerance is often confused with food allergies due to the similarity in symptoms. However, the mechanisms behind these two conditions are distinct. Food allergies involve an immune response triggered by specific proteins (immunoglobulins), while histamine intolerance is a result of the body's inability to break down naturally occurring histamine in food. Additionally, a true allergy will elicit symptoms more immediately and more predictably than with histamine intolerance, as histamine reactions may be variable and differ in onset time. Proper diagnosis is crucial for tailored treatment plans, emphasizing the importance of consulting with healthcare professionals for accurate assessments.

Histamine and Anaphylaxis

While histamine is involved in the anaphylactic reaction, histamine intolerance itself will not cause anaphylaxis. However, individuals who suffer from both allergies and histamine intolerance may be more likely to suffer anaphylaxis than individuals who do not have histamine intolerance [5]. This is why it’s important to identify whether you have a histamine intolerance, a food allergy, or food sensitivities, as overt food allergies are much more likely to result in anaphylaxis, which can be life-threatening.

The Histamine Restricted Diet

The best way to test for histamine intolerance is to trial a low-histamine diet and monitor symptoms. It is important to work with a healthcare professional when following a low-histamine diet to ensure you are not cutting out necessary macro or micronutrients. If your symptoms go away on a low-histamine diet, you likely have histamine intolerance [1]. Once this is determined, your healthcare professional should help you get to the root cause of your histamine intolerance by checking for the common causes listed above (nutrient deficiencies, heavy metals, digestive conditions, gene mutations, etc.).

High histamine foods to avoid:

  • Alcohol (especially wine and beer)

  • Vinegar containing foods (pickles, relish, etc.)

  • Fermented foods (sauerkraut, kimchi, kefir, yogurt, kombucha, sourdough bread, etc.)

  • Aged cheeses (parmesan, cheddar, Swiss, gouda, etc.)

  • Dried fruits & citrus

  • Some vegetables: spinach, avocado, eggplant, tomato

  • Processed or smoked meats (salami, bologna, bacon, pepperoni, canned fish)

  • Peanuts

  • Wheat

  • Bone broth

Histamine “liberators” to avoid:

  • Some fruits: bananas, citrus, papaya, pineapple, strawberries

  • Chocolate

  • Cow’s milk

  • Artificial preservatives and dyes

  • Nuts; especially peanuts, walnuts, and cashews

  • Black and green tea

  • Beans (black beans, kidney beans, garbanzo beans, etc.)

Histamines and Eczema

Studies show that some individuals with eczema may have their condition worsen following consumption of high-histamine foods, as histamines are thought to play a role in the pathophysiology of eczema [3]. Eczema sufferers may therefore benefit from adopting a low-histamine diet.

Histamine and Hormones

It may be hard to imagine that your daily peanut butter and banana smoothie is the reason for your severe menstrual cramps, but studies show that there is a direct link between histamine intolerance and hormonal imbalances [6]. In fact, PMS is one of the most common symptoms for females with histamine intolerance. This is due to the fact that histamine and estrogen are explicitly linked, and elevated histamine may lead to increased estrogen production. High levels of estrogen have also been shown to slow DAO production in the gut, further worsening histamine issues. Symptoms of estrogen-related histamine intolerance include:

  • Painful period cramps

  • Brain fog

  • Headaches

  • Fatigue

  • Bloating, stomach pain, and diarrhea

Why Not Just Take Antihistamines? 

Antihistamines such as Benadryl and Zyrtec may alleviate the symptoms of histamine intolerance in the short term, however they are not fixing the root cause and would need to be taken indefinitely to see continued results. Not only would this be expensive and tedious, long-term use of antihistamines has been linked to an increased risk of dementia and cognitive decline [7]. The safer option is to work with a trusted professional to get to the root cause of your histamine intolerance and consider a low-histamine diet or histamine-reducing natural supplements in the meantime.

Supplements for Histamine Intolerance

Numerous nutrients and herbs have shown benefit for histamine intolerance by either helping to rid excess histamine from the system, improving overall immune function, or lowering inflammation. Our top supplement recommendations for histamine intolerance include:

  • DAO Enzyme Supplements - The DAO enzyme can be taken before meals to reduce the amount of histamine that is absorbed.

  • Vitamin C - Vitamin C is a cofactor for the DAO enzyme with strong immune-boosting properties. Vitamin C may also help to balance estrogen / progesterone ratios for optimized hormonal function.

  • Stinging Nettle - The stinging nettle herb has been shown to act as a natural antihistamine and lower symptoms of histamine intolerance.

  • Quercetin - Quercetin is a powerful antioxidant and anti-inflammatory compound that has been shown to modulate the immune response and block the release of histamine.

Additional Resources:

  • The 4-Phase Histamine Reset Plan: Getting to the Root of Migraines, Eczema, Vertigo, Allergies and More - Dr. Becky Campbell

  • What HIT Me? Living with Histamine Intolerance: A guide to diagnosis and management of HIT - Genny Masterman

See Dr. Lana’s Approved Histamine Intolerance Recommendations Here

Histamine intolerance is a multi-faceted condition that is often misdiagnosed and misunderstood. However, the effects of histamine intolerance can be serious and may be playing a role in your digestive conditions, hormonal imbalances, and chronic inflammation. For personalized guidance on identifying and managing histamine intolerance, click here to work with the Dr. Lana Wellness team.

References

  1. Hrubisko, M., Danis, R., Huorka, M., & Wawruch, M. (2021). Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients, 13(7), 2228. https://doi.org/10.3390/nu13072228

  2. Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American journal of clinical nutrition, 85(5), 1185–1196. https://doi.org/10.1093/ajcn/85.5.1185

  3. Behrendt, H., & Ring, J. (1990). Histamine, antihistamines and atopic eczema. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 20 Suppl 4, 25–30. https://doi.org/10.1111/j.1365-2222.1990.tb02473.x

  4. Hakl, R., & Litzman, J. (2023). Histamine intolerance. Histaminová intolerance. Vnitrni lekarstvi, 69(1), 37–40. https://doi.org/10.36290/vnl.2023.005

  5. Winbery, S. L., & Lieberman, P. L. (2002). Histamine and antihistamines in anaphylaxis. Clinical allergy and immunology, 17, 287–317.

  6. Knigge, U., & Warberg, J. (1991). The role of histamine in the neuroendocrine regulation of pituitary hormone secretion. Acta endocrinologica, 124(6), 609–619. https://doi.org/10.1530/acta.0.1240609

  7. Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R., Walker, R., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA internal medicine, 175(3), 401–407. https://doi.org/10.1001/jamainternmed.2014.7663

  8. Schedle, A., Samorapoompichit, P., Füreder, W., Rausch-Fan, X. H., Franz, A., Sperr, W. R., Sperr, W., Slavicek, R., Simak, S., Klepetko, W., Ellinger, A., Ghannadan, M., Baghestanian, M., & Valent, P. (1998). Metal ion-induced toxic histamine release from human basophils and mast cells. Journal of biomedical materials research, 39(4), 560–567. https://doi.org/10.1002/(sici)1097-4636(19980315)39:4<560::aid-jbm9>3.0.co;2-h

  9. Afrin, L. B., & Khoruts, A. (2015). Mast Cell Activation Disease and Microbiotic Interactions. Clinical therapeutics, 37(5), 941–953. https://doi.org/10.1016/j.clinthera.2015.02.008



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