Histamine Intolerance: Causes, Symptoms, and Diagnosis

What is Histamine?  

Histamine is a biologically active substance that is found in the living organism. It is a local response that is produced by the immune system of the body to cause inflammation.

Histamines are guards of the body and help get rid of foreign particles that can harm the body. Foreign particles in this context refer to allergens or a substance that can trigger allergy.

It also performs other tasks like chemical messenger, neurotransmitter and important functions in the bowel.

Histamine is secreted by mast cells and basophils. The secretion of histamine denotes a local immune response to invading foreign particles.

The release of histamine will make the capillaries to become more permeable and allows the white blood cells and other proteins to pass through them.  

The white blood cells and other proteins that are involved in the immune reaction will target and attack the invading particles. Histamine is produced in humans, animals and by certain plants. For example, some insects contain histamine in their venom.

Histamine Intolerance

We tend to hear a person saying the word food allergy. This means that histamines are involved in the trigger response.  

When you eat or drink foods that trigger an allergic reaction in the body, the histamines work together to produce reactions in your gut.

When you consume foods that are allergic, the immune system will send a series of reactions to defend you.  

There will be a signal “release histamines” sent to your mast cells in your skin, nose, lungs, gut, mouth and blood.  

When histamine is released from the mast cells, it boosts the blood flow of the body in the allergic-affected region. This will lead to an inflammation of the affected region.

Now the immune cells will step in, and the repair work will start. For example, if you have an allergy to pollen and it affects your mucus membrane. Histamines will be released in the walls of the nose, and more mucus will be produced. So, you might have a stuffed nose or runny nose.

Histamine intolerance also called as enteral histaminosis. People with histamine intolerance will be sensitive to dietary histamine. These people affected with histamine intolerance will not have the ability to metabolise the ingested histamines.

According to NCBI, the histamine intolerance condition requires more research to confirm and clinically manage this condition.

What causes Histamine Intolerance?

According to NCBI, histamine intolerance is caused due to deficiency of the gastrointestinal enzyme diamine oxidase (DAO). This will lead to the food not being degraded properly or fully absorbed by the gastrointestinal tract.

This can trigger a histamine intolerance reaction with the help of gastrointestinal tract mucosa and certain medication, which can reduce gastrointestinal DAO activity.

When a person consumes histamine-containing food, the primary consequence will be an unbalanced and elevated quantity of histamine in the blood.  

However, apart from food, there are various disorders and diseases that can lead to histamine intolerance assisted with certain functional gastrointestinal tract symptoms.

So, these additional diseases and disorders must be taken into account before evaluating the aetiology and providing personalised treatment.

According to NCBI, titled “Histamine Intolerance Originates in the Gut”, histamine intolerance is a metabolic disease, and inadequate digestion can cause the secretion of excess histamine throughout the body, which can lead to various symptoms. However, the fact that histamine is involved in various aetiology of a disease is inevitable.

Symptoms of Histamine Intolerance

Some of the common symptoms of histamine intolerance are listed below.

• Nasal congestion,
• Headache,
• Hives,
• Digestive issue,
• Nausea,
• Vomiting,
• Sinus,
• Irregular menstrual cycle,
• Tissue swelling,
• Abdominal pain,
• Dizziness,  
• High blood pressure,
• Irregular heart rate and  
• Anxiety.

Histamine breakdown in the body

Histamine will be regulated and metabolised by the extracellular oxidative deamination of the primary amine groups.  

In people who are healthy, the body will break the histamine and rapidly detoxifies the histamine into amine oxidase. People with histamine intolerance will have low amine oxidase activity, which can lead to histamine intolerance or toxicity.

Foods for Histamine Intolerance

People with histamine intolerance should be watchful about the foods they consume.

Foods to avoid for Histamine Intolerance

If a person has histamine intolerance, these foods should be avoided.

• Avocados,
• Dried fruits,
• Eggplant,
• Shellfish,
• Aged cheese,
• Alcohol,  
• Fermented beverages,
• Spinach,
• Wheat germ,
• Citrus fruits,
• Food dyes,
• Nuts and
• Bananas.

However, some foods may not be allergic, and they can differ from one person to another.

Foods to include for Histamine Intolerance

Some of the foods that can be included are listed below.

• Fresh meat,
• Eggs,
• Gluten-free grains
• Fresh vegetables and
• Dairy substitutes.

Testing for Histamine Intolerance

There is no proven test for the clinical manifestation of histamine intolerance. The blood DAO activity and histamine levels are measured and correlated with the symptoms.

Additionally, it is also important to consider other diseases and disorders while evaluating the symptoms of histamine intolerance. The other factors to be considered are mast cell disorders, allergies, inflammatory bowel disease, fructose malabsorption, celiac disease, colitis and small intestinal bacterial overgrowth.

After considering these factors, the elimination of certain foods that trigger a histamine reaction can be suggested.

According to NCBI, the diagnosis of histamine intolerance can be precisely inconsistent as there will be similar stimuli for various manifestations in the same individual.

Treating Histamine Intolerance

The treatment for histamine intolerance depends on the symptoms of the individuals, and the main treatment will be the elimination of certain foods that triggers a histamine reaction. A detailed treatment availability is discussed below.

Elimination Phase

The primary treatment of histamine intolerance will be eliminating certain foods that trigger the release of histamine.  

The patient will be asked about the foods that cause an allergic reaction. And the foods will be evaluated, and the histamine levels will be checked.

However, it will not be decided at the first stage that the adverse reaction was due to histamine intolerance. It can also be caused due to other allergies. Considering these, certain foods that trigger allergic reactions will be eliminated.

Some of the foods that have high histamine and should be eliminated from the diet are   

• Vegetables- Eggplant, tomato and pumpkin.
• Processed meat- Ham, sausage, salami and bologna
• Seafood- Tuna, mackerel, crab and shrimp.
• Cheese- Gouda, cheddar, mozzarella and cottage cheese.
• Fruits- Cherry, plum, strawberry, cranberry, raspberry and apricots.

Test phase

After identifying the foods that cause a reaction, they will be eliminated. After eliminating those foods, certain foods that do not cause any reaction will be evaluated.

The healthcare professional will ask you to consume foods that are low in histamine and will not cause any reaction. These foods will be tested to see if they trigger a reaction.

If the suggested foods cause a reaction, the doctor will check for other diseases and disorders. If these foods don’t cause any reaction, the doctor will ask you to include them in your diet.  

Long-term nutrition

Treatment for histamine intolerance does not mean that you have to eliminate all the foods you eat. If you do so, the body will not get any nutrition, and there is a chance that it can lead to malnutrition.

You can consume foods that are low in histamine. Some of the food suggestions are listed below.

• Do not consume any raw foods. Try to cook them properly and consume foods when they are hot.
• Consume foods in their original form.
• Record the foods you eat, and if they cause any reaction, record them too.
• Avoid processed and junk foods.
• Before making any changes in your diet, have a consultation with your dietician.
• Consult your doctor about the supplements and the dosage for supplements. But be watchful, not take any supplements on your own.

Medications for Histamine Intolerance

Medications for histamine intolerance will help reduce the release of histamine and block the histamine receptors. These blockers will help to reduce the symptoms a person can experience.

Some of the common drugs used to treat histamine intolerance are listed below.

• Antihistamines,
• DAO enzyme supplements and  
• Corticosteroids.

Conclusion

Certain foods contain a high histamine level, and when people with allergies consume such foods, it can lead to a reaction. So be watchful about the foods you eat. Most histamine intolerance can lead to gastrointestinal tract infections.

To manage histamine intolerance, the first thing to do is make certain dietary changes. Certain lifestyle changes will also be required and limit the consumption of alcohol and processed foods.  

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