Histamine Intolerance

Adverse food reactions come in all shapes and sizes, from watery eyes to deadly anaphylaxis.  The study of food sensitivities is not keeping pace with the number of people experiencing myriad symptoms from foods they ingest.  Because of this the medical community is lagging behind in diagnosing and treating food related symptoms.  Celiac disease and gluten intolerance are grossly underdiagnosed but the gluten free marketplace is booming.  Gluten sensitive individuals are bypassing their doctors and finding relief with a gluten free diet.  Once riddled with diarrhea predominant IBS or neurological symptoms associated with gluten consumption, former sufferers are challenging the paradigms of traditional medical treatments.

Following on the heels of the gluten free revolution is histamine intolerance.  Just as gluten free diets gained popularity via internet searches by frustrated patients, so is the low histamine diet.  Histamine is a biogenic amine that is naturally occurring in many foods.  It is also the principle mediator released from mast cells, immunocytes that get triggered in allergic reactions.  But sometimes mast cells inappropriately release histamine or individuals are unable to effectively degrade histamine, leaving one with histamine overload.  Mast cells originate in the bone marrow and are found in heavy concentration in many body organs, such as skin, lungs, uterus, central nervous systems, and gastrointestinal tract.  Interstitial cystitis is largely considered a mast cell abnormality and sufferers often follow a low histamine diet.  While not yet a recognized medical diagnosis, some have coined the term mastocytic enterocolitis to describe diarrhea caused by too many mast cells in the gut or mast cells that behave badly and unleash histamine.

Knowing that antihistamines alleviate symptoms of seasonal allergies, most people underestimate the power of histamine overload.  The most serious effect of histamine toxicity is anaphylaxis, which is seen in IgE mediated allergies or mastocytosis and mast cell activation syndrome (MCAS), conditions that are considered rare.   But in between runny noses and anaphylaxis are other manifestations including diarrhea, headache, itching, flushing, vertigo, dyspnea, arrhythmias, dysmenorrhea, blood pressure abnormalities, nausea, vomiting and  stomach cramps.  The dots rarely get connected for these common symptoms, so the diagnosis of histamine intolerance has remained elusive.  Symptoms may also wax and wane, confusing the clinical picture.  Having too much histamine can come from ingesting too much through food, having mast cells release histamine or the body’s inability to clear histamine.  Once one’s threshold for histamine is exceeded, symptoms will appear.

Just like with non-celiac gluten intolerance, no testing methods are available in the United States for histamine intolerance.  In European countries, one can have their level of diamine oxidase (DAO) tested.  DAO is principle enzyme that breaks down and clears ingested histamine.   Without adequate testing, one can only remove histamine rich foods from their diet and see if symptoms abate.  Relief can often be found with the use of antihistamines that block the effects of histamine.  DAO supplements are now available in this country and may also provide some benefit.

Food contributes to histamine load by either containing histamine or by liberating histamine from cells.  Fish and shellfish are likely culprits because when fish die they rapidly convert histidine to histamine.  Improperly processed fish has probably caused many to avoid seafood thinking they were allergic, when in fact it could have been a histamine reaction.   The low histamine diet also eliminates berries, tomatoes, citrus and stone fruits, some nuts and legumes, eggplant, spinach and pumpkin.  Aged and fermented foods, such as cheeses, alcoholic beverages, dried fruits, fermented soy products, salami and pepperoni, sauerkraut and vinegar all contain high levels of histamine.  Also on the avoid list are chocolate, tea, certain spices, food dyes and preservatives.

Eliminating foods is a safe, non-drug approach for the array of symptoms associated with histamine intolerance.  While the diet can be quite limiting, individuals who are hitting brick walls with conventional medical treatments are finding they can manage troubling symptoms by avoiding offending foods, use of over the counter antihistamines and the addition of DAO supplements.   There is still much to be learned about histamine intolerance and why it arises, but for now a low histamine diet can be a step on the road to recovery.

Mary Beth George, MEd, RD/LD, LPC

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