By: @dermahealthnutrition

Histamine plays several important roles in the body, including regulating gastric acid production, controlling blood vessel dilation, modulating immunity and response to allergens. Histamine is found in varying amounts in almost all foods.

Histamine intolerance results from an imbalance between histamine intake and histamine metabolism in the body. It's important to note that histamine intolerance is different from a true allergy. An excess of histamine in the body can cause a range of symptoms and there is hardly a symptom that has not been associated with histamine intolerance: headaches and migraines, skin problems such as hives, itching or flushing, gastrointestinal symptoms such as abdominal pain, diarrhea or bloating, nasal congestion and runny nose, fatigue, irregular menstrual cycles and sleep disturbances. This wide range of potential symptoms, which can overlap with various other medical conditions, and the lack of a specific biomarker and diagnostic tools make it very difficult for healthcare professionals to diagnose histamine intolerance.

The cause of histamine intolerance remains unknown, and its existence is even doubted by some medical professionals. Various factors have been proposed as possible contributors, with a reduction in the enzyme diamine oxidase (DAO), which is responsible for breaking down histamine in the digestive tract, generally considered the prime suspect in causing symptoms. However, it is important to note that blood levels do not accurately reflect DAO levels and function in the gastrointestinal tract. Therefore, neither blood DAO levels nor stool histamine levels can be relied upon as a diagnostic tool, leaving histamine intolerance a clinical diagnosis. 

Ripened and fermented foods naturally contain higher levels of histamine or are more likely to release histamine than others. These include mature cheeses, sauerkraut, alcohol, processed meats, fish, ripe bananas, tomato (paste), spinach, walnuts, and chocolate. In addition, gastrointestinal conditions such as irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO) and celiac disease can inhibit the gut's ability to process histamine.

Individualized nutritional advice and personalized dietary changes or meal adjustments can be used to manage histamine intolerance. See below for a list of my recommendations. 

Diary: Start with a detailed food diary including an assessment of symptoms and food intake. This can help to identify individual patterns.

3-step histamine elimination diet: Work with a healthcare provider or registered dietitian to develop an individualized plan. The first phase (abstinence phase) lasts ten to 14 days. During this time, the aim is to reduce symptoms as much as possible with a histamine-reduced diet. Clinical guidelines recommend a plant-focused diet and a strict abstinence from alcohol. The fresher the food, the less histamine it contains. The abstinence phase is followed by the second phase, which should last up to six weeks. During this time, the individual’s histamine tolerance is assessed. The emphasis is on broadening the individual’s choice of foods. The final phase is the long-term dietary phase with the aim of permanently integrating the dietary recommendations based on personal histamine tolerance.

Probiotics: Some probiotic strains (lactobacillus/bifidobacteria) have shown promise in improving gut health and histamine regulation.

Dietary supplements: Some individuals may benefit from taking DAO supplements or antihistamines to help manage symptoms.

Lifestyle changes: Reducing stress can help manage symptoms and improve overall wellbeing.

References:

Hrubisko M, Danis R, Huorka M, Wawruch M. Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients. 2021 Jun 29;13(7):2228. doi: 10.3390/nu13072228. PMID: 34209583; PMCID: PMC8308327.

Zhao Y, Zhang X, Jin H, Chen L, Ji J, Zhang Z. Histamine Intolerance-A Kind of Pseudoallergic Reaction. Biomolecules. 2022 Mar 15;12(3):454. doi: 10.3390/biom12030454. PMID: 35327646; PMCID: PMC8945898.

Schnedl WJ, Enko D. Histamine Intolerance Originates in the Gut. Nutrients. 2021 Apr 12;13(4):1262. doi: 10.3390/nu13041262. PMID: 33921522; PMCID: PMC8069563.

Kettner L, Seitl I, Fischer L. Toward Oral Supplementation of Diamine Oxidase for the Treatment of Histamine Intolerance. Nutrients. 2022 Jun 24;14(13):2621. doi: 10.3390/nu14132621. PMID: 35807806; PMCID: PMC9268349.

Sánchez-Pérez S, Comas-Basté O, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content? Nutrients. 2021 Apr 21;13(5):1395. doi: 10.3390/nu13051395. PMID: 33919293; PMCID: PMC8143338.