You may have been diagnosed with IBS, but did you know that you could have a histamine intolerance that has been missed?
Despite a histamine intolerance being common, there seems to be a lack of awareness in general healthcare.
This post will give you an overview of the condition, how it is diagnosed and how to manage it.
A histamine intolerance occurs due to the inability to break down histamine in the body. This leads to a build-up of the substance, causing symptoms.
It is thought that around 1-3% of people have a histamine intolerance (1). However, the actual number of people may be higher due to the potential mis or undiagnosed numbers.
What Is Histamine?
Histamine is a substance produced by cells during an infection. It signals the immune system to start an inflammatory response which is what helps the body to fight infection.
After histamine is used, it is broken down in the body. In those with an intolerance, this break down does not occur and instead there is a build-up leading to symptoms.
In allergies, histamine is incorrectly released by the body in response to something e.g. nuts. It is this histamine which leads to the symptoms you see in a food allergy.
What Causes a Histamine Intolerance?
It is thought that a histamine intolerance is caused by previous digestive diseases and / or genetic problems (5).
When these enzymes are not working correctly, it leads to a build of histamine and you start experiencing symptoms (5).
A Histamine Intolerance is Not an Allergy
Although histamine is involved with food allergies, a histamine intolerance is not an allergy. The symptoms of a histamine intolerance are caused by the inability of your body to break down histamine. It is not caused by your immune system wrongly recognising things as dangerous.
Unlike a food allergy, those with a histamine intolerance can manage their symptoms by reducing their overall intake of histamine. They do not need to be 100% histamine free.
Symptoms of a Histamine Intolerance
The symptoms of a histamine intolerance are not life threatening but can really reduce your wellbeing. Simple things like eating out can become an issue.
Symptoms vary depending on the level of histamine you have built up in your body and are very similar to an allergic reaction. The more histamine you have, the more severe your symptoms will be.
Symptoms can occur any time between hours or days after eating trigger foods (8).
Symptoms Include (12);
- Runny or blocked nose
- Asthma related wheezing
- Low blood pressure
- Severe skin itching
- Bladder irritation
- Persistent urinary tract infections
Histamine Intolerance Triggers
There are a few medications which can block the DAO from working efficiently (also known as a histamine liberator effect). To ensure that your medications are not doing this, check with your pharmacist.
There are also some medications that can help to reduce your levels of histamine, you can discuss this with your doctor for more information.
Some foods contain high levels of histamine which are difficult to break down if you have an intolerance. Other foods can also block the DAO enzyme from working and some people need to avoid these also.
3. Medical Conditions
The symptoms of certain medical conditions can cause an overproduction of histamine which can trigger symptoms in those with a histamine intolerance (12).
These conditions or symptoms are;
- gastrointestinal bleeding
The Low Histamine Diet
The information available about foods and histamine is confusing. There doesn’t seem to be a very clear-cut path to what you should be doing. However, we know a low histamine diet has been shown to improve symptoms in 80% of people (9).
From the research we have done, there seems be a consensus of ‘best practise’ between experts (10). This is based on a combination of scientific studies and what medical experts have seen in their own practises.
The experts say that you should be approaching this in a series of ‘stages.’ This is because, everyone has a different level of sensitivity and so going straight onto a very restrictive diet may not be required.
The below stages outline the process and you only need to work through each one if you find that your symptoms are still troublesome.
As we have already mentioned, this condition is an intolerance. However, your tolerance to histamine may differ depending on hormones, stress and other factors (10). Therefore, foods that you tolerate one day, may become a problem a couple of weeks later.
It goes without saying, this diet is complicated. Just as with the low FODMAP diet, it is recommended that you do this with a dietitian to ensure you do not become deficient in any nutrients and are also doing it accurately.
- To avoid just the foods that you know have caused you symptoms. This may be difficult to remember, so it is worth keeping a food and symptom diary to start with.
- To avoid all foods which are known to be high in histamine or which reduce the effect of the DAO enzyme (stopping it from breaking down histamine).
- To avoid foods that we think may result in higher levels of histamine in your body.
What Should You Avoid?
High Histamine Foods (12)
- Cheese: gouda, camembert, cheddar, emmental, swiss, parmesan
- Meat: fermented sausage, salami, fermented ham
- Vegetables: sauerkraut, spinach, eggplant, tomato ketchup
- Red wine vinegar
- Alcohol: white wine, red wine, beer, champagne
Histamine Releasing Foods
We know that these foods can cause histamine to be released but there are no oral challenge tests to prove this affect in the human body as of yet (11).
- Plant: citrus fruit, papaya, strawberries, pineapple, nuts, peanuts, tomatoes, spinach, chocolate
- Animal: fish, crustaceans, pork, egg white
- Other: additives, liquorice, spices
- Certain medications (speak to your doctor or pharmacist)
For a more comprehensive list, please click here.
DOA enzymes are oral supplements which you can take before each meal in order to break down the histamine in the food you eat.
Now, before you get excited, these enzymes have not really been proven to be that useful. There has been 1 study showing looking at taking a DAO enzyme (7% DAO with an enzymatic activity of 10,000 HDU/ml) 20 minutes before a meal (13).
The study showed that the enzymes helped to reduce the pain of headaches related to the condition, but that is it.
It is also important to note that these enzymes are extracted from pigs kidneys and are therefore not suitable for vegans.
How to get a Histamine Intolerance Diagnosis
The ‘gold standard’ for diagnosing a histamine intolerance (12);
- Clinical assessment from an experienced doctor – this will include medical tests to rule out other possible conditions.
- A 4 week low histamine diet under the supervision of a registered dietitian.
- A double-blinded placebo controlled provocation test with histamine.
- A histamine intolerance is a common condition which results in the individual being unable
to break down histamine.
- Symptoms vary and may come hours or days after eating a high histamine food.
- Symptoms can also be affected by other factors such as stress and hormones.
- Research on the subject is limited.
- A diagnosis comes from a combination of assessment from a specialist consultant and a trial of a histamine elimination diet.
- The low histamine diet should be done in a staged approach with a registered dietitian.
Book a Free Phone Consultation Now
If you are struggling to manage your histamine intolerance or think that you may have one. Please book in for a complimentary phone call consultation with one our specialist dietitians.
- Jarisch R, Götz M, Hemmer W, Missbichler A, Raithel M, Wantke F. Histamin‐Intoleranz.
Histamin und Seekrankheit. (Histamine Intolerance. Histamine and Motion
Sickness.). 2 ed Stuttgart, NY: Georg Thieme Verlag; 2004. (in German).