Histamine Intolerance: Symptoms, Causes, Test, & Treatment

In the case of histamine intolerance, the body cannot break down enough histamine, leading to an accumulation of this inflammatory compound.

Because its root cause often lies in the gut, the first symptoms of histamine intolerance are usually gastrointestinal complaints.

Table of Contents:

• What Is Histamine Intolerance?
• What Are the Symptoms of Histamine Intolerance?
• What Causes Histamine Intolerance?
• How to Test Histamine Intolerance
• How to Cure Histamine Intolerance
• Foods to Eat
• What to Avoid

What Is Histamine Intolerance?

Histamine intolerance means that you have too much histamine in your body.

Histamine intolerance is not an allergy or intolerance but the body’s inability to break down histamine.

Histamine is not fundamentally unhealthy but a chemical messenger that fulfills the following essential tasks in the body:

• Communicates messages to the brain
• Releases stomach acid to aid digestion
• Triggers an inflammatory response as part of the immune response to injuries and allergies

It only becomes a problem when people have an abnormal amount of histamine or can no longer break down histamine properly.

What Are the Symptoms of Histamine Intolerance?

The most common symptoms of histamine intolerance include (Hrubisko et al. 2021; Kovacova-Hanuskova et al. 2015; Wantke et al. 1993):

• Watery eyes
• Runny nose
• Stuffy nose
• Sinus infections
• Headaches
• Migraine
• Nausea
• Vomiting
• Diarrhea
• Fatigue
• Insomnia
• Dizziness
• Hives
• Skin irritation
• Itching
• Eczema
• Digestive problems
• Abdominal pain
• Abnormal menstrual cycle
• Tissue swelling
• Mood swings
• Anxiety
• Low blood pressure
• Hypertension
• Increased heart rate
• Flushing

Although histamine intolerance is not an allergy, its symptoms are difficult to distinguish from a conventional allergic reaction.

You may suffer from histamine intolerance if you regularly experience these symptoms after eating histamine-containing foods. The symptoms can occur in both children and adults.

What Causes Histamine Intolerance?

The cause of histamine intolerance is an imbalance between the production and breakdown of histamine in the body (Maintz et al. 2007).

Cells release histamine in response to a trigger.

Once produced, histamine is either stored or broken down by enzymes:

• Histamine N-methyltransferase (HMT) breaks down histamine in the central nervous system.
• Diamine oxidase (DAO) breaks down histamine in the digestive tract.

These enzymes help the body to break down and excrete histamine naturally (Comas-Basté et al. 2020).

The body may not produce these enzymes in sufficient quantities for various reasons.

HNMT is produced in brain cells and is usually genetic (Yoshikawa et al. 2019).

DAO is formed in the intestine and is responsible for the breakdown of ingested histamine.

New research findings suggest that histamine intolerance originates in the gut (Schnedl et al. 2019).

Damage to the gastrointestinal mucosa or disturbances in the intestinal flora can reduce DAO activity.

The following things can influence DAO enzymes and histamine levels (Zhao et al. 2022):

• Diet: Foods can block DAO enzymes or trigger histamine release. Histamine-rich foods can cause DAO enzymes to malfunction (see below).
• Gastrointestinal disorders: Inflammatory bowel disease, irritable bowel syndrome (IBS), or celiac disease can cause DAO deficiency.
• Medications: Drugs can block the functions of DAO or prevent its production (see below).
• Bacterial overgrowth of the small intestine (SIBO): When food is not digested correctly, bacteria grow, producing excessive histamine. Normal DAO enzyme levels can then no longer break down the increased histamine.
• Genetics: The gene that triggers the production of DAO may have a mutation.

How to Test Histamine Intolerance

There is currently no test that can determine histamine intolerance.

Doctors first try to rule out diseases or allergies that cause similar symptoms:

• Allergies
• Mast cell diseases
• Inflammatory bowel diseases
• Celiac disease
• Fructose malabsorption
• Bacterial overgrowth of the small intestine (SIBO)
• Colitis

Afterward, they may use the following tests to diagnose histamine intolerance (Zhao et al. 2022):

• DAO test: A test for antibodies against tissue transglutaminase can measure DAO concentration and activity. Levels are lower in people with hemin intolerance than in others.
• Urine test: Compared to determining DAO concentration, this method is faster, more convenient, and, therefore, more acceptable to patients.
• Blood test: A blood test checks the ratio of histamine and DAO enzymes. A high proportion of histamine to DAO means that the DAO level is too low to break down the histamine.
• Prick test: Another way to diagnose histamine intolerance is a skin prick test. It involves applying drops to the skin—the skin prick test for histamine checks for allergic reactions within 50 minutes.
• Intestinal biopsy: A gastroscopy can detect the DAO concentration in the intestine. An intestinal biopsy to see and cultivate the intestinal flora can also help diagnose.

How to Cure Histamine Intolerance

The key to curing histamine intolerance is to identify the root cause of the problem.

The intolerance often occurs with other conditions, such as candida overgrowth, gluten intolerance, or leaky gut syndrome.

Hence, treatment requires an integrative approach:

1. Diet

A low-histamine diet is the first treatment for histamine intolerance.

The intolerance varies from person to person. People can react very differently to histamine-rich foods and their dosage.

In addition, foods that release the body’s own histamine have just as significant an effect (see below).

In addition, studies show that lectins promote the release of histamine. Therefore, a low lectin diet can be just as effective, as it avoids all known histamine releasers and can improve an irritated gut.

When underlying problems such as irritable bowel syndrome or SIBO improve, histamine tolerance also improves.

A low FODMAP diet can help with both conditions and should be followed under the supervision of a doctor.

2. Balance

Dietary changes are strenuous and a social challenge. Here’s what helps to master them:

• Exercise: Exercise and any movement helps to cope with physical and mental dietary changes.
• Relaxation: Most methods to reduce stress are simple and free, such as yoga, meditation, or relaxing music.
• Sleep: 8 hours per night is non-negotiable and lowers cortisol levels.
• Family and friends: Seek help from family or friends who support the transition.

3. Tools

• App for histamine content
• Symptom tracker app
• Low histamine cookbooks
• Lectin-free diet list

4. Supplements

Vitamin C, B1, B6, B12 zinc, copper, magnesium, and quercetin can help. However, it is best to get these nutrients from low-histamine foods (see below).

DAO supplements also exist. However, there are not enough studies to prove their effectiveness (Comas-Basté et al. 2020).

Please use supplements under the guidance of a doctor. They can be helpful if used correctly but can also have side effects.

5. Medications

Antihistamines, topical and oral steroids, and homeopathic and herbal creams can help with symptoms.

However, they only have a short-term effect and do not combat the causes of histamine intolerance.

Foods to Eat

In the case of histamine intolerance, eating the following low-histamine foods helps to alleviate the symptoms:

• Meat: Freshly cooked meat and poultry
• Fish: Fresh or frozen
• Milk: Coconut milk, almond milk
• Fats: Animal fats, such as pasture butter or lard
• Vegetable oils: Extra virgin olive oil, virgin coconut oil
• Vegetables: Onions, sweet potatoes, asparagus, broccoli, beet.
• Cereals: White rice
• Spices: Fresh and dried herbs, salt
• Drinks: Water, mineral water, herbal tea
• Fruit: blueberries, apricots, cranberries, apples, mangoes, peaches

What to Avoid

A balanced diet contains moderate amounts of histamine. To reduce the symptoms of histamine intolerance, you should avoid foods that impair histamine metabolism.

The following lists include foods that release endogenous histamine, histamine-rich foods, and foods and medications that interfere with DAO enzyme activity.

Currently, little consistent data is available on the histamine content of foods. Nevertheless, the majority of the following drug and food lists could be based on current study data (Zhao et al. 2022; Hrubsiko et al. 2021; Pramod et al. 2007):

Histamine-Releasing Foods

• Alcohol
• Wheat
• potatoes
• Beans
• Tomatoes
• Bananas
• Pineapple
• Papaya
• Strawberries
• Citrus fruits
• Chocolate
• Walnuts
• Cashew nuts
• Peanuts
• Additives

DAO-Blocking Foods

• Alcohol
• Black tea
• Green tea
• Mate tea
• Energy drinks

High Histamine Foods

• Fermented, smoked and canned fish: mackerel, herring, sardine, tuna
• Matured cheese: Gouda, Camembert, Cheddar, Emmental, Swiss cheese, Parmesan
• Processed meat: fermented sausage, salami, fermented ham
• Fermented dairy products: Yoghurt, kefir, buttermilk
• Fermented vegetables: sauerkraut, pickles, pickled vegetables,
• Vegetables: eggplants, tomatoes, avocados
• Sauces and dressings: red wine vinegar, soy sauce, ketchup
• Alcohol: wine, beer, champagne
• Fruit: Dried fruit, strawberries, citrus fruits
• Legumes: chickpeas, soybeans, peanuts
• Cereals: Wheat
• Other: cinnamon, chocolate

DAO-Blocking Medications

The following medications can reduce DAO activity:

• Aspirin
• Antibiotics: Cefuroxime, cefotiam, ciprofloxacin
• Antidepressants: Amitriptyline, monoamine oxidase-1 inhibitors
• Anti-infectives: Clavulanic acid, isoniazid, pentamidine, chloroquine, doxycycline, neomycin B, acriflavine, D-cycloserine
• Asthma medication: Aminophylline, theophylline
• Antihypertensives: Dihydralazine, verapamil, alprenolol
• Chemotherapeutic agents: Cyclophosphamide
• Dehydrating agents: Amiloride, furosemide
• Cardiotonic: Dobutamine, dopamine
• Cough suppressant: Noscapine
• Contrast agent
• Local anesthetics: Lidocaine, prilocaine, marcaine, procaine
• Gastrointestinal medication: cimetidine, metoclopramide
• Medication for cardiac arrhythmia: Propafenone
• Anti-vomiting medication: Metoclopramide
• Muscle relaxants: Pancuronium, alcuronium, D-tubocurarine
• Narcotics: Thiopental, prilocaine
• Opioids: Pethidine, morphine, codeine
• Psychotropic drugs: Valium, diazepam, barbiturates, haloperidol
• Expectorants: Acetylcysteine, ambroxol
• Painkillers: Docein, metamizole, naproxen, acetylsalicylic acid, ibuprofen, propafenone, quinidine

Frequently Asked Questions (FAQ)

References

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

Comas-Basté, O., Sánchez-Pérez, S., Veciana-Nogués, M. T., Latorre-Moratalla, M., & Vidal-Carou, C. (2020). Histamine Intolerance: The Current State of the Art. Biomolecules, 10(8). https://doi.org/10.3390/biom10081181

Yoshikawa, T., Nakamura, T., & Yanai, K. (2019). Histamine N-Methyltransferase in the Brain. International Journal of Molecular Sciences, 20(3). https://doi.org/10.3390/ijms20030737

Schnedl, W. J., & Enko, D. (2021). Histamine Intolerance Originates in the Gut. Nutrients, 13(4). https://doi.org/10.3390/nu13041262

Zhao, Y., Zhang, X., Jin, H., Chen, L., Ji, J., & Zhang, Z. (2022). Histamine Intolerance—A Kind of Pseudoallergic Reaction. Biomolecules, 12(3). https://doi.org/10.3390/biom12030454

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

Pramod, S. N., Venkatesh, Y. P., & Mahesh, P. A. (2007). Potato lectin activates basophils and mast cells of atopic subjects by its interaction with core chitobiose of cell-bound non-specific immunoglobulin E. Clinical and Experimental Immunology, 148(3), 391-401. https://doi.org/10.1111/j.1365-2249.2007.03368.x