Managing Histamine Intolerance

Content reviewed by Donna Gates
Written by Body Ecology on July 10th, 2023

 histamine intolerance title image

When the average person thinks of “histamines,” they likely think of anti-histamines they pick up at the drugstore in the Spring to provide relief from sneezing, itchy, watery eyes, and other “seasonal allergy” symptoms. But what is it that so many people are allergic to, and why must they “fight” histamines? 

Histamine intolerance is a somewhat complicated topic, but let’s simplify it by looking at what exactly it is.

Histamines are organic compounds (meaning something that is produced by living organisms, animals, some plants, and even some insects) that can trigger an immune response. Histamine acts as a neurotransmitter, or chemical messenger, that the body uses to carry chemical messages from a nerve cell to another cell.

Histamine in Action

Histamine plays an essential role in many functions in the body, such as managing the body’s inflammatory response. The uncomfortable symptoms experienced with seasonal allergies are associated with this inflammatory response. The itching that comes along with hives is another example. While sometimes uncomfortable, the release of histamine is a vital function as it helps the body target and attack foreign invaders.   

Histamine is released in the body by basophils, a type of white blood cell composed of tiny granules called granulocytes, which are found within mast cells. Both mast cells and basophils originate in the body’s connective tissue near (where histamine is released) in response to what the body perceives as a foreign invader.

histamine in action

The release of histamine makes it easier for white blood cells to pass through the tiniest capillaries which then target and attack foreign invaders in nearby tissues as part of the  immune response.

Histamine also controls specific functions in the gut as part of a vast network of tissues throughout the body where mast cells are found. For example, histamine, along with several other compounds is involved in regulating stomach acid. It is released by mast cells found throughout the gut lining. 

When a substantial amount of histamine is released, frequently, unpredictably, and/or when accompanied by severe reactions, the result can be one or even hundreds of symptoms taking place anywhere in the body. This type of severe inflammatory reaction brought on by a histamine response, is referred to as Histamine Intolerance (HIT.) 

Different Allergic Responses

Anaphylaxis, an intense and immediate reaction caused by exposure to a specific antigen such as a bee sting or the consumption of shellfish, by someone with an allergy to these substances, can result in an extreme histamine reaction. Anaphylaxis is dangerous and often fatal.

An anaphylactic allergic response is a type of allergic response called an Immunoglobulin E (IgE) response. In someone with this allergy, the immune system reacts strongly to that particular allergen by producing (IgE) antibodies. People can react differently to IgE antibodies. Some people will react to pet dander for example, but only if they have the IgE antibodies specific to that type of pet.

IgE allergies can occur within minutes, especially after ingesting a reactive food. Symptoms can include hives, inflamed skin, vomiting and/or a potentially fatal anaphylaxis reaction requiring immediate emergency medical treatment with symptoms such as swelling of the lips, tongue or throat, shortness of breath, difficulty breathing, and/or wheezing. 

Many people with susceptibility to severe reaction carry an EpiPen, a type of autoinjector they keep with them at all times to self-inject at the onset of an anaphylactic reaction. EpiPen contains epinephrine, a neurotransmitter and hormone and the substance most commonly used to treat anaphylaxis.

By contrast, an IgG reaction, characterized by Immunoglobulin G (IgG), is a different type of reaction with a different antibody response characterized by lower grade, more chronic symptoms such as swollen joints or rhinitis. Both types of reactions can be triggered by reactions to specific foods.

Histamine intolerance is often confused with a related condition called Mast Cell Activation Syndrome (MCAS.) With MCAS, mast cells secrete multiple chemicals that transmit information between cells, tissues, or organs, with HIT, mast cells release only histamine. 

Is Histamine Intolerance a Pseudo Allergy?

Histamine intolerance is sometimes referred to as a “pseudo-allergy” because many of the symptoms associated with HIT appear to be attributable to general “allergies” (as with the common seasonal allergies.) But in reality, they do not actually involve the same set of symptoms and are legitimately different.

Compared with a general allergic reaction, Histamine Intolerance prompts a more serious response in the body which happens when excessive levels of histamine are present -whether it is released by the body in response to a perceived foreign invader or from exposure to an allergen such as a pet or a peanut. In either case, the body cannot efficiently break down histamine -and this is further complicated by receptor sites that are overly sensitive. 

Think of receptor sites as proteins that are found on the surface of cells. They can recognize and then bond to specific particles. Histamine, acts on a variety of histamine receptors which are at the root of different symptoms. 

Causes of Histamine Intolerance 

What causes Histamine Intolerance? Excessive release of histamine along with a decreased ability to break it down, are the primary reasons. 

Decreased Diamine oxidase (DAO) production, (a gastrointestinal enzyme), is a major contributor to Histamine Intolerance. HIT is attributed to a deficiency of DAO and the food component of histamine not being broken down and/or absorbed properly in the GI tract.

DAO helps dampen reactions that trigger the body to produce excessive histamine-producing symptoms (or lessen those that have already appeared.) 

Making sure the DAO enzyme can function effectively is crucial in managing the histamine response. Body Ecology’s Histamine Reducing Probiotic (powder) is a blend of beneficial bacteria that support the DAO enzyme and help to lower high levels of mast cells in the gut and the breakdown of histamine in the intestines. 

Decreased levels of Histamine N-methyltransferase (HNMT) (another enzyme needed to break down histamine) also contributes to histamine intolerance. HNMT is an enzyme found in the central nervous system that specifically metabolizes histamine though exactly how it works is not known. 

Inadequate levels of these enzymes or a deficiency in these enzymes can lead to excessive amounts of histamine.

histamine symptoms

HIT Symptoms

Because histamine impacts so many different body systems, it can stimulate a wide range of symptoms that can pop up either frequently or occasionally. One’s weak points in the body, tend to be the areas most effected.  Those who have “experience” with HIT become used to symptoms being activated for many different reasons. 

The most common complaints amongst those afflicted with HIT tend to be gastrointestinal symptoms. Lactose intolerance, small intestinal bacterial overgrowth and irritable bowel syndrome, are considered to be related to histamine reactions in some studies. 

Consuming foods with high histamine content may trigger abdominal cramps and severe diarrhea almost immediately following a meal. Digestive problems such as gas, abdominal pain, stomach or intestinal cramps, chronic diarrhea, nausea and vomiting are common.

Other symptoms commonly experienced by many HIT patients:

Medical professionals are in agreement that most disease states originate with chronic inflammation. It is no doubt accurate to say that HIT contributes to aggravating most chronic inflammatory conditions.

Treatment Challenges

HIT is a complicated condition involving multiple body systems, approaches to treatment, and challenges to managing its many symptoms. Often, the goal of treatment is to “teach” the body how to manage its histamine response while supporting the best possible quality of life for patients struggling with this condition. 

There are several different drugs on the market prescribed to control histamine reactions. Some reduce or eliminate responses triggered by excessive histamine secretion. Others address reactions with symptoms involving the nose, motion sickness, or vertigo. Those suffering from histamine intolerance can take both types of medication. 

Over-the-counter medications can also address Histamine Intolerance, but in a different way. Prescription drugs or over-the-counter medications will not address many symptoms. In fact, these medications may make symptoms worse because some medications, taken for conditions unrelated to HIT, can dramatically impact HIT symptoms.

Risks and benefits must always be weighed when considering any drug -taking into consideration, potential side effects and nutrient depletions.

Strategies for Managing HIT

Following a low histamine diet may reduce symptoms without the need for prescription medication. The time it takes to see results on a low histamine diet varies from person to person but treating HIT with a natural approach is preferable in the long run because the body can “learn” how to produce histamine in a more controlled manner. This results in treating the root cause of HIT rather than the symptoms. 

High Histamine Foods to Avoid

  • Alcohol, (particularly beer and wine) 
  • Hard cheeses, goat cheese
  • Shellfish
  • Certain fish: mackerel, mahi-mahi, tuna, anchovies, sardines
  • Chickpeas, soybeans, peanuts
  • Walnuts, cashews
  • Chocolate/cocoa
  • Avocados, eggplant, spinach, tomatoes
  • Wheat-containing products
  • Vinegar
  • Processed foods
  • Salty snacks, sweets with preservatives and artificial colorings
  • and more

high histamine foods to avoid

Understanding how to diagnose and treat this complicated condition is challenging for medical professionals and patients alike. But careful attention to diet, supplementation where appropriate, and medication when necessary, all contribute to a comprehensive approach needed to address Histamine Intolerance. Diligent patients can learn to manage symptoms and live with HIT.

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