Food intolerances are widespread these days and make life difficult for many people. However, they are usually not true allergies, as they are caused by an enzyme deficiency. If someone suffers from histamine intolerance, they experience symptoms after consuming histamine-rich foods. Histamine intolerance can also be caused by certain medications, some illnesses, or a nutrient deficiency.

What is histamine?

Histamine is a biogenic amine produced during the breakdown of the amino acid histidine. It is then stored in nerve cells, platelets, granulocytes, and mast cells. Histamine is subsequently released by the body's own enzymes, the ingestion of medications, certain foods, or chemical substances.

Histamine is needed in the body for a whole range of processes:

• the contraction of the muscles in the intestines and uterus
• the production of gastric juice
• the narrowing of the airways and central blood vessels
• the regulation of body temperature and the sleep-wake cycle
• the dilation of blood vessels in the legs and arms

What is histamine intolerance?

Histamine intolerance is not a common phenomenon; only about one percent of the population suffers from it. In affected individuals, the body cannot completely break down histamine, resulting in significantly elevated histamine levels.

Histamine intolerance is not a classic allergy, but rather a metabolic disorder, also known as a pseudoallergy. The symptoms of histamine intolerance do not arise from an overreaction of the immune system. Various stimuli trigger the release of histamine, such as oxygen deficiency, injuries, or inflammation.

Histamine intolerance cause

The cause of histamine intolerance is the excessive production of histamine in the human body. This can occur, for example, when you are under severe stress. On the other hand, a deficiency of the enzyme diamine oxidase (DAO) can also be present, resulting in insufficient histamine breakdown.

Enzyme deficiency is often due to an inflammatory bowel disease such as Crohn's disease or ulcerative colitis. However, it can also be caused by a deficiency in B vitamins or zinc. If histamine levels are already elevated and you then consume histamine-rich foods, corresponding symptoms are almost inevitable.

In short, the following factors can contribute to high histamine levels:

• Inhibition of the enzyme diamine oxidase by drugs or alcohol
• Consumption of certain amines such as serotonin, tyramine, or phenylethylamine
• Consumption of histamine liberators that release histamine
• Gastrointestinal infections

Histamine intolerance symptoms (physical)

Suffering from histamine intolerance can manifest in both physical and psychological symptoms. Physical symptoms include the following:

• Gastrointestinal complaints such as nausea, vomiting, constipation, diarrhea, abdominal cramps and bloating
• Conjunctivitis as well as watery and red eyes
• Skin reactions such as eczema, swelling, hives and itching
• Cardiovascular disorders such as high blood pressure, cardiac arrhythmia, rapid heartbeat and dizziness
• Pain in joints and muscles

Histamine intolerance symptoms (psychological)

When histamine intolerance and its symptoms are discussed, usually only the physical symptoms are mentioned. Many people are unaware that the central nervous system, the brain, and the psyche can also be affected.

Headaches, sometimes migraine-like, are a common symptom. Furthermore, histamine intolerance can also cause concentration and sleep problems, nervousness, and even panic attacks.

Diagnosis of histamine intolerance

The symptoms of histamine intolerance are quite nonspecific, making diagnosis not always easy. Furthermore, there is currently no reliable diagnostic procedure available to doctors.

One might think that measuring the DAO enzyme would provide information, but unfortunately that's not the case. First, other intolerances, cancers, irritable bowel syndrome, and inflammatory bowel diseases must always be ruled out.

A food diary facilitates diagnosis.

In principle, a histamine intolerance can only be definitively diagnosed by eliminating certain foods. These foods are completely removed from the diet for several weeks, followed by a food challenge to analyze the reactions.

Histamine intolerance can vary in severity, and the tolerance threshold differs from person to person. Keeping a food diary for a few weeks can help you record what you eat and note any symptoms you experience after consuming certain foods. This can then be used to adjust your diet and prevent future health problems.

Histamine intolerance tests

After a thorough medical history, the doctor may order various tests. As already explained, there is the so-called provocation test, which is controversial. This is because severe histamine intolerance can lead to serious allergic reactions in the form of shortness of breath.

Typically, a blood test is performed first, focusing on the histamine level in the blood plasma. In addition, the activity of the enzyme diamine oxidase is usually also checked. However, it is important to eat normally beforehand; avoiding histamine-rich foods would skew the test results. The test is then usually repeated after two weeks.

Histamine intolerance treatment

Treating histamine intolerance is actually quite simple, as it essentially involves following a diet. The key is to ensure that the body receives as little histamine as possible. However, it's not always possible to restrict intake, in which case taking antihistamines may be advisable.

Cromoglicic acid can also reduce histamine levels in the body, thus alleviating symptoms. In some cases, taking vitamin C or vitamin B6 may also improve symptoms. Furthermore, there are medications containing the enzyme diamine oxidase, which promotes the breakdown of histamine.

Treating histamine intolerance through diet

When it comes to treating histamine intolerance, dietary changes are essential. A special diet can significantly improve symptoms. You should typically notice a noticeable improvement after about 14 days.

When it comes to your diet, you should avoid all foods and drinks very high in histamine. You must also avoid foods and medications that release histamine in the body. The best way to find out what you tolerate and which foods you should eliminate from your diet is to experiment. Your body will clearly tell you what it can and cannot tolerate.

Histamine intolerance food list

The following foods are generally well tolerated by people with histamine intolerance:

Meat/Poultry/Fish and meat products

Fresh or frozen meat and poultry, fish such as cod, pollock, plaice, haddock, redfish and haddock, cooked and scalded sausages

Milk and dairy products/cheese

Fresh milk, yogurt, buttermilk, kefir, cream, butter, cream cheese, quark, butter cheese, young Gouda

Cereals and cereal products

Bread, baked goods, cereal flakes, rice, pasta, spelt, wheat, barley, millet

Fruit

Melon, blueberries, cranberries, lychee, mango, rhubarb, cherries, currants, apples, apricots, nectarines, peaches, pears

Vegetables

Potatoes, green salad, cabbage, beetroot, pumpkin, onions, radishes, daikon radish, peppers, carrots, broccoli, cucumber, leeks, zucchini, corn, asparagus, garlic, fresh herbs

confectionery

Fruit candies, gummy bears, chewing gum, popcorn, honey, jam

drinks

Coffee, tea, water, fruit juices (except citrus fruits)

alcohol

Clear spirits, white wine, light beer (Pilsner, Kölsch)

Miscellaneous

Butter, margarine, oils, spices, apple cider vinegar

Which bread is suitable for histamine intolerance?

Generally, no discomfort is to be expected after eating bread and other baked goods. At most, very fresh baked goods might cause some stomach upset. However, this is common to everyone and is not necessarily related to histamine intolerance.

Day-old bread, toast, crispbread, and rusks are generally well tolerated. Stomach aches could result from eating coarse breads like pumpernickel or whole-grain bread, but this can also occur in healthy individuals. Rye sourdough bread may be problematic in some cases. If you are suffering from diarrhea, avoid baked goods made with refined flour to reduce your fiber intake.

Beverages permitted for histamine intolerance

If a histamine intolerance is present, symptoms are frequently reported after consuming sparkling wine and red wine. This also applies to cocktails, especially if they contain carbonation. White wine, on the other hand, is usually well tolerated, at least in small amounts.

Clear spirits and beer are usually well tolerated. You can also try espresso, lupin coffee, decaffeinated coffee, still water, and freshly squeezed juices.

Histamine intolerance medications

Normally, you'll manage well with a change in diet. However, there are situations where it's difficult to pay close attention to your diet, such as when traveling. Furthermore, there are also people for whom dietary changes don't bring the desired results. In this case, you may need to use medication, at least temporarily.

Initially, treatment is attempted with conventional antihistamines such as levocabastine, levocetirizine, fexofenadine, cetirizine, or loratadine. Supplementation with vitamins C and B6 may also be helpful in some cases. Antihistamines inhibit histamine in the body and prevent skin rashes, dizziness, allergic rhinitis, and headaches. Alternatively, therapy with diamine oxidase (DAO) enzymes in capsule form could be considered.

Conclusion

Histamine intolerance can usually be well managed with a special diet and by avoiding certain foods. Therefore, it's generally not necessary to take medication continuously. Medication should really only be used sporadically, when needed.

However, histamine intolerance should never be taken lightly, as in the worst case it can lead to life-threatening symptoms. For this reason, those affected should always have a fast-acting antihistamine readily available.