Histamine is a substance belonging to the class of biogenic amines, better defined as a mediator, produced by certain cells in our body, particularly mast cells, and is responsible for some important functions such as:
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But what is histamine intolerance?
Histamine intolerance, sometimes mistakenly called an allergy, is a condition that occurs when there is an imbalance between the accumulation and degradation of histamine within the body.
Symptoms of histamine intolerance
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Some common reactions associated with this intolerance include:
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In more severe cases of histamine intolerance, you may experience:
- abdominal cramps
- tissue swelling
- high blood pressure
- irregular heart rate
- anxiety
- difficulty regulating body temperature
- dizziness
How is dietary histamine metabolized?
Histamine, present in every food (of animal and plant origin), must be metabolized to be eliminated from the urine without problems. Note that exogenous histamine does not have a functional role within the body and, for this reason, it is eliminated without utilizing any properties.
There are two main known pathways of histamine metabolism in living organisms, involving histamine N-methyltransferase (HMT) and diamine oxidase (DAO).
HMT is an enzyme that degrades histamine in liver tissue, but it is also present in lower amounts in other tissues.
DAO is the most important enzyme that degrades histamine, but it is found only in certain tissues, particularly in the intestinal mucosa, kidneys, placenta, thymus, and seminal vesicles.
What causes high histamine levels?
In people suffering from histamine intolerance, there is a reduction in the activity of a particular enzyme, DAO (diamine oxidase), which is responsible for degrading excess histamine. This reduction can be due to various causes:
- a genetic predisposition
- as a consequence of gastrointestinal diseases (such as inflammatory bowel disease) that inhibit its production
- following the consumption of substances that inhibit its action.
- drugs that block DAO functions or prevent its production, such as antibiotics, antidepressants, diuretics, painkillers, but also some NSAIDs (non-steroidal anti-inflammatory drugs) such as acetylsalicylic acid.
- foods containing histamine that cause improper functioning of DAO enzymes
Researchers are still studying the amount of histamine present in most foods and beverages, as well as how certain nutrients impair DAO activity, as concentrations of histamine and other biogenic amines in foods are highly variable within the same family, and even between two samples of the same product.
Foods and histamine
We can distinguish two types of foods: foods rich in histamine, such as:
- alcohol and other fermented beverages
- fermented foods and dairy products, such as yogurt and sauerkraut
- nuts
- avocado
- eggplant
- spinach
- processed or smoked meats
- mollusks and certain types of fish
- aged cheeses
Foods that trigger the release of histamine in the body, meaning foods that do not contain histamine but are capable of stimulating its release by the body. They contain certain substances, such as proteins, that stimulate immune system cells, known as mast cells, to degranulate (i.e., release the intracellular histamine contained in their granules), triggering all those inflammatory mechanisms involved in histamine intolerance itself. Among the histamine-releasing foods are:
- alcohol
- canned tuna
- bananas
- tomatoes
- wheat germ
- beans
- papaya
- chocolate
- citrus fruits
- nuts, particularly walnuts, cashews, and peanuts
- food dyes and other additives
How is it diagnosed?
There is still no reliable procedure for the diagnosis of adverse reactions to ingested histamine. Most of the time it is self-diagnosed by the patient or based solely on medical history.
Therefore, the diagnosis of adverse reactions to histamine has so far been made purely based on symptoms and in the absence of reliable laboratory parameters. The therapeutic approach should be largely guided by the individual tolerance of affected individuals.
Further research is needed to establish the relevance of measuring biomarkers, risk factors in intestinal barrier function, as well as the dose of histamine that causes pharmacological effects. Until then, expert nutritional advice can help patients avoid diets that result in an unnecessary reduction in their quality of life.
My advice?
If you have histamine intolerance, incorporating low-histamine foods into your diet can help reduce symptoms. Unfortunately, there is no histamine-free diet. Consult your nutritionist, who may suggest following an elimination diet for 14-30 days. In this way, all histamine-rich or histamine-triggering foods are removed and then slowly reintroduced to observe any tolerances to certain foods.
Bibliography
- Kofler L, et al. (2011). Histamine 50-skin-prick test: A tool to diagnose histamine intolerance.
- Maintz L, Novak N. “Histamine and histamine intolerance.” Am J Clin Nutr. 2007
- Mayo Clinic Staff. (2018). Allergy skin tests.
- https://www.deficitdao.org/
- Reese, I., Ballmer-Weber, B., Beyer, K. et al. German guideline for the management of adverse reactions to ingested histamine. Allergo J Int 26, 72–79 (2017).