Histamine intolerance: causes and treatment
Histamine intolerance primarily occurs after eating certain foods. It can lead to severe symptoms that can become life-threatening. Find out here what causes histamine intolerance and what treatment is possible.
What is histamine?
Histamine is a so-called biogenic amine, a hormone precursor that is found in food and is also formed in the body. It is involved in the immune system’s defense against foreign substances and therefore plays a central role in allergic reactions. It acts as a messenger substance that is released in response to inflammation and causes the tissue to swell.
What happens with a histamine intolerance?
The consumption of histamine in food is normally harmless. Under normal circumstances, histamine is broken down in the intestine. The enzyme diamine oxidase (DAO) is formed in the intestinal mucosa, which acts as a transport protein in the metabolism and thus transports the histamine out of the body.
If the formation of DAO is disturbed, for example by taking medication, drinking alcohol or gastrointestinal inflammation, the histamine balance in the body begins to falter. There is more histamine than can be broken down by the enzymes, allowing larger amounts than normal to enter the bloodstream and trigger a variety of ailments.
Accordingly, histamine intolerance is not an allergy in the true sense of the word, but a degradation disorder whose symptoms are only very similar to those of an allergy. In such a so-called pseudoallergy, the immune system is not directly involved in the reactions that occur. No antibodies are formed in the blood.
Histamine intolerance is usually not congenital, but occurs when there is an overload of histamine. The phenomenon affects about 1 percent of the European population, 80 percent of whom are middle-aged women.
How does a histamine intolerance manifest itself?
Histamine intolerance can cause a wide variety of symptoms, which usually appear a few minutes to an hour after ingesting histamine. Basically, these are very similar to the symptoms that histamine causes in the event of an allergic reaction.
- headache or migraine
- Gastrointestinal complaints (e.g. diarrhea , abdominal pain, flatulence, heartburn, nausea)
- Skin disorders such as hives , itching, wheals, swelling, eczema
- runny nose
- asthma
- cardiovascular problems
- dizziness
- sleep disorders
- exhaustion
- body aches
Note: Unlike most other intolerances, such as lactose intolerance or celiac disease , the reactions of histamine intolerance can become life-threatening.
What causes histamine intolerance?
Since histamine is an endogenous substance, histamine intolerance can in principle also occur without external influences. In some cases, however, a pollen allergy , for example, contributes to the increased release of histamine. Usually, however, an excess of histamine in the body is caused by the consumption of food.
In principle, histamine is contained in all foods. However, the following applies: the histamine content increases as a result of maturation or fermentation processes involving bacteria or microorganisms. It is therefore advisable to always eat food as fresh as possible. Prepared meals are eaten immediately if possible and finished products are avoided as far as possible.
The following foods should be avoided if you have histamine intolerance, as they either contain large amounts of histamine or act as so-called histamine liberators in the body, i.e. they stimulate the cells to release histamine:
Animal products:
- Fish, especially canned fish
- seafood
- shellfish
- Smoked meat and sausages
- Hard cheese (the higher the degree of ripeness, the higher the histamine content)
Vegetables:
- tomatoes
- eggplants
- spinach
- avocados
- sauerkraut
- all kinds of canned vegetables
Fruit:
- citrus fruits
- pineapple
- banana
- plums
- pears
- kiwi
- strawberries
- raspberries
- all kinds of fruit preserves
Beverages:
- fruit juices
- black tea
- Green tea
- mate tea
- energy drinks
- Coffee
- alcoholic drinks
The histamine content is particularly high in red wine and beers with a high yeast content. Alcohol also promotes the release of histamine from cells while inhibiting DAO. In addition, histamine can be absorbed more easily from liquids than from solid food components.
Other foods:
- chocolate, cocoa
- marzipan
- beans and legumes
- soy products
- nuts
- Yeast
- Vinegar and products made with vinegar (such as mustard)
- hot spices
- colors and preservatives
- glutamate
How is histamine intolerance diagnosed?
Because histamine intolerance can manifest itself in so many different ways, it is very difficult to reliably diagnose right away. The diagnosis is further complicated by the fact that other intolerances, which could be responsible for the symptoms, often occur together with a histamine intolerance. A detailed anamnesis discussion with the doctor treating you is therefore usually the first step in therapy. This is very important in order to clarify the medical history, to define the clinical picture precisely and, if necessary, to rule out some potential causes for the symptoms that occur.
It is also very helpful to keep a so-called food diary, in which it is noted what was eaten and when and whether and what kind of complaints occurred. If information is collected over several weeks, these long-term values can often be used to draw conclusions about possible intolerances.
A provocation test is usually used to clearly identify histamine intolerance . In the case of other allergies or intolerances, the affected person is directly exposed to the relevant allergen. However, since histamine intolerance can lead to very severe to life-threatening reactions, a kind of “negative provocation” takes place in this case.
For this purpose, the person concerned follows a strict, low-histamine diet for several weeks. A blood sample is then used to measure the DAO levels and the histamine concentration in the blood. If the DAO values are significantly reduced compared to the specified standard values, this speaks for a histamnine intolerance. Even if the histamine concentration has decreased significantly due to the diet, this indicates an existing intolerance.
How is histamine intolerance treated?
- For acute cases of histamine intolerance, the attending physician can prescribe fast-acting antihistamines .
- In the long term, a low to zero histamine diet is necessary to avoid discomfort and symptoms. In the initial phase of this diet, i.e. the first few weeks or months, foods containing histamine should be avoided completely if possible in order to restore the histamine balance in the body.
- To support the breakdown of histamine, it is also possible to take the enzyme DAO in the form of a dietary supplement .
- In some cases, the doctor also prescribes high-dose vitamin C , as this also promotes the breakdown of histamine.
- If there is a proven lack of vitamin B6 , this can also be prescribed as a preparation, as it is involved in the synthesis of DAO in the intestine.