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Histamine Intolerance: Symptoms,  Diagnosis, Causes, and Treatment

Histamine Intolerance symptoms diagnosis treatment supplements
One of the hottest topics currently in the realm of functional medicine revolves around the production and intolerance of histamine in some individuals.  Getting to a diagnosis of histamine being a marker for an underlying disorder can take decades.  Meanwhile, people continue to go from conventional practitioner to conventional practitioner searching for answers to very real, (and often) very painful symptoms.  Two of the conditions around histamine issues that functional medicine addresses are Histamine Intolerance and Mast Cell Activation Syndrome.
 
 

Histamine Intolerance

Doctors give most people with on-going gastrointestinal or skin issues a pill or cream.  They then send patients on their way.  This is instead of giving them a diagnostic test.  Diagnostic testing is the only way to determine high histamine levels in the blood or urine that can point to this condition.

Histamine intolerance is a condition that occurs when the body either produces excessive amounts of histamine or fails to adequately break it down. Histamine is a naturally occurring chemical involved in various physiological processes, including digestion, immune response, and neurotransmission. An imbalance in histamine production or breakdown can lead to a wide range of symptoms, from mild discomfort to severe health issues.

What is Histamine?

Histamine is an organic nitrogenous compound that plays a critical role in the body. It is involved in:

  1. Digestion: Histamine stimulates the production of gastric acid in the stomach, which is essential for the digestion of food.
  2. Immune Response: It is released during an immune response to allergens, contributing to inflammation and other allergy symptoms.
  3. Neurotransmission: Histamine acts as a neurotransmitter, facilitating communication between nerve cells in the brain and throughout the nervous system.

 

What Causes Histamine Intolerance?

Histamine intolerance is when the body creates too much histamine or cannot properly break down histamine. Histamine is a chemical the body produces naturally.  It involves various processes, such as digestion, immune response, and neurotransmission. When the body produces too much histamine or cannot break it down properly, it can lead to symptoms ranging from mild to severe.

Histamine intolerance can arise from several factors, including:

  1. Overproduction of Histamine: Certain foods and beverages, such as aged cheeses, fermented products, alcohol, and smoked meats, can trigger the body to produce excessive histamine. Additionally, some bacterial infections can increase histamine levels in the gut.

  2. Deficiency of Enzymes: The body relies on specific enzymes, primarily diamine oxidase (DAO) and histamine N-methyltransferase (HNMT), to break down histamine. A deficiency or dysfunction of these enzymes can lead to histamine accumulation. Genetic mutations, certain medications, or health conditions such as gastrointestinal disorders can impair enzyme activity.

  3. Intestinal Permeability: Also known as “leaky gut,” this condition allows histamine and other substances to pass through the gut lining into the bloodstream, exacerbating histamine intolerance symptoms.

  4. Gut Dysbiosis: An imbalance in gut microbiota can influence histamine levels, as some gut bacteria can produce histamine, while others help break it down.

 

Symptoms of Histamine Intolerance

The symptoms of histamine intolerance can vary widely.  Many people may not even be aware that they are suffering from this condition. Shortly after eating histamine-rich foods, symptoms occur.  Histamine-rich foods include aged cheeses, fermented foods, and alcoholic beverages, or they can be triggered by other factors such as stress, medications, or environmental allergens.  Some of the common symptoms of histamine intolerance include:

The symptoms of histamine intolerance are diverse and can affect multiple systems in the body. They may include:

 

  • Gastrointestinal Issues: Abdominal pain, bloating, diarrhea, and nausea.
  • Respiratory Symptoms: Nasal congestion, sneezing, and asthma-like symptoms.
  • Skin Reactions: Hives, rashes, itching, flushing, and eczema.
  • Neurological Symptoms: Headaches, migraines, dizziness, anxiety, depression, fatigue, and weakness.
  • Cardiovascular Effects: Irregular heart rate, heart palpitations, and low blood pressure.

If you are experiencing any of these symptoms, you should speak with your healthcare provider such as a functional medicine coach.  They can help you determine if histamine intolerance or DAO deficiency may be the underlying cause.  Don’t be surprised if your doctor says you have been spending too long on the internet.  Keep looking until you find a provider that will help you.

 

Diagnosing Histamine Intolerance

Diagnosing histamine intolerance can be challenging because there is no single specific test for it. However, a healthcare provider may diagnose histamine intolerance based on a combination of symptoms and a thorough medical history combined with a consistently high histamine level in the blood or urine. A healthcare provider may also recommend a low-histamine diet or a food diary to help identify trigger foods.  In addition to modifying your diet, several supplements can help to increase DAO levels and reduce histamine intolerance symptoms. 

 

Supplements and Herbs for Histamine Intolerance

This intolerance is often linked to a deficiency in Diamine Oxidase (DAO), an enzyme responsible for the degradation of histamine. To manage this condition, many individuals turn to herbal supplements and vitamins that support DAO activity and mitigate histamine’s effects. This article delves into several herbal supplements and vitamins that may help alleviate the symptoms of histamine intolerance, supported by scholarly references.

Quercetin

Quercetin is a plant flavonoid found in many fruits and vegetables, renowned for its anti-inflammatory and antioxidant properties. It stabilizes mast cells, which play a crucial role in releasing histamine, thus potentially reducing histamine levels in the body. Studies have shown that quercetin can help decrease inflammation and oxidative stress, making it a promising supplement for those suffering from histamine intolerance.

Stinging Nettle

Stinging nettle (Urtica dioica) has been used in traditional medicine for centuries to treat allergies and inflammation. The bioactive compounds in stinging nettle inhibit several key inflammatory pathways and can help manage symptoms associated with histamine intolerance. Research indicates that stinging nettle can reduce the production of inflammatory mediators, thereby alleviating allergic responses and inflammation.

Butterbur

Butterbur (Petasites hybridus) is another herb with significant anti-inflammatory and anti-allergic properties. Butterbur extract has been shown to inhibit leukotrienes and histamines, which are chemicals involved in allergic reactions and inflammation. Clinical studies have demonstrated the efficacy of butterbur in reducing symptoms of allergic rhinitis and migraines, conditions often exacerbated by histamine intolerance.

Vitamins and Minerals for DAO Deficiency

In addition to herbal supplements, certain vitamins and minerals are essential for supporting DAO enzyme activity. These include vitamin C, vitamin B6, copper, and zinc.

  • Vitamin C: This antioxidant vitamin helps degrade histamine and reduces its levels in the blood. Vitamin C also supports immune function and reduces inflammation.
  • Vitamin B6: This vitamin is a cofactor for the DAO enzyme and is crucial for its proper functioning. B6 deficiency can impair histamine breakdown, exacerbating symptoms of histamine intolerance.
  • Copper: Copper is another essential cofactor for DAO. Ensuring adequate copper intake is necessary for optimal DAO activity and histamine metabolism.
  • Zinc: Zinc supports the immune system and has a role in the structural integrity of DAO. Zinc deficiency can lead to reduced DAO activity and increased histamine levels.

DAO for Histamine Intolerance

Low DAO levels may cause histamine intolerance. DAO deficiency can occur due to various factors, including genetics, diet, and lifestyle.  Some people may have a genetic tendency to low DAO levels.  Others may experience DAO deficiency due to poor dietary habits, such as eating foods that are high in histamine.

Fortunately, there are several ways to address histamine intolerance and low DAO levels. One of the most effective ways to manage histamine intolerance is by reducing your intake of histamine-rich foods. Some foods high in histamine include fermented foods, aged cheeses, cured meats, and alcohol.

Dietary Changes for Histamine Intolerance

In addition to herbal supplements, dietary changes may also help reduce the symptoms of histamine intolerance. The Plant Paradox Diet, developed by Dr. Steven Gundry, is a dietary approach that emphasizes the consumption of foods that are low in lectins.  Lectins are proteins found in many foods that can cause inflammation and other health problems.

The Plant Paradox Diet focuses on consuming a variety of vegetables, fruits, and healthy fats while avoiding or limiting certain foods that are high in lectins, such as grains, legumes, nightshade vegetables, and dairy products. The diet also emphasizes the consumption of fermented foods that are low in histamine, such as sauerkraut and kimchi.

Histamine intolerance is a condition that can cause a variety of symptoms and can be challenging to diagnose. Few healthcare providers know it, so you often have to educate them about it.  Meanwhile, dietary and herbal interventions such as the Plant Paradox Diet and supplements such as quercetin, stinging nettle, and butterbur, make it possible to manage the symptoms of histamine intolerance and improve overall health and well-being.

 

Comparing Histamine Intolerance and
Mast Cell Activation Syndrome

Histamine intolerance (HIT) and Mast Cell Activation Syndrome (MCAS) are both conditions related to the body’s handling of histamine, a critical biogenic amine involved in immune response, gastric acid secretion, and functioning as a neurotransmitter. Understanding how these conditions overlap and differ is crucial for proper diagnosis and management.

Histamine Intolerance (HIT)

Histamine intolerance occurs when there is an imbalance between histamine intake and its breakdown. Normally, the enzyme diamine oxidase (DAO) degrades histamine in the gastrointestinal tract, while histamine-N-methyltransferase (HNMT) degrades it intracellularly. When these enzymes are deficient or overwhelmed, histamine accumulates, leading to symptoms such as headaches, gastrointestinal disturbances, skin rashes, and respiratory issues (Maintz & Novak, 2007).

Mast Cell Activation Syndrome (MCAS)

MCAS, on the other hand, is a condition characterized by the abnormal release of mediators, including histamine, from mast cells, which are immune cells involved in allergic reactions and immune defense. Unlike histamine intolerance, where the problem lies in histamine degradation, MCAS involves an excessive or inappropriate release of histamine and other chemicals from mast cells. This can result in a wide array of symptoms, including cardiovascular, dermatological, gastrointestinal, and neurological manifestations (Afrin et al., 2016).

Comparison and Contrast

1. Pathophysiology

  • HIT: Histamine intolerance is primarily due to the impaired breakdown of histamine, often linked to a deficiency in the DAO enzyme. It can be aggravated by histamine-rich foods and certain medications that inhibit DAO (Wantke et al., 1993).

  • MCAS: MCAS involves the inappropriate release of histamine and other mediators from mast cells, which can be triggered by various factors, including allergens, stress, and infections. It is a systemic disorder affecting multiple organ systems (Hamilton et al., 2011).

2. Symptoms

  • Overlap: Both conditions can present with similar symptoms such as flushing, headaches, gastrointestinal issues, and skin rashes. This overlap can sometimes make differential diagnosis challenging.

  • Differences: MCAS tends to have a broader and more systemic range of symptoms compared to HIT. For instance, MCAS may include cardiovascular symptoms like tachycardia and hypotension, which are less common in HIT (Theoharides et al., 2015).

3. Diagnosis

  • HIT: Diagnosis is often clinical, based on the presence of symptoms after ingestion of histamine-rich foods, and improvement upon a low-histamine diet. DAO activity levels in the blood can also be measured (Schwelberger, 2010).

  • MCAS: Diagnosis involves more extensive testing, including serum tryptase levels, 24-hour urine collection for histamine and prostaglandin D2, and bone marrow biopsy in certain cases. A detailed patient history and symptom diary are crucial (Valent et al., 2012).

4. Treatment

  • HIT: Management primarily involves dietary modifications to reduce histamine intake and, in some cases, supplementation with DAO enzyme (Rosell-Camps et al., 2013).

  • MCAS: Treatment may include antihistamines, mast cell stabilizers, leukotriene inhibitors, and other medications to manage symptoms. Identifying and avoiding triggers is also essential (Molderings et al., 2011).

While histamine intolerance and Mast Cell Activation Syndrome share some common symptoms due to the role of histamine, they are distinct conditions with different underlying mechanisms. Understanding these differences is crucial for appropriate diagnosis and management, ensuring patients receive the most effective care tailored to their specific condition.

 

References

 

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Further Reading: Mystery, Undiagnosed,
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