Everything You Need to Know About Histamine Intolerance

19 August, 2020 ,

Histamine is a chemical compound derived from the amino acid histidine. It is known for its role in the body’s immune response to foreign proteins, especially the allergic response. During an allergic reaction, antibodies cause histamine to release, which can trigger a series of inflammatory reactions and cause symptoms to arise. On a daily basis, small amounts of histamine help regulate functions throughout the body. Histamine is produced by the body’s white blood cells, specifically the mast cells, but is also naturally present in many foods. The amount of histamine found in a food may be inherent in the food or depend on external factors such as the stage of maturation, as well as the storage, processing method, and origin.

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Histamine intolerance

An intolerance to histamine can develop when the body produces more histamine than it can break down. Some hypotheses suggest that histamine intolerance may be caused by a lack or reduced activity of the diamine oxidase enzyme (DAO) which helps break down histamine in the body, or by an increased production of endogenous histamine, as well as by genetic predispositions. If histamine levels in the body are high for any reason, eating histamine-rich foods can trigger a variety of symptoms that can vary from person to person. It should be noted that taking certain medications may also increase the concentration of histamine in the body.

How do you know if you have an intolerance to histamine?

Just like people who are intolerant to FODMAPs*, those who have an intolerance to histamine may have digestive symptoms (stomach ache, bloating, diarrhea, constipation, reflux, abdominal pain, mouth ulcers, nausea, vomiting). However, unlike a FODMAP intolerance, a histamine intolerance is usually also accompanied by non-digestive symptoms. These may include tightness in the throat or chest, heart palpitations, migraines, headaches, dizziness, vertigo, joint or muscle pain, hot flashes, itching, hives or eczema, fatigue, depression, or nasal congestion. Symptoms can differ greatly from a person to another. Generally, symptoms can occur either immediately after the ingestion of a trigger food or later (two to four hours after). Sometimes, symptoms can vary depending on the season of the year. Taking antihistamine medications can help reduce symptoms associated with histamine intolerance. Since a food intolerance does not trigger an immune response from the body, an allergy test cannot diagnose an intolerance to histamine. However, it is still important to consult with an allergist to rule out the presence of a food allergy or an allergy to any substance that could cause the symptoms. The only way to identify an intolerance to histamine is to follow a specific elimination diet. The blood level of DAO enzyme may also help to identify an intolerance to histamine. It should be noted that some people may be intolerant to other chemical compounds found in foods, such as sulfites, salicylates and glutamates. The Royal Prince Alfred Hospital (RPAH) in Sydney Australia has established a protocol to identify intolerances to certain chemical compounds found in food.

Low histamine diet

A histamine elimination diet consists of temporarily eliminating the main dietary sources of histamine. To begin, it is recommended to eliminate only the foods that have the highest content in histamine, which are fish and seafood including canned tuna and shrimp, fish sauce and fermented foods (pickles, sauerkraut, soy sauce, tempeh, miso, kefir, Kombucha, beer, wine, etc.). This can sometimes be enough to lessen symptoms and to avoid having to adopt a very restrictive diet. It is always possible to eliminate more foods later if necessary. The list below presents the main food sources of histamine. If there is an improvement in symptoms with a low histamine diet, it is then suggested to reintroduce each food one at a time to more accurately identify those that cause the symptoms, since food triggers vary greatly from one person to another. As mentioned above, the amount of histamine in a single food can vary greatly over time depending on various external factors including the freshness of the food. In addition, an individual’s tolerance to a histamine-rich food may differ from one time to another depending on the level of histamine already present in their body. For example, some people are more sensitive to histamine-rich foods at times of the year when they have seasonal allergies.

To follow a low-histamine diet, subscribe to our PREMIUM or VIP service, while specifying in section ‘Food Preferences’ of your profile that you want to exclude the main dietary sources of histamine.

Food sources of histamine

1) Foods naturally high in histamine

  • Fermented foods (Kombucha, pickles, sauerkraut, soy sauce, tempeh, miso, kefir)
  • Canned or fresh fish (except freshly caught fish), seafood and fish sauce
  • Spinach
  • Eggplant
  • Tomato
  • Cherry
  • Avocado
  • Soybeans and all its derivatives
  • Nutritional yeast
  • Aged cheeses
  • Processed or aged meats (sausages, cured meats, bacon, aged steaks, etc.)
  • Yogurt
  • Condiments that contain vinegar (vinaigrettes, ketchup, mustard, mayonnaise, BBQ sauce, etc.)
  • Leftover meat or poultry and expired food

2) Foods with histamine-releasing capacities

  • Citrus fruit
  • Strawberry
  • Peach, apricot and plum
  • Papaya
  • Pineapple
  • Chocolate
  • Licorice
  • Some spices (cinnamon, cloves, anise, nutmeg, curry powder and chili powder)
  • Foods containing certain additives (sulfites, BHA, BHT and dye, especially tartrazine)
  • Alcohol, especially wine (especially red) and beer (alcohol blocks the function of the enzyme that breaks down histamine)

It is not recommended to eliminate all of these foods in the long term, as this can lead to unnecessary restrictions, nutritional deficiencies, a negative relationship with food and a diminished quality of life. If you suspect that you have an intolerance to histamine, you should consult with your doctor as well as with a Registered Dietitian who specializes in gastrointestinal health.

*FODMAPs are fermentable carbohydrates that are partly responsible for causing symptoms in people with irritable bowel syndrome (IBS). For more info, read this article.


References

  • Maintz et Novak (2007) Histamine and histamine intolerance. Am J Clin Nutr; 85:1185–96.
  • Music et coll. (2011) Serum diamine oxidase (DAO) activity as a diagnostic test for histamine intolerance. Clin Transl Allergy; 1(Suppl 1): P115.
  • Lackner et coll. (2019) Histamine-reduced Diet and Increase of Serum Diamine Oxidase Correlating to Diet Compliance in Histamine Intolerance. Eur J Clin Nutr; 73(1):102-104.
  • San Mauro Martin, Brachero et Garicano Vilar (2016) Histamine intolerance and dietary management: A complete review. Allergol Immunopathol (Madr); 44(5):475-483
  • Communauté d’intérêts Suisse de l’intolérance à l’histamine (SIGHI). Informations sur l’histaminose / intolérance à l’histamine, pour les personnes concernées et les professionnels de la santé. Last updated on February 7, 2019. https://www.histaminintoleranz.ch/fr/therapie_regimealimentaire.html
  • Kovacova-Hanuskova et coll. (2015) Histamine, histamine intoxication and intolerance. Allergol Immunopathol (Madr); 43(5):498-506.
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Author

Kathryn Adel

Kathryn Adel

Kathryn completed degrees in kinesiology and nutrition, as well as a Masters in Sports Nutrition. She is a member of OPDQ and of the Academy of Nutrition and Dietetics. She ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health. Kathryn is experienced with the low FODMAP diet and she completed the Monash University low FODMAP dietitian’s training.

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