Histamine Intolerance: Causes, Symptoms & Treatment

Many people suffer from food allergies these days. However, some people cannot be diagnosed with a food allergy and yet they have a wide variety of food intolerance reactions. It could be histamine intolerance or histamine intolerance.

What is histamine intolerance?

The term histamine intolerance denotes an imbalance between histamine supplied by food and histamine broken down in the body. In the body, the enzyme diamine oxidase ensures the breakdown of histamine supplied by food in varying concentrations. If this is not produced in sufficient quantities, the body reacts with various intolerance reactions such as diarrhea, stomach irritation, fatigue, asthma, dizziness, skin rashes, nausea, etc.. This is an acquired disorder, and genetic evidence is lacking to date.

Causes

One of the main causes of histamine intolerance is the concentration of histamine-rich food intake. Many foods are not naturally high in histamine, but become so through aging and fermentation. Foods to which bacteria are added have particularly high histamine levels, e.g. smoked meat, smoked fish, red wine, cheese, sauerkraut and wheat beer. But so-called histamine liberators (foods that stimulate the release of histamine in the body) are also responsible for intolerance. These histamine liberators include strawberries, egg whites and fish. Alcohol equally promotes the release of histamine and decreases its breakdown. Medications also interfere with the breakdown of histamine in the body, for example, cough-relieving drugs, sleeping pills, painkillers and rheumatism medications.

Symptoms, complaints, and signs

Histamine intolerance manifests itself through very nonspecific complaints, the most common being digestive complaints, skin rashes and migraines. Symptoms may appear immediately after eating foods or drinks containing histamine, or they may appear hours later. If the digestive tract is affected, histamine intolerance becomes unpleasantly noticeable through abdominal pain, stomach cramps, flatulence, nausea and heartburn. Diarrhea and vomiting are also possible. Headaches and migraine attacks are triggered in many cases by histamine intolerance. They are sometimes accompanied by dizziness, circulatory problems and palpitations, but these complaints can also be signs of histamine intolerance in themselves. Skin reactions manifest themselves in the form of rashes, severe itching, swelling and wheals. Especially after drinking alcoholic beverages, the so-called “flush” is characteristic: a seizure-like reddening of the skin spreads over the neck and face, and rarely also over the upper body. Histamine intolerance can also affect the respiratory tract: Possible symptoms include irritable cough, shortness of breath to the point of asthma-like choking, increased sneezing, and a stuffy or runny nose. Occasionally, swelling of the lips and eyes is observed, and sleep disturbances, depressive moods, water retention in the tissues, fatigue and joint pain can also be attributed to histamine intolerance in some cases. In women, histamine can affect hormone balance and cause menstrual irregularities.

Diagnosis and course

Histamine intolerance affects an increasing number of people, especially middle-aged women. Although widespread and recognizable by many symptoms, histamine intolerance is still relatively unknown. Many people have to run from doctor to doctor before their symptoms are recognized as histamine intolerance by attentive physicians. It cannot be detected by the usual food allergy tests because it is not an allergic reaction. Diagnosis is often only possible by blood and urine tests and a reduction diet, in which the intake of histamine-rich foods is restricted. A provocation test, in which histamine is deliberately added, and a food diary can also provide information. Numerous complaints after eating histamine-rich foods may indicate histamine intolerance:

Complications

Due to histamine intolerance, there are many different complications and complaints that can extremely limit the life and everyday life of the affected person and reduce the quality of life. As a rule, the intolerance causes severe redness on the skin and the development of itching. There is also nausea with dizziness and the patient suffers from severe vomiting. Pain and cramps occur in the abdominal region, which in many cases leads to irritability and restrictions in everyday life. It is not uncommon for patients to also suffer from headaches and a runny nose and cold. The symptoms can also lead to psychological limitations and depression in many patients. In severe cases, histamine intolerance can also lead to breathing difficulties, so that patients suffer from shortness of breath and gasping for breath. There is usually also relatively severe joint pain and general fatigue. In acute emergencies, the symptoms can be treated with the help of medication. In general, however, those affected by histamine intolerance must avoid certain foods and are thus restricted in their diet. However, further complications do not occur if the patient abstains from these foods.

When should one go to the doctor?

If symptoms recur after eating foods high in histamine, it is possible that histamine intolerance is the underlying cause. A visit to the doctor is indicated if symptoms interfere with well-being or cause serious complications. For example, symptoms such as nausea and vomiting, severe skin rash and breathing difficulties should be clarified by a doctor. Women should seek medical advice if menstrual cramps are repeatedly noticed after eating certain foods. People who experience shortness of breath, sweating, or loss of consciousness after eating are best to seek hospital care. In the event of a shock reaction, the emergency services must be called. In general, those affected should already have a suspected histamine intolerance clarified. Through a medical diagnosis, the disease can be treated specifically and further complications can be avoided. Parents who notice corresponding signs of an allergy or intolerance in their child are best advised to talk to their pediatrician. If in doubt, the emergency medical service can be contacted first. In the case of other symptoms, too, it is ideally best to speak to a doctor immediately. In addition to the general practitioner, a specialist in internal medicine can be consulted.

Treatment and therapy

Because histamine-rich foods are the main cause of histamine intolerance, the most important treatment method is to be aware of histamine-rich foods and reduce them in the diet or avoid them altogether if possible. The following foods are considered particularly high in histamine and should be reduced or avoided:

  • Red wine
  • Wheat beer
  • Mature cheeses such as Emmental, Tilsiter, etc.
  • Salami, ham
  • Smoked fish, canned fish
  • Vegetables such as spinach, sauerkraut
  • Restriction of histamine liberators citrus fruits, bananas, strawberries, raspberries, pears, walnuts, chocolate, cocoa, legumes, wheat germ.
  • Avoidance or restriction of preserved foods.

In addition, the histamine release in the body can be stabilized with medication or administered antihistamines. Many doctors still try to combat complaints symptomatically, because they do not put the complaints in the right context. However, this does not help sufferers.

Outlook and prognosis

The prospect of getting typical symptoms of histamine intolerance or histamine intolerance under control depends on various parameters and the countermeasures taken. The problem is due to the fact that various influencers are involved in histamine intolerance. Histamine is also a maturation hormone that is contained in numerous foods.Hardly anyone can completely avoid this hormone. Histamine intolerance is triggered either by histamine-containing foods, or by histamine liberators and biogenic amines. Some foods contain only one of these triggers, but others contain two. If the latter can be avoided, and the other foods are consumed as infrequently as possible, the prognosis is good. Avoidance of long and artificially post-ripened foods with high levels of the ripening hormone is an important measure. Another option is the rotation diet. This can improve the prognosis with the intake of varying and low amounts of histamine. It is also possible to take an enzyme called diamine oxidase, or DAO for short. If this is taken before histamine-containing meals, the symptoms may improve. Food preparation with the help of special cookbooks is recommended. Attending appropriate self-help groups can also be helpful in cases of histamine intolerance. It becomes problematic when histamine intolerance occurs as a consequence of a long-standing lactose intolerance or is accompanied by other food intolerances. In this case, the prospects of complete freedom from symptoms are significantly worse.

Prevention

The most important prevention for histamine intolerance is to avoid or limit histamine-rich foods. Once the intolerance is known, it is relatively easy for those affected to identify the foods to which they are particularly sensitive. There is no direct prevention, since this disorder is acquired and depends on the histamine concentration in the body. Because the histamine concentration is particularly high in preserved foods, fresh cooking can be one of the most important preventive measures. As an affected person, you should limit or avoid preserved foods, because the histamine concentration depends on the degree of ripeness. Each affected person must find out individually what concentration is tolerated.

Follow-up

It is imperative that those affected adhere permanently to the dietary changes that have been made and, as part of these, avoid histamine-containing foods and histamine releasers. In the initial period, lists on which one notes all forbidden food components and takes the time when shopping to study all ingredients for their compatibility are helpful. As soon as symptoms such as headaches, skin rashes, shortness of breath or digestive disorders appear again, it is recommended to keep a food diary. All ingested foods, medications and symptoms are noted in this diary and evaluated after some time. A well kept diary will then show parallels in symptoms and make it easier to identify other intolerable foods. It is important to keep a list of intolerable drug ingredients with you and to give it to any treating physician. Nevertheless, it is advisable to check the list before each prescription and injection. Particularly with regard to upcoming operations, but also for anesthetic injections at the dentist, this should be taken into account. Carrying an emergency ID card in your wallet can help in medical emergencies where you are no longer able to provide information about incompatibilities yourself. Such an ID card can be requested free of charge on the Internet. In the case of life-threatening symptoms, the prescription of an EpiPen for an emergency can be discussed together with the doctor.

Here’s what you can do yourself

If histamine intolerance has been diagnosed, the diet must be changed. Since it varies from person to person which foods and drinks are tolerated, those affected should create a diet plan. If the typical symptoms occur after eating a certain food, it should be entered in the “red list” and avoided in the future. In general, histamine-rich foods such as seafood that has been stored for a long time, fresh fish, meat and cheese, and fermented foods such as sauerkraut should be avoided. For some allergy sufferers, bananas, avocado, tomatoes, spinach, strawberries, pineapple and nuts release histamine in the body. It is recommended to eat many foods with vitamin B6, manganese and zinc, because these substances relieve the symptoms. In consultation with the doctor, dietary supplements can be taken. If foods containing histamine are nevertheless consumed, the symptoms should be cured with bed rest and natural painkillers.In most cases, the symptoms disappear after a few hours and no medical treatment is necessary. In severe cases, drug treatment with diamine oxidase preparations can also be useful. Histamine tolerance should be diagnosed in any case, because only then is targeted treatment possible.