Histamine intolerance: what is histamine?

 

Do you notice dizziness and a runny nose after a glass of red wine, a salami sandwich or a piece of chocolate? Something that might initially appear to be an allergy could be due to histamine intolerance.

Histamine has a bad reputation. The messenger substance is mainly known for causing discomfort, especially when it comes to allergies. In fact, histamine has an important function in the body and is essential for our immune system. Inflammation triggered by histamine helps fight pathogens and toxins that enter the body. 

However, in some people, the body is unable to break down histamine quickly enough. If histamine enters the system through food, inflammation occurs, leading to headaches, gastrointestinal discomfort and itching. This is called histamine intolerance.

Read on to gain more insights into histamine intolerance, the enzyme diamine oxidase (DAO), as well as histamine intolerance symptoms, causes and treatment.

What is histamine?

Histamine is a messenger substance, which passes on and spreads information between the cells and is important for our immune system, among other things. Histamine is produced by an amino acid, which is produced by the body itself as well as ingested through food. Discomfort only arises when the body cannot completely break down the histamine after it has used it.^[1]

Histamine belongs to the group of biogenic amines that occur in nature and are frequently produced during decomposition.^[2]

What function does histamine have in the body?

As a messenger substance, histamine takes on a whole range of tasks: it transmits stimuli from one nerve to the next, expands blood vessels and ensures that our muscles contract and relax. Histamine is also involved in the digestion of fats, our immune system, blood formation, wound healing and the regulation of our sleeping patterns.

If there is too much histamine in the body, precisely these problems may occur. The consequences are heart rhythm issues, blood pressure fluctuations and neurological problems.^[1]

What is histamine intolerance? 

With a histamine intolerance, also known as histamine sensitivity, the interaction of histamine and two enzymes is presumably disrupted. The body is therefore unable to break down histamine effectively enough – not even the histamine found in certain foods. If you experience histamine intolerance symptoms after eating foods with a high histamine content, this is referred to as histamine intolerance.^[1]

Did you know that the term ‘histamine intolerance’ is derived from the term ‘lactose intolerance’? Enzyme deficiency is also characteristic of lactose intolerance.^[3]

What role does diamine oxidase play?

In connection with histamine intolerance, diamine oxidase, DAO for short, is often mentioned. DAO is the enzyme that is primarily responsible for breaking down the histamine that you ingest through your diet. The most common theory on the development of histamine intolerance is that the activity of DAO is disrupted, meaning that the enzyme breaks down histamine very slowly, and  excess histamine causes discomfort.

Histamine intolerance and food allergies

Histamine intolerance is not an allergy. However, it is often difficult to distinguish between the two health conditions because the symptoms which occur after food consumption in both cases and are virtually identical. This is why histamine intolerance is also called a pseudo-allergy.

This makes it all the more important to clearly distinguish an intolerance from an allergy.^[4] In response to the typical symptoms, doctors usually carry out a test for food allergies, which usually identifies a histamine intolerance. You and your doctor should become aware of a possible histamine intolerance at this stage.^[2]

Of course, it can also be the case that you suffer from a food allergy as well as from histamine intolerance – however, different foods are usually responsible for various reactions.^[5]

What causes histamine intolerance?

To date, from a scientific point of view, there is no definitive proof that the cause of histamine intolerance can be attributed to a problem with the enzyme DAO. Some critics even suspect that histamine intolerance does not exist or is psychosomatic.^[6]

We can all only tolerate a certain amount of histamine! In healthy people, this is a maximum of 100 milligrammes of histamine per day. This much can be found in some fish, for example. If we cross this threshold, histamine levels are deemed poisonous. If you have a histamine intolerance, you will react to a much smaller dose that might not trigger poisoning.^{[7, 8]}

What are the causes of histamine intolerance?

A histamine intolerance means that the body has problems with breaking down histamine. There are two possible explanations for this:^[9]

1. Affected individuals have too much histamine – for example, due to overproduction (due to allergies, bacteria or bleeding in the gastrointestinal tract) or absorption of histamine, histidine or other biogenic amines in the form of food or alcohol
2. There is too little or only the inactive form of the enzyme diamine oxidase (DAO) in the body of the affected individual

The result is the same in both cases: there is too much histamine in the body.^[2]

What causes an enzyme deficiency?

But why do some people lack the enzyme DAO? There are different explanations and possible causes for this, especially:

• Chronic intestinal strain
• Vitamin and zinc deficiency
• Medication and alcohol

Are histamine intolerance and chronic intestinal strain linked?

Chronic diseases of the gastrointestinal tract can presumably contribute to the development of histamine intolerance. People with irritable bowel syndrome, gastritis, Crohn’s disease or gastrointestinal ulcers are often affected. In these cases, changes in the intestinal mucosa can lead to the enzyme DAO no longer being produced in sufficient quantities.^[10]

Can medication and alcohol trigger histamine intolerance?

Other possible causes of acquired histamine intolerance are medications and alcohol. Both can inhibit the activity of the enzyme DAO. For example, the following active substances can influence the function of DAO and consequently, histamine levels:^[2]

Active ingredient	Usage
Acetylcysteine (ACC)	painkiller
Ambroxol	cough syrup
Aminophylline	for asthma
Amitriptyline	for depression/anxiety
Chloroquine	for malaria
Isoniazide	antibiotics
Metamizole	painkiller
Metoclopramide	for nausea
Propafenone	for cardiac arrhythmias
Verapamile	for coronary heart diseases

If you are taking any of these medications regularly and experience histamine intolerance symptoms, consult your doctor. Changing your medication may be enough to alleviate symptoms.

Vitamin and zinc deficiency

The two vitamins B6 and C work closely together with the enzyme DAO to break down histamine in the body. If we are deficient in the two nutrients, our histamine levels increase accordingly. Some researchers have considered this as a possible explanation for histamine intolerance in people who did not have lower DAO levels. However, other experts doubt that vitamin B6 and C can really contribute to the intolerance.^[10]

The mineral zinc can also potentially help with histamine intolerance. Zinc is needed to activate vitamin B6, which in turn supports the enzyme DAO in breaking down histamine.

In short: People with histamine intolerance have too much of the messenger substance histamine in their bodies, especially after they consume histamine-rich foods. The reason for this may be an enzyme deficiency caused by gastrointestinal diseases or medication.

To find out more about testing for zinc deficiency, browse our products for mineral deficiency. The Mineral Deficiency Test checks not only your zinc levels but also your selenium and magnesium levels.

Histamine intolerance symptoms

What are signs of histamine intolerance?

Histamine intolerance symptoms are initially similar to those experienced during an allergic reaction. This often makes it difficult to identify the intolerance. Complaints occur after consuming high-histamine foods, usually immediately or up to two hours later. These symptoms can last up to 12 hours or longer.

Since histamine can attach itself to certain cells in the entire body and trigger inflammatory reactions, histamine intolerance is often felt in many parts of the body. Typical histamine intolerance symptoms include:^{[1, 2]}

Body part	Symptoms
Skin	Redness, itching, swelling
Intestinal tract	Cramps, bleeding, diarrhoea
Lungs and respiratory tract	Cough, asthma, cramps, runny nose, difficulty swallowing
Cardiovascular system	Changes in blood pressure, palpitations, heart rhythm abnormalities, unconsciousness
Nervous system	Headache, migraine, dizziness

Symptoms are not the same for everyone. Some people may find that symptoms appear earlier; for others, reactions are stronger, and most people experience only some of the possible symptoms. In addition, each person has a different individual tolerance level. This means, for example, that one person will react immediately after sipping red wine, while the other will only notice after drinking an entire glass.^[4]

Is there a link between migraines and histamine?

Histamine can cause headaches in people with and without migraines.^[4] How exactly a migraine develops has not yet been conclusively determined, but it is probably related to messenger substances that trigger inflammatory reactions. Histamine could also play a role by dilating blood vessels, which then triggers the pain experienced when a migraine occurs.^[11]

This theory is supported by the fact that studies have often identified low DAO concentrations in the blood of people suffering from migraines. In addition, many people with migraines have observed a link between eating histamine-rich foods and their migraine attacks.^[12]

Do hormones affect histamine levels?

Scientists have observed that pregnant women are less likely to suffer from histamine intolerance. Migraines and headaches in particular are less common or do not occur at all during pregnancy. This could be due to the fact that hormone fluctuations during pregnancy ensure that there is a significantly greater amount of DAO in the body. After birth, however, values return to normal and histamine intolerance usually returns.^[4]

During menstruation, histamine intolerance symptoms may also be more severe. On the other hand, women with histamine intolerance often suffer from more pronounced menstrual symptoms – especially painful cramps in the abdomen. This is probably due to the interaction between histamine and the female sex hormones. If there is a lot of histamine in the body, oestrogen production is promoted and progesterone production is inhibited. This leads to an increased release of pain messengers and menstrual symptoms are more severe.^{[13, 15–17]}

To gain more insights into female sex hormones and how they affect our health, visit our Health Portal blog article on oestrogen and menopause.

Histamine and atopic dermatitis

Histamine intolerance is considered a possible trigger of atopic dermatitis flare-ups. This skin disease causes itching and dry skin rashes and the messenger substance histamine plays an important role. Studies have shown that people with atopic dermatitis often lack the enzyme DAO and have too much histamine in their blood. A diet low in histamine can presumably improve skin appearance and lead to less frequent outbreaks. In nutritional coaching, people with atopic dermatitis are therefore often advised to avoid foods rich in histamine.^[17]

Histamine intolerance treatment

If you suffer from histamine intolerance, the most effective histamine intolerance treatment is to avoid high-histamine foods. However, this is easier said than done. Histamine is present in many foods, and to make matters worse, manufacturers are often not obliged to include information about histamine content on packaging.

Furthermore, it is almost impossible to completely avoid histamine, as it is present almost everywhere – at least in small amounts. But many sufferers are relieved by avoiding certain foods that contain a lot of histamine or that promote the production of the messenger substance.

How is histamine intolerance treated? 

Do you suspect you suffer from histamine intolerance? You can gradually change your diet to suit your needs – this is called an elimination diet. This happens in several phases:

Phase 1: Elimination phase

Initially, remove high-histamine foods from your diet for 14 days. If you notice that your histamine intolerance symptoms rapidly improve, this is a clear indication of an intolerance to histamine.

Phase 2: Test phase

After the 14-day strict elimination period, you may gradually reintroduce small amounts of histamine into your diet. It is best to reintroduce only one food per day. The goal is to test your tolerance. It is best to keep a symptom diary, in which you list what you ate, when you ate it and which symptoms occurred at which times. This way, you can find out which foods you can tolerate and in what quantity.

This test phase should last about six to eight weeks. During this time, you will also be able to observe which other factors influence your symptoms. These can include stress, medication and menstruation.

Phase 3: Long-term nutrition

The third phase of the elimination diet involves utilising this overview of which foods you can tolerate and in what quantities. You will then have established a balanced and tasty diet. Since it may be appropriate in some cases to adhere to this diet for an indefinite period of time, this final phase is recognised as the permanent nutrition phase.^[18]

Curious about how to carry out an elimination diet? Head over to our dedicated Health Portal article for more information.

Which foods should I avoid with histamine intolerance?

Histamine is found mainly in foods that are fermented or in which fermentation play a role – for example, in foods that have matured for a long time. Freshly caught fish contains very little histamine, while heavily processed and preserved fish contains a lot of histamine. In general, the list of histamine-containing foods is long:^[18]

Food group	Histamine content	Suitable alternatives
Fish	Canned fish (tuna, anchovies, mackerel), marinated and smoked fish	Freshly caught local fish or frozen fish
Cheese	Aged varieties such as Parmesan cheese, Swiss cheese, blue cheese, ripe Camembert, cheese with unpasteurised milk	Cottage cheese, curd cheese, mozzarella, buttery cheese, young gouda
Meat/Sausage	Cured, smoked and air-dried sausage and meat products such as salami, raw ham and bacon	Sausage products that can be cooked, such as veal sausage, pork sausage, cooked ham
Vegetables	Sauerkraut, spinach, tomatoes, tomato products (such as ketchup, tomato paste, tomato sauce), avocado, aubergine, pickled vegetables	All other types of raw or steamed products
Fruits	Ripe bananas, kiwi, strawberries, pineapple, citrus fruits	All other types, including juices
Sweets	Chocolate, cocoa	Cakes and biscuits without chocolate/nuts
Snacks/other	Peanuts, hazelnuts, walnuts, glutamate-containing snacks, balsamic vinegar	Popcorn, millet, savoury pastries, breadsticks, crackers, all other types of vinegar
Alcohol	Red wine, dessert wines,  champagne, Prosecco, fermented beers (wheat beer), ageing spirits (whisky, cognac), liqueurs	White wine, red wine  low in histamine, sparkling wine or champagne low in histamine, non-alcoholic beer (mostly), Pilsner, clear schnapps, vodka, gin

Alcoholic beverages tend to promote the release of histamine. It may therefore be worth avoiding alcohol.

Unfortunately, you can’t remove histamine from food when cooking: whether you freeze it, bake it, fry it or put it in the microwave. Hot and cold temperatures do not destroy histamine.^[2]

Additional nutritional tips 

There are not only foods that contain a lot of histamine, but also foods that ensure the body releases a greater amount of histamine. These include:^[19]

• Strawberries, citrus fruits, pineapple, kiwi 
• Seafood
• Milk

Other foods can interfere with the histamine-degrading enzyme DAO:^[19]

• Chocolate
• Fruit: citrus fruits, pineapple, papaya, raspberries, pears, bananas
• Tomatoes and legumes
• Wheat germ
• Cashews, walnuts

Did you know that the histamine content in food can vary greatly depending on how fresh and ripe the food is and which variety it is?^[20]

Histamine intolerance treatment: colon therapy

A healthy colon can contribute to an improved production of the histamine-degrading enzyme DAO. If your intestinal mucosa is inflamed or there is damage to the cells of the intestinal epithelium, the enzyme can no longer be produced sufficiently. A bad colonisation of bacteria in the intestine can be another problem. Colon therapy can remedy this situation and promote the production of DAO enzymes again. Supporting this colonisation with microorganisms at least once a year is the basic building block for this. It is worth it, because an acquired histamine intolerance can be reduced or even cured.

Does medication help histamine intolerance?

Histamine intolerance cannot be cured with medication. However, medication can help you to relieve the symptoms in the short term. Even with medication you should continue to avoid red wine, mature cheese and such. The most common medications are antihistamines and the product DAOsin.

When is the use of antihistamines recommended?

Antihistamines prevent cells of the immune system from releasing histamine. They are also the active ingredient of anti-allergy medications. Whether they relieve histamine intolerance symptoms depends on the symptoms that are bothering you. If the intolerance causes diarrhoea, antihistamines can often help. They are less effective for headaches. As a rule, doctors prescribe antihistamines in any case to treat certain symptoms. They should not be taken continuously.^[19]

Histamine intolerance supplements

Especially at parties and when eating out in a restaurant, it is often difficult to completely avoid histamine-rich food. Many affected individuals rely on the product DAOsin from the pharmaceutical manufacturer STADA for such cases. The dietary supplement contains DAO derived from animals. It is intended to help your intestines break down histamine. Studies have not yet confirmed the effectiveness of this histamine intolerance supplement – some experts say that there is currently no medication that can increase the activity of the enzyme DAO.^[18]

Some experts believe that a deficiency in vitamin B6 and C is linked with histamine intolerance;  these vitamins have been shown to relieve histamine intolerance symptoms. Despite this valuable insight, more research needs to be conducted in order to find more conclusive evidence for the roles of these vitamins as histamine intolerance supplements.

In short: If you suspect a histamine intolerance, you should avoid alcohol, histamine-rich foods and foods that may release histamine. You can take antihistamines to combat the symptoms for a short period of time.

Histamine intolerance testing

Since it is not yet clear exactly what happens in the body with a histamine intolerance, there is no standardised method for measuring this particular intolerance. The first step is usually to determine the symptoms and specifically omit certain foods in order to observe possible changes.

Which test can tell me if I suffer from histamine intolerance?

There are two ways to confirm a suspected intolerance.

1. Provocation test: Your doctor will administer you a certain amount of histamine – usually in the form of a tablet. On a different day, you will receive another tablet without histamine. The doctor will observe how your body reacts in each case.^[3]

2. Laboratory diagnostics: In practice and in scientific studies, DAO enzyme levels are increasingly measured. Studies revealed that people who observed histamine intolerance had significantly lower concentrations of the enzyme in their blood than healthy control groups.^{[3, 14, 15]}

The measurement of methylhistamine in urine, on the other hand, is strongly criticized. According to some experts, the value is very inaccurate and can also be increased by a protein-rich diet.

Which other health issues should I check for?

Symptoms indicating histamine intolerance may also be related to other health problems. If you regularly have gastrointestinal discomfort, you should consult a doctor about possible inflammatory bowel diseases, such as gastritis and Crohn’s disease. Other sources of your discomfort could also be intolerances such as lactose, fructose and sorbitol intolerance.^[2]

Where can I take a histamine intolerance test?

If you want to take a histamine intolerance test, you can do this at a doctor’s surgery, for example – GPs often offer DAO tests. Doctors will usually ask you about your symptoms and may instruct you to keep a symptom diary.

An alternative is an at-home histamine intolerance test you can take at home. Such tests ensure that you can simply test how high the DAO levels in your blood are – and get an indication of whether you have an intolerance. For the test, take a small amount of blood from your fingertip and send the sample to a specialist laboratory. You will receive a comprehensive result report with information about your DAO levels along with valuable health tips.

Histamine intolerance – at a glance What is histamine? Histamine is a messenger substance with important functions for the immune system. It is also responsible for allergy symptoms. What is a histamine intolerance? People with histamine intolerance suffer from an intolerance to histamine-rich foods. You may have too little of the enzyme DAO that breaks down histamine in your body. What are the symptoms of histamine intolerance? Typical symptoms are headaches, a runny nose, heart rhythm abnormalities and skin rashes. Histamine intolerance symptoms can also include menstrual cramps, migraines and atopic dermatitis. What are the causes of histamine intolerance?  Researchers have not yet fully understood the cause of histamine intolerance. Some believe that chronic gastrointestinal diseases, medication and alcohol can prevent the DAO enzyme from properly doing its job. How can I combat histamine intolerance? There is no medicine that cures the intolerance. All you can do is try to see if antihistamines can relieve the symptoms in the short term. The only effective histamine intolerance treatment is to avoid histamine-rich foods as much as possible, preferably with a gradual diet change. Which foods contain a lot of histamine? Histamine is found mainly in fermented and highly matured foods – for example, in canned fish, red wine, mature cheeses and cured meat.

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