There are a lot of questions on histamine. I come across clients with histamine intolerance a lot and it can be mistaken for allergy as the symptoms of excess histamine can be similar to that of allergy. It’s not always easy to establish! 

So what is histamine? 

Histamine is a prevalent neurotransmitter in the brain so that means it affects our MOOD, COGNITIVE FUNCTION and causes WAKEFULNESS. 

We need to be able to degrade/breakdown/detoxify histamine, if we don’t the result is histamine intolerance or excess. 

The symptoms of excess histamine include:

• Rash
• Itchiness
• Swelling
• Wheezing

This is why it can be mistaken for allergy rather than histamine intolerance but there is a difference, and there are more symptoms!

Difference between histamine intolerance and allergy

A histamine influx can occur in allergy when allergy antibodies known as IgE interact and trigger the release of histamine, which is stored in white blood cells known as our mast cells. This response is generally quick and immediately occurring when we eat an allergenic food.

But histamine intolerance or excess has a different cause. This is related to a saturation of histamine that the body is not clearing. This could be due to the inability of the enzymes known as DAO and HNMT to keep up with the demand of deactivating histamine.

How do we develop a saturation of histamine?

Due to a diet high in histamine foods which are generally fermented, matured, and ripe foods such as:

• Sauerkraut
• Sardines
• Mackerel
• Parmesan cheese
• Wine

Or the enzymes DAO and HNMT may be inhibited, which can happen with some medications, alcohol, and with some foods that don’t contain histamine but they inhibit the enzymes activity such as:

• Pawpaw
• Nuts
• Fish
• Egg white
• Citrus fruit
• Strawberries
• Pineapple
• Peanuts
• Tomatoes
• Spinach
• Chocolate
• Pork,
• Crustaceans
• Additives
• Liquorice
• Spices

Or not enough of the nutrients that make DAO and HNMT enzymes – these include:

• Vitamin B6
• Vitamin C
• Copper 

Unlike allergy-triggered histamine, in histamine intolerance the effect is accumulative so you might be ok when you have sauerkraut, but then if you have sardines, or wine, due to the extra load then you start to get the symptoms.

Histamine intolerance can also result in other symptoms not just rash, itching, swelling but also insomnia, headaches, migraines, general gut issues, and even menstrual pain.

Tests you can do 

1. Look for elevated total IgE levels to ensure you are not dealing with allergy
2. Remove the high histamine foods and foods which inhibit the enzymes. If symptoms resolve then start bringing a few things back in to learn your threshold and use vitamin C and B6 to help those enzymes do their job.

Here is a list of the histamine foods, the medication, and the list of foods that inhibit the enzymes which detoxify histamine.

HISTAMINE FOODS

• Fish (frozen/smoked or salted/canned)
• Mackerel
• Herring
• Sardine
• Tuna
• Gouda cheese
• Camembert cheese
• Cheddar cheese
• Emmental cheese
• Swiss cheese
• Parmesan
• Fermented sausage
• Salami
• Fermented ham
• Sauerkraut
• Spinach
• Eggplant
• Tomato ketchup
• Red wine vinegar
• White wine
• Red wine
• Top-fermented beer
• Bottom-fermented beer
• Champagne

FOODS WITH SUGGESTED HISTAMINE -RELEASING CAPACITIES

• Citrus fruit
• Fish
• Additives
• Papaya
• Crustaceans
• Liquorice
• Strawberries
• Pork
• Spices
• Pineapple
• Egg white
• Nuts
• Peanuts
• Tomatoes
• Spinach
• Chocolate

DRUGS RELEASING HISTAMINE OR INHIBITING DIAMINE OXIDASE (DAO)

• Agent interfering with the histamine metabolism
• Contrast media Muscle relaxants – Pancuronium, alcuronium, tubocurarine
• Narcotics -Thiopental
• Analgesics – Morphine, pethidine, nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, metamizole
• Local anesthetics – Prilocaine
• Antihypotonics – Dobutamine
• Antihypertensive drugs – Verapamil, alprenolol, dihydralazine
• Antiarrhythmics – Propafenone
• Diuretics – Amiloride
• Drugs influencing gut motility – Metoclopramide, Antibiotics Cefuroxime, cefotiam, isoniazid, pentamidine, clavulanic acid, chloroquine
• Mucolytics – Acetylcysteine, ambroxol
• Broncholytics – Aminophylline
• H2-receptor antagonists – Cimetidine
• Cytostatics – Cyclophosphamide
• Antidepressants – Amitriptyline

Reference 

https://academic.oup.com/ajcn/article/85/5/1185/4633007
Rachel Arthur – Nutritionist

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463562/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885995/