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It was way back in 1998 that I had my first of many episodic attacks that would randomly occur over the years that followed. I remember it well, the headache from hell that started a few hours after dinner and increased throughout the night into my first ever “migraine”. The blinding throbbing pain resisted several doses of ibuprofen over night and when I woke early the next morning the intensity had me spinning and heaving. Evacuation from both ends provided much relief and later that day it was as if nothing had happened at all! Weird?!

Then it happened again of few months later. And again – randomly. What was causing this? Was it specific foods? Back then I worked in the restaurant business and part of the job was to sample the wines and rich foods. Not preparing my own foods made it impossible to figure out my triggers.

Fast forward to 2010 and my patients are exhibiting similar signs and symptoms. Many have visited their primary doc and are prescribed migraine medications that don’t always help. They experience unexplained headaches or anxiety and heart palpitations. They flush or develop hives when drinking red wine or beers. Itchy noses, throats and tongues when eating eggplant, pizzas or tomato sauces – but not always. I’ve met patients who stopped eating guava, pears, oranges, carrots, almonds etc. and then tried them again later to find out that those weren’t their triggers after all.

Histamine Intolerance?

I first read about this about 5 years ago and then so much of my history suddenly made sense. I realized that the use of ibuprofen and antihistamines for my headaches and seasonal allergies all those years ago actually made things much worse.
Most know what an antihistamine is, but what is Histamine and what role does it play in perceived food sensitivity?

Histamine is a chemical produced by a type of white blood cell named basophils and by another immune cell known as a mast cell. As part of the immune system Histamine increases the permeability of the capillary walls allowing white blood cells and some proteins to engage invaders in the surrounding tissues. This increase in histamine levels is what can result in headaches and itchiness and flushing. All part of the natural immune response. This action also makes it important in the digestive system and central nervous system. It is here that histamine is considered a neurotransmitter where it is involved in communication up and down the gut brain axis.

The body puts histamine into action quickly and has a check and balance system where it also breaks down and clears histamine accumulation. It is when you don’t break down histamine efficiently, that you could develop what is known as histamine intolerance (HIT).

Being that it is primarily released from blood cells, it circulates throughout your body where it can contribute to a host of symptoms and problems throughout the circulatory system, skin, nervous system, and of course the gut.

Signs and symptoms of histamine intolerance:

Think bad allergy attack and you know what these signs and symptoms feel like; Headaches, migraines, flushing, nasal congestion, sneezing, difficulty breathing, hives, fatigue, swelling of tissues, especially of the mucous membranes.

Other signs or symptoms that are attributed to histamine that you may not think of are:
Sleeping problems (especially trouble falling asleep), being hot then cold, dizziness, nausea, irregular heart beat, anxiety, hypertension or hypotension, abdominal cramps and even an abnormal menstrual cycle.

What Causes High Histamine Levels?
Well obviously your immune system in the case of true allergies, as in the classic IgE reactions do. Also fermented beverages like wine, beer, champagne, kefir, kombucha and other histamine rich foods. But the really important factor is gut health and your microbiome. You’ll see HIT associated with Small Intestinal Bacterial Overgrowth (SIBO), Candida overgrowth, and intestinal permeability.

This is likely because the gut is the most important site of action for of an enzyme known as diamine oxidase (DAO) which breaks down histamine. With gut infection there is likely inflammation and increased histamine levels and compromised enzymatic function of DAO. So if the enzymatic activity of DAO determines the rate of histamine breakdown and you have a DAO deficiency you will not be able to clear enough of the histamine consumed in with foods and the symptoms of histamine intolerance will occur.

Histamine in Foods:
In addition to the histamine produced inside your body, there are also a variety of foods that naturally contain histamine, cause the release of histamine, or block DAO.

High Histamine Foods: Essentially fermented, cured, aged, soured, smoked, and pickled products especially from animals or yeast products. Also some dried fruits and nuts. Click Here for a list of high histamine foods or do an internet search. Complete elimination is very difficult and I guide patients through this process often.

Foods that raise your histamine levels: Alcohol and many food preservatives and artificial colorings. Bananas, strawberries, papaya, pineapple, and tomatoes. Shellfish and most meat eaten as left overs.
Foods that inhibit DAO: Alcohol (again) and caffeine.

This sounds like you – now what do you do?
If these signs and symptoms sound like you and you may be deficient in DAO. You can find this as a supplement on the internet and take DAO for a couple of months and see what happens. Better yet identify the cause of your histamine intolerance.

Don’t treat the symptoms. Treat the underlying cause.

Looking into your own immune response to foods is a good place to start. Peruse the list and consider cutting all the major offenders way down. You can have me run a food sensitivity test, but these test often have mixed results. After a consult I can guide you through an elimination diet that works for your lifestyle.

Medications such as NSAIDs (ibuprofen, aspirin), histamine (H2) blockers (Tagamet, Pepcid, Zantac), antidepressants (Effexor, Prozac, Zoloft), immune modulators (Humira, Enbrel, Plaquenil), and antihistamines (Allegra, Zyrtec, Benadryl) and others have been implicated in messing with the histamine balance and some by depleting DAO levels.

Fix your gut! As mentioned IBS, IBD, SIBO, LGS, and Candida are all associated with HIT. How do you know if you need to address this? Well if you experience heart burn, GERD, frequent gas, bloating, constipation, diarrhea, hives, rashes, hemorrhoids, depression, anxiety etc…or your symptoms are not even related to your gut such as anemia, fatigue or hypothyroidism. All disease starts in the gut.

Testing for Histamine Intolerance?
I can test this for you, but is this test ultimately the best bang for your buck? Thorough evaluation of the individual is needed before deciding on lab tests. If this is something you would like to talk more about please contact my office I would be happy to help.

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