What are histamine liberators? How does histamine intolerance occur? What are the symptoms and treatment options for histamine intolerance? Explore the answers to these questions and more in this comprehensive guide.

Understanding Histamine: The Immune System’s Messenger

Histamine is a crucial player in the body’s immune response, aiding in the inflammatory process when the body encounters allergens, infections, or injuries. This chemical compound is produced by cells throughout the body and is responsible for a range of physiological functions, including digestion and sleep regulation.

Histamine Intolerance: When the Body Overreacts

Histamine intolerance occurs when the body struggles to break down and eliminate histamine, leading to an accumulation of the chemical compound. This can result in a wide range of symptoms, including stuffy or runny nose, wheezing, headaches, diarrhea, itching, hives, low blood pressure, and even anaphylaxis.

Who is affected by histamine intolerance, and how common is it? Researchers estimate that approximately 1 to 3 percent of the population may have histamine intolerance, with the condition being more prevalent in middle-aged adults.

Identifying Histamine Liberators: Foods That Trigger Reactions

Certain foods are known as “histamine liberators,” meaning they have the ability to release histamine from other foods. These include citrus fruits, peanuts, fish, shellfish, and egg whites. People with histamine intolerance may need to eliminate or reduce their consumption of these foods, in addition to those high in histamine.

High-Histamine Foods to Avoid

Foods that are high in histamine include:

• Fermented dairy products, such as aged cheeses, yogurt, sour cream, and kefir
• Fermented vegetables like sauerkraut, kimchi, and pickles
• Cured or fermented meats, including sausages, salami, and fermented ham
• Alcoholic beverages, such as wine and beer
• Certain fruits and vegetables, including tomatoes and spinach

Treating Histamine Intolerance: Dietary Modifications and Supplements

The primary treatment for histamine intolerance involves following a low-histamine diet, which involves eliminating or reducing the consumption of high-histamine and histamine-releasing foods. In some cases, healthcare providers may also recommend taking diamine oxidase (DAO) supplements, which can help break down histamine in the body.

The Role of DAO Supplements

A 2019 study found that patients with histamine intolerance experienced a significant reduction in symptoms when taking DAO supplements before meals. This suggests that DAO supplements may be a helpful adjunct to dietary modifications in managing histamine intolerance.

Diagnosing Histamine Intolerance: The Elimination Diet Approach

Since there are no standardized blood tests to identify histamine intolerance, the “gold standard” for diagnosis is an elimination diet. This involves removing high-histamine and histamine-releasing foods from the diet and then slowly reintroducing them, one at a time, to determine which foods trigger symptoms.

This process should be conducted under the guidance of a healthcare professional, such as a dietitian who specializes in food intolerances, to ensure the diet is safe and effective.

Histamine Intolerance Symptoms: From Headaches to Digestive Woes

The symptoms of histamine intolerance can vary widely from person to person, but may include:

• Headaches
• Skin irritations, such as hives or redness
• Diarrhea
• Sinus problems
• Fatigue
• Digestive issues, including nausea and vomiting
• Dizziness

The severity of these symptoms can also range from mild to severe, depending on the individual’s level of intolerance and the amount of histamine consumed.

The Increasing Prevalence of Histamine Intolerance

While researchers estimate that histamine intolerance affects 1 to 3 percent of the population, the actual incidence may be on the rise. This is because research in this area is still relatively new, and as more diagnostic tools and awareness of the condition become available, more people may be identified as having histamine intolerance.

The increasing prevalence of histamine intolerance may be due to a variety of factors, including changes in dietary habits, gut health, and exposure to medications that can interfere with the body’s ability to break down histamine.

Histamine – Food & Intolerance

Histamine is an important part of your body’s immune response, but high levels of the chemical compound can cause health problems.

Histamine is a chemical produced in cells throughout the body as part of the body’s inflammatory response to allergy, infection, or injury.

When damaged or exposed to allergens, cells in the skin, nose, throat and lungs release histamine, resulting in pain, itchiness, redness, runny nose, and wheezing.

Histamine also plays an important role in digestion by aiding in the production of stomach acid, as well as regulating sleep.

Histamine Intolerance

Histamine intolerance occurs when the body responds to foods that are high in histamine or that prompt release of the body’s own histamine.

The symptoms of histamine intolerance may vary from person to person.

Histamine intolerance can mimic many of the symptoms of an allergic reaction and may range from mild to severe.

Symptoms may include stuffy or runny nose, wheezing, headache, diarrhea, itching, hives or redness of the skin, low blood pressure, and anaphylaxis.

Researchers estimate that approximately one percent of people have histamine intolerance. It’s most common in middle-aged adults.

Histamine intolerance may be treated with a histamine-free diet and antihistamine medications.

Histamine in Food

Long-ripened or fermented products, including aged cheeses, processed (deli) meats, sauerkrauts, and wine contain high levels of histamine.

Yeast products such as beer and some breads are also histamine-rich. Certain fruits and veggies, including tomatoes and spinach, also contain high levels of histamine.

Some foods, while low in histamines themselves, are known as histamine liberators, meaning that they help to release histamine from other foods.

Foods with histamine-releasing properties include citrus, peanuts, fish, shellfish, and egg whites.

People with histamine intolerance may be instructed by their doctor to eliminate or reduce histamine-rich foods and histamine-releasing foods from their diets.

How it can benefit you and what to eat

From headaches to itchy skin and nausea, histamine intolerance can make life uncomfortable. A low-histamine diet can help.

Histamine plays a role in our immune and digestive systems, and helps our neurological function.

Our body naturally produces this chemical, but it can also be found in food.

Some people are less tolerant of histamine – they have too much of it in their system.

Dietitian Nicole Dynan says this may be because they lack an enzyme called diamine oxidase (DAO), which breaks down histamine in the body.

“People may lack DAO due to interference by medications or if they have a gut disorder. Some foods also block the release of DAO,” says Nicole, of Dietitians Association of Australia.

Is histamine intolerence becoming more common?

A 2020 review noted some researchers estimate histamine intolerance affects 1 to 3 per cent of the population.

However given research into this area is still relatively new, the incidence may increase as more is understood about the issue and diagnostic tools improve.

How do you know if you can’t tolerate histamine?

There are no standard blood tests to identify intolerance, so an elimination diet is the “gold standard” to identify a problem.

This involves removing high-histamine foods from your diet and slowly adding them back in, one at a time. This should be done with a dietitian who specialises in food intolerances.

“You may be able to tolerate a certain amount of histamine and when you get beyond a threshold, you get symptoms,” says dietitian Aloysa Hourigan, of Nutrition Australia.

“You might be fine having avocado on toast in the morning, but if you then have aged cheese at lunchtime or chocolate after dinner – all foods that contain higher levels of histamine – you may release or consume too much histamine and get a headache.”

Signs of histamine intolerance

Symptoms include:

• Headaches
• Skin irritations
• Diarrhoea
• Sinus problems
• Fatigue
• Hives
• Digestive problems
• Nausea or vomiting
• Dizziness.

How is histamine intolerence be treated?

A 2019 study found an improvement in symptoms when patients took a DAO supplement.

The study assessed 28 patients with histamine intolerance over four weeks. They were given a DAO capsule before meals, followed by a period where they did not take a capsule.

Researchers observed a significant reduction in symptoms while patients were taking the supplement.

But largely, people with histamine intolerance are advised to avoid or reduce foods with higher levels of the chemical to manage their symptoms.

What are high-histamine foods?

Foods to avoid include:

• Fermented dairy products such as cheese – particularly aged cheese, yoghurt, sour cream and kefir
• Fermented vegetables like sauerkraut, kimchi and pickles
• Cured or fermented meats – sausages, salami, fermented ham
• Wine, beer and champagne (which can also harm your immune system)
• Fermented soy products – tempeh, miso, soy sauce
• Sourdough bread
• Tomatoes, eggplant and spinach

Some foods don’t contain high levels of histamine, but they are “histamine liberators” that promote the release of the chemical in our body.

These include:

• Pineapples
• Bananas
• Citrus fruits
• Strawberries
• Nuts
• Spices
• Legumes
• Seafood
• Egg whites

What are low-histamine foods?

These include:

• Fresh meat, chicken and fish
• Eggs
• Gluten-free grains
• Apples and just ripe bananas
• Potatoes and sweet potato
• Pumpkin
• Zucchini
• Carrot
• Cucumber
• Celery
• Shallots

“If you cut out certain foods, you need to make sure you still have nutritional balance in your diet. Otherwise you miss out on some vitamins and minerals,” advises Aloysa.

“For example, if you follow a low-histamine diet you may not have as much citrus fruit, which is a great source of vitamin C.

“So, you need to add fruits and vegetables that contribute to vitamin C like blueberries, guava and melon.”

A low-histamine day on a plate

Breakfast: Eggs on gluten-free toast

Lunch: Salad sandwich with gluten-free breads but without tomatoes, avocado and spinach

Dinner: Fresh fish, potatoes, zucchini and carrot

Snacks: Coconut yoghurt, tinned or peeled pear or grated apple, a plain gluten-free biscuit.

Source: Nicole Dynan, DAA

Looking for more diet and nutrition advice? Check out our archives.

Written by Jenna Meade. Updated January 2021.

Histamine Intolerance: Symptoms, Diet & Treatment

Treat any underlying disorder first. This may improve histamine tolerance.

I generally like to focus on dietary treatments because I prefer to do as much as possible with diet instead of medication. But, histamine intolerance truly requires an integrative approach, as it often occurs in conjunction with other disorders that need to be addressed beyond dietary modifications.

Diet: A low histamine diet is the treatment of choice (food lists are below). This can be challenging if someone is already on a restricted diet such as a gluten-free or low FODMAP diet and should be done under the care of a health care practitioner so that proper nutritional intake is maintained. The tolerance to histamine varies from person to person and the amount of histamine tolerated must be deduced by trial and error. Some people can only tolerate very small amounts and others can be more liberal.

What is important to note is that tolerance to histamine seems to improve once underlying issues are addressed. For example; if IBS or SIBO are treated, reactions to histamine often decrease. It is imperative to treat the underlying disorder in conjunction with dietary changes.

Once the elimination diet is completed one must individually assess tolerance to particular foods and liberalize the diet as tolerated so that optimum nutrition and lifestyle are attained.

Sleep: 7-8 hours a night helps everything!

Support: Health issues and dietary restrictions are stressful and challenging. Seek out support from family, community, faith organizations, online support groups, local support groups. Avoid those who provide negative interactions. Negative interactions delay healing.

Exercise: Any exercise is helpful. Aim for 30-60 minutes daily. Don’t feel bad if you only fit in 15 – it still helps!

Relaxation: The benefits of relaxation techniques cannot be emphasized enough. Breathing exercises or progressive muscle relaxation are easy, portable, and free. Yoga and meditation are great as well. Relaxation for you may also be reading, enjoying time with friends, or playing music.

Medications: Antihistamines, topical steroids/creams, oral steroids, topical homeopathic or plant-based creams, and lotions for rashes.

Supplements: There is little to no data on these, but the following are sometimes used. Vit C, B6, Zn, Cu, Magnesium, Mangosteen, Quercetin, DAO promoters and supplements, topical creams. Please use any supplement under the guidance of a practitioner. Supplements can have toxic side effects.

Histamine content app: https://itunes.apple.com/us/app/food-intolerances/id419098758

Symptom tracker app: https://itunes. apple.com/gb/app/mysymptoms-food-diary/id405231632?mt=8&ign-mpt=uo%3D4

Books: Try a low histamine cookbook. It will make preparing meals easier, especially during the elimination phase.

Is Your Food Allergy Really a Histamine Intolerance?

Nasal congestion, sneezing, and respiratory symptoms: When your blood vessels dilate because of excess histamine, the histamine can travel anywhere it pleases, including your nasal passageways, Dr. Shah explains. (Plus, certain areas, like your nose and mouth, already have a lot of mast cells as it is.) There, it can cause symptoms like sneezing and congestion. On a related note, histamine can affect other parts of your respiratory system beyond your nose, including your airways. In extreme cases of histamine intolerance, you may experience side effects such as trouble breathing.

Dermatological problems like rashes, eczema, and itchy skin: In the same way that excess histamine can trigger nasal drama when it travels, it can also pop up in the form of skin issues.

Racing heart or other palpitations: Cardiovasular struggles like a racing heart can occur because histamine can act directly on cells in your heart, Dr. Dizon says.

If someone has a histamine intolerance, symptoms can be brought on by eating histamine-rich foods or foods that allow the body to release more histamine.

First things first: A lot remains to be discovered when it comes to histamine intolerance. With that said, the prevailing theory is having too much of the chemical in your body can lead to unpleasant symptoms if you’re overly sensitive to this chemical, Dr. Shah says.

This may happen if someone with a histamine intolerance eats or drinks something with a lot of histamine (which doesn’t only exist in your body, but is present in many foods and beverages, too). Symptoms of a sensitivity might happen if your tolerance level for histamine is naturally low and you have a helping of a high-histamine food or beverage, Johane Filemon, R.D.N. , an Atlanta-based dietitian specializing in food intolerances and anti-inflammatory diets, tells SELF.

The biggest offenders, according to a review published in The American Journal of Clinical Nutrition, are fermented foods and drinks such as aged cheeses, yogurt, kefir, sauerkraut, processed meats (or meats that aren’t super-fresh), and alcoholic drinks (sob)—especially wine, champagne, and beer. This is because histamine levels increase with maturation. Some vegetables, like eggplant, are also considered more histamine-rich than others, but the general rule is that the less processed the food, the less likely it is to have as much histamine. There’s also a theory that some foods are “histamine liberators,” meaning they’re not histamine-rich themselves, but they can trigger the body’s cells to release histamine, Dr. Dizon says. These foods might include citrus fruit, strawberries, nuts, and chocolate, among others, though more studies need to be done before researchers can confirm this hypothesis.

Another possibility is that you may experience symptoms of histamine intolerance if something is preventing your body from processing the chemical as seamlessly as usual.

One notion is that this may happen if enzymes that are supposed to break down excess histamine in your body aren’t as active as they should be, Dr. Shah says.

DAO (street name: diamine oxidase) is the main enzyme that helps the body metabolize the histamine found in foods. DAO is produced in the musoca of your small intestine, from which it eventually makes its way into your blood. Although there’s not a conclusive link between lowered DAO and histamine intolerance, it’s a prevalent theory, one that may implicate gastrointestinal disorders as a risk factor for this sensitivity.

How To Use a Low Histamine Diet for Histamine Intolerance

What To Eat, What to Avoid, and How to Use the Low Histamine Diet

If you have recurring frequent diarrhea or nausea, dizziness, itching skin, or rashes after eating certain foods, you may have a histamine intolerance. As is often the case, choosing the right diet can be the difference between constant, unexpected symptoms and relief. Let’s explore histamine intolerance, the low histamine diet and how to use it, and which supplements can help your low histamine diet succeed.

What Is Histamine Intolerance?

Histamine is a naturally occurring compound in some foods and drinks. Histamine is also released from immune system cells when they are exposed to allergens, like dust, pollen, or food allergens.

Some research suggests that histamine intolerance originates in the gut [1 Trusted SourcePubMedGo to source]. How?

Histamine from food is broken down in the digestive tract by the enzyme diamine oxidase (DAO) [2 Trusted SourcePubMedGo to source]. If you become deficient in DAO, excess histamine can cause allergic reaction symptoms and immune responses in your gut and body [2 Trusted SourcePubMedGo to source, 3 Trusted SourcePubMedGo to source, 4 Trusted SourcePubMedGo to source].

Histamine intolerance affects approximately 1% of Americans [5 Trusted SourcePubMedGo to source] and more commonly affects women [2 Trusted SourcePubMedGo to source, 6]. This may be due to monthly fluctuations in estrogen, which appears to encourage the release of histamine [7, 8 Trusted SourcePubMedGo to source, 9 Trusted SourcePubMedGo to source].

But one study also showed that 30%-55% of people with digestive symptoms also have histamine intolerance [10 Trusted SourcePubMedGo to source]. And in another study, more than 50% of individuals with celiac disease who did not respond to a gluten-free diet also had histamine intolerance [11 Trusted SourcePubMedGo to source].

Evidence suggests low levels of DAO enzyme in the gut can be triggered by:

Low DAO levels have been associated with Crohn’s disease and ulcerative colitis [17 Trusted SourcePubMedGo to source, 18 Trusted SourcePubMedGo to source], and histamine intolerance is associated with leaky gut [12 Trusted SourcePubMedGo to source].

When levels of histamine build up, either due to eating high histamine foods or reduced DAO action in the gut, histamine symptoms occur. An overabundance of histamine can cause a wide range of symptoms.

Here are some typical symptoms of histamine intolerance:

• Itching, redness, hives, rash, and/or swelling of the lips, tongue, or skin
• Red or swollen eyes or eyelids
• Sneezing and nasal congestion
• Low blood pressure
• Heart arrhythmia
• Gut health symptoms, including abdominal pain, bloating, diarrhea, gas, nausea, or vomiting
• Headache, migraines, or dizziness
• Sleep disturbances
• Menstrual irregularity
• Chronic fatigue
• Mood symptoms such as anxiety or depression

Let’s talk about how to improve histamine intolerance with a low histamine diet.

Low Histamine Diet

Histamine in foods is produced by the process of fermentation and aging by bacteria and yeasts [19].

On a low histamine diet, you eat low histamine foods and avoid high histamine foods, which reduces the burden on your DAO enzyme levels. You can also support your DAO levels with a few particular supplements.

There aren’t yet a lot of data about low histamine diets, but several small studies suggest a low histamine diet can help control histamine intolerance symptoms.

Decreasing histamine in your diet has been shown to correlate with increased levels of DAO in your blood and to reduce food allergies and histamine intolerance symptoms [20 Trusted SourcePubMedGo to source]. In another study, a low histamine diet improved chronic hives in a group of adults [21].

The low FODMAP diet may also have a role to play on a low histamine diet. The low FODMAP diet has been shown to reduce IBS symptoms by decreasing  available food for symptom-causing gut bacteria [22]. Histamine intolerance and IBS symptoms and causes overlap, indicating that bacterial overgrowth may be a cause for both conditions [12 Trusted SourcePubMedGo to source, 23 Trusted SourcePubMedGo to source, 24 Trusted SourcePubMedGo to source, 25 Trusted SourcePubMedGo to source]. This suggests a low FODMAP diet adapted for low histamine may be an important approach for histamine intolerance.

How To Do a Low Histamine Diet

If you are experiencing a lot of histamine symptoms, a low histamine diet can improve your quality of life.

Step 1: Clean up your regular diet first: Don’t start a low histamine diet until you are already eating a whole-foods diet free of common allergens and food additives. A simple elimination diet, like the paleo or low FODMAP diet, are an excellent place to start.

Step 2: Remove high histamine foods: If you still have histamine symptoms once you have adopted a clean diet, you can adapt it to the low histamine diet.

Using a high histamine food list (see below), do a three-week elimination of high histamine foods, histamine liberating foods, and foods that block the action of the DAO enzyme. If you don’t experience symptom relief, histamine is not likely part of your symptom picture.

Step 3: Reintroduce foods to test for a reaction: Once you have completed the elimination, it’s time to begin reintroducing foods, one at a time. Start with the foods you miss most.

As histamine intolerance is due more to the overall load of histamine foods, work to find your ideal threshhold. The key to remaining symptom free is to not eat more histamine than your body can metabolize. Using a food diary can help you track your reactions.

Step 4: Maintenance: Continue to avoid the quantity of histamine foods that trigger symptoms while you work on resolving your root causes.

Remember that an elimination diet is not meant to be forever.  Continue to avoid the foods that clearly cause a reaction, but feel free to add foods that don’t cause reactions back into your diet. There’s no need to continue to avoid foods that don’t cause symptoms.

If you need support with a low histamine diet, be sure to consult with a dietitian, nutritionist, or health coach.

Foods To Avoid on a Low Histamine Diet

There are three categories of foods to avoid on a low histamine diet: foods that are high in histamine, foods that may trigger a histamine release in the body (called histamine liberators), and foods that block or inhibit the action of the DAO enzyme. Here are lists of foods in these various categories. For a more complete guide, download our Low Histamine Diet eBook.

High Histamine Foods

Histamine in foods is created by the transformation of the amino acid histidine into histamine, often by the action of bacteria or yeasts. This means that fermented or aged foods usually have higher levels of histamine than fresh foods. However, certain vegetables, including spinach and eggplant, also have high histamine levels [26].

During the elimination phase, remove histamine-rich foods from your diet for a period of three weeks. Here is a list of high histamine foods.

• Aged cheeses
• Alcoholic beverages of any kind (especially red wine)
• Avocado
• Dried fruits
• Eggplant 
• Fermented or aged meats, including salami, sausages, and pepperoni
• Fermented beverages like kombucha and water kefir
• Fermented dairy products (yogurt, kefir, sour cream, buttermilk, cottage, and ricotta cheese)
• Fermented or pickled vegetables (kimchi, sauerkraut, pickles, miso, natto)
• Fish and seafood, particularly tuna or mackerel, especially if left over, smoked, salted, or canned, or not gutted and frozen immediately after harvest [27 Trusted SourcePubMedGo to source]
• Ketchup
• Soy sauce, tamari, coconut aminos, and liquid aminos
• Spinach
• Leftovers or unfresh food
• Tea (black, green, white, or yerba mate tea)
• Tomatoes
• Vinegars, including apple cider, rice wine, and balsamic
• Yeast products

Histamine Liberators

Some foods may not be high in histamine themselves, but are thought to trigger the body to release histamine.  You may or may not react negatively to these foods, so some careful attention is required to determine if you need to remove them from your diet. Here is a list of foods that may be histamine releasers:

• Additives or preservatives
• Alcohol
• Fruits such as bananas, citrus fruits (like lemon, lime, and grapefruit), papaya, pineapple, and strawberries
• Chocolate and cocoa
• Egg whites
• Fish and shellfish
• Legumes like lentils or chickpeas
• Licorice
• Nuts, especially such as cashews, peanuts, sunflower seed, and walnuts
• Pork
• Some spices

DAO Blockers

Other foods are known to inhibit the action of the DAO enzyme, which can increase the effect of other high histamine foods. The worst culprit is alcohol, because it is both high in histamine and is a DAO blocker [28]. Energy drinks and teas (green tea, black tea, and yerba mate) are also DAO blockers.

Low Histamine Foods

There are plenty of low histamine foods to include on a low histamine diet. An anti-inflammatory diet template like the Paleo diet is a good place to start. This includes whole foods like:

• Fresh meat and lower histamine fish
• Gluten free grains like rice, quinoa, or millet
• Fresh vegetables like lettuce, cucumbers, zucchini, kale, onions, green beans, or sweet potatoes
• Fresh fruits like apples, blueberries, kiwis, or pears
• Healthy fats such as olive oil, butter, ghee, coconut oil, or coconut milk
• Herbal teas

Low Histamine Diet Meal Plan

What can you eat on a low histamine diet? Lots of delicious foods. When reorganizing your diet, it’s a good idea to follow these simple tips:

• Keep it simple to start: choose a few particular recipes and use them to develop some simple, customized food lists. Be willing to repeat your core basic recipes frequently in the beginning, then expand.
• Be prepared: Stock your pantry and kitchen with foods you can eat, and build your meals and snacks around those.
• Be as strict as possible for 2-4 weeks.
• Don’t stay on the diet too long if it’s not working.
• Reintroduce foods slowly, one at a time to check for reactions. Chances are you won’t react to all the high histamine foods. Work with a food journal to help you clarify which foods are your worst triggers.

Here is a sample day on a low histamine diet:

Breakfast: Oatmeal with blueberries, toasted almonds, coconut, and a drizzle of maple syrup.

Lunch: Green salad with rice, cucumbers, grated carrot, radishes, and fresh herbs, and roasted chicken breast, with an olive oil-apple juice dressing.

Snack: Gluten free crackers with hummus and carrot sticks, or coconut milk-protein powder-blueberry-pear smoothie.

Dinner: Freshly thawed, grilled turkey burger with a side of oven-roasted, herbed, garlic potatoes, and sauteed kale.

Low Histamine Food Tips

Because histamine levels increase in protein-rich foods the longer they are stored, a few key tips can help you avoid additional histamine in your diet.

Meat handling: Histamine levels increase in meat and fish the longer it sits before cooking. Freezing arrests this process of histamine production. When you return from the store with meat, either cook it immediately or freeze it to thaw and cook later.

Leftovers: Similarly, histamine builds in leftovers as they are stored in the refrigerator. Freeze leftovers in serving sizes appropriate for you or your family, and thaw later to reheat.

Ripeness: Additionally, consuming slightly under-ripe fruits and vegetables that are generally high in histamine may reduce your intake.

Ripeness: Histamine can increase with ripening. So, if eating higher histamine fruits and vegetables like avocado or tomato, choosing under-ripe options can help to reduce your intake.

Histamine Intolerance Supplements

Some dietary supplements can help your body do a better job of breaking down histamine. Antihistamine medications block the histamine receptors but do nothing to deal with the excess of histamine present in the first place.

Probiotics and Histamine Intolerance

Many people on the internet have promulgated the opinion that certain types of probiotics are histamine producers or increase histamine intolerance symptoms. It’s likely that probiotics actually lower histamine. However, some controversy exists. We don’t have any direct research about probiotics and histamine intolerance, but we can make some educated inferences.

Studies make a direct connection between histamine intolerance and gut conditions [10 Trusted SourcePubMedGo to source], with patients with histamine intolerance more likely to test positive for gut bacteria imbalances and leaky gut when compared with controls [12 Trusted SourcePubMedGo to source].

Research clearly shows that probiotics are effective against gut infections such as SIBO [33 Trusted SourcePubMedGo to source, 34 Trusted SourcePubMedGo to source, 35 Trusted SourcePubMedGo to source], bacterial and parasitic infections [36 Trusted SourcePubMedGo to source, 37 Trusted SourcePubMedGo to source, 38 Trusted SourcePubMedGo to source, 39 Trusted SourcePubMedGo to source], and leaky gut [40 Trusted SourcePubMedGo to source, 41 Trusted SourcePubMedGo to source, 42 Trusted SourcePubMedGo to source, 43 Trusted SourcePubMedGo to source]. There is limited specific data about whether probiotics help resolve histamine intolerance, but probiotics have certainly been shown to benefit histamine-mediated conditions, such as seasonal allergies [44 Trusted SourcePubMedGo to source, 45 Trusted SourcePubMedGo to source], non-allergic rhinitis [46 Trusted SourcePubMedGo to source], and eczema and asthma [47 Trusted SourcePubMedGo to source]. These data suggest that probiotics have a role to play in moderating histamine intolerance.

There’s no need to select specific “low histamine” probiotics. Including a quality probiotic from each of the three main categories — Lactobacillus and Bifidobacteria blends, Saccharomyces boulardii, and a soil-based probiotic — and adapting that protocol to how your body responds is your best approach. For more on how to use probiotics, see our Probiotics Starter Guide.

Improve Your Histamine Intolerance

A low histamine diet can make a huge difference in your histamine intolerance symptoms and help you feel better. By reducing your histamine burden, you give your body and your DAO enzyme a chance to rebound. Give the low histamine diet a try, and consider using probiotics, DAO enzyme, and vitamin B6 to feel better.

➕ References

1. Schnedl WJ, Enko D. Histamine Intolerance Originates in the Gut. Nutrients. 2021 Apr 12;13(4):1262. doi: 10.3390/nu13041262. PMID: 33921522; PMCID: PMC8069563. Trusted SourcePubMedGo to source
2. Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185. PMID: 17490952. Trusted SourcePubMedGo to source
3. Mušič E, Korošec P, Šilar M, Adamič K, Košnik M, Rijavec M. Serum diamine oxidase activity as a diagnostic test for histamine intolerance. Wien Klin Wochenschr. 2013 May;125(9-10):239-43. doi: 10.1007/s00508-013-0354-y. Epub 2013 Apr 12. PMID: 23579881. Trusted SourcePubMedGo to source
4. Manzotti G, Breda D, Di Gioacchino M, Burastero SE. Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol. 2016 Mar;29(1):105-11. doi: 10.1177/0394632015617170. Epub 2015 Nov 16. PMID: 26574488; PMCID: PMC5806734. Trusted SourcePubMedGo to source
5. Kohn JB. Is there a diet for histamine intolerance? J Acad Nutr Diet. 2014 Nov;114(11):1860. doi: 10.1016/j.jand.2014.09.009. Epub 2014 Oct 24. PMID: 25439083. Trusted SourcePubMedGo to source
6. Jarisch R. Histamine Intolerance: Histamine and Seasickness.
7. Bonds RS, Midoro-Horiuti T. Estrogen effects in allergy and asthma. Curr Opin Allergy Clin Immunol. 2013 Feb;13(1):92-9. doi: 10.1097/ACI.0b013e32835a6dd6. PMID: 23090385; PMCID: PMC3537328.
8. Jing H, Wang Z, Chen Y. Effect of oestradiol on mast cell number and histamine level in the mammary glands of rat. Anat Histol Embryol. 2012 Jun;41(3):170-6. doi: 10.1111/j.1439-0264.2011.01120.x. Epub 2011 Nov 24. PMID: 22112012. Trusted SourcePubMedGo to source
9. Vasiadi M, Kempuraj D, Boucher W, Kalogeromitros D, Theoharides TC. Progesterone inhibits mast cell secretion. Int J Immunopathol Pharmacol. 2006 Oct-Dec;19(4):787-94. doi: 10.1177/039463200601900408. PMID: 17166400. Trusted SourcePubMedGo to source
10. Enko D, Meinitzer A, Mangge H, Kriegshäuser G, Halwachs-Baumann G, Reininghaus EZ, Bengesser SA, Schnedl WJ. Concomitant Prevalence of Low Serum Diamine Oxidase Activity and Carbohydrate Malabsorption. Can J Gastroenterol Hepatol. 2016;2016:4893501. doi: 10.1155/2016/4893501. Epub 2016 Nov 30. PMID: 28042564; PMCID: PMC5155086. Trusted SourcePubMedGo to source
11. Schnedl WJ, Mangge H, Schenk M, Enko D. Non-responsive celiac disease may coincide with additional food intolerance/malabsorption, including histamine intolerance. Med Hypotheses. 2021 Jan;146:110404. doi: 10.1016/j.mehy.2020.110404. Epub 2020 Nov 21. PMID: 33268003. Trusted SourcePubMedGo to source
12. Schink M, Konturek PC, Tietz E, Dieterich W, Pinzer TC, Wirtz S, Neurath MF, Zopf Y. Microbial patterns in patients with histamine intolerance. J Physiol Pharmacol. 2018 Aug;69(4). doi: 10.26402/jpp.2018.4.09. Epub 2018 Dec 9. PMID: 30552302. Trusted SourcePubMedGo to source
13. Martner-Hewes PM, Hunt IF, Murphy NJ, Swendseid ME, Settlage RH. Vitamin B-6 nutriture and plasma diamine oxidase activity in pregnant Hispanic teenagers. Am J Clin Nutr. 1986 Dec;44(6):907-13. doi: 10.1093/ajcn/44.6.907. PMID: 3098085. Trusted SourcePubMedGo to source
14. Hunt IF, Murphy NJ, Martner-Hewes PM, Faraji B, Swendseid ME, Reynolds RD, Sanchez A, Mejia A. Zinc, vitamin B-6, and other nutrients in pregnant women attending prenatal clinics in Mexico. Am J Clin Nutr. 1987 Oct;46(4):563-9. doi: 10.1093/ajcn/46.4.563. PMID: 3661474. Trusted SourcePubMedGo to source
15. Jarisch R, Wantke F. Wine and headache. Int Arch Allergy Immunol. 1996 May;110(1):7-12. doi: 10.1159/000237304. PMID: 8645981. Trusted SourcePubMedGo to source
16. Maintz L, Yu CF, Rodríguez E, Baurecht H, Bieber T, Illig T, Weidinger S, Novak N. Association of single nucleotide polymorphisms in the diamine oxidase gene with diamine oxidase serum activities. Allergy. 2011 Jul;66(7):893-902. doi: 10.1111/j.1398-9995.2011.02548.x. Epub 2011 Apr 13. PMID: 21488903. Trusted SourcePubMedGo to source
17. Schmidt WU, Sattler J, Hesterberg R, Röher HD, Zoedler T, Sitter H, Lorenz W. Human intestinal diamine oxidase (DAO) activity in Crohn’s disease: a new marker for disease assessment? Agents Actions. 1990 Apr;30(1-2):267-70. doi: 10.1007/BF01969057. PMID: 2115243. Trusted SourcePubMedGo to source
18. Raithel M, Matek M, Baenkler HW, Jorde W, Hahn EG. Mucosal histamine content and histamine secretion in Crohn’s disease, ulcerative colitis and allergic enteropathy. Int Arch Allergy Immunol. 1995 Oct;108(2):127-33. doi: 10.1159/000237129. PMID: 7549499. Trusted SourcePubMedGo to source
19. Landete JM, Ferrer S, Pardo I. Biogenic amine roduction by lactic acid bacteria, acetic bacteria and yeast isolated from wine. Food Control. 2007. Volume 18, Issue 12, Pages 1569-1574, ISSN 0956-7135. https://doi.org/10.1016/j.foodcont.2006.12.008.
20. Lackner S, Malcher V, Enko D, Mangge H, Holasek SJ, Schnedl WJ. Histamine-reduced diet and increase of serum diamine oxidase correlating to diet compliance in histamine intolerance. Eur J Clin Nutr. 2019 Jan;73(1):102-104. doi: 10.1038/s41430-018-0260-5. Epub 2018 Jul 18. PMID: 30022117. Trusted SourcePubMedGo to source
21. Son JH, Chung BY, Kim HO, Park CW. A Histamine-Free Diet Is Helpful for Treatment of Adult Patients with Chronic Spontaneous Urticaria. Ann Dermatol. 2018 Apr;30(2):164-172. doi: 10.5021/ad.2018.30.2.164. Epub 2018 Feb 21. PMID: 29606813; PMCID: PMC5839887.
22. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9):940. doi: 10.3390/nu9090940. PMID: 28846594; PMCID: PMC5622700.
23. Chen B, Kim JJ, Zhang Y, Du L, Dai N. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul;53(7):807-818. doi: 10.1007/s00535-018-1476-9. Epub 2018 May 14. PMID: 29761234. Trusted SourcePubMedGo to source
24. Schmulson M, Bielsa MV, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, Peláez-Luna M, Remes-Troche JM, Tamayo JL, Valdovinos MA. Microbiota, gastrointestinal infections, low-grade inflammation, and antibiotic therapy in irritable bowel syndrome: an evidence-based review. Rev Gastroenterol Mex. 2014 Apr-Jun;79(2):96-134. English, Spanish. doi: 10.1016/j.rgmx.2014.01.004. Epub 2014 May 23. PMID: 24857420. Trusted SourcePubMedGo to source
25. Takakura W, Pimentel M. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry. 2020 Jul 10;11:664. doi: 10.3389/fpsyt.2020.00664. PMID: 32754068; PMCID: PMC7366247. Trusted SourcePubMedGo to source
26. Sánchez-Pérez S, Comas-Basté O, Rabell-González J, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Biogenic Amines in Plant-Origin Foods: Are They Frequently Underestimated in Low-Histamine Diets? Foods. 2018 Dec 14;7(12):205. doi: 10.3390/foods7120205. PMID: 30558197; PMCID: PMC6306728.
27. Rahmani J, Miri A, Mohseni-Bandpei A, Fakhri Y, Bjørklund G, Keramati H, Moradi B, Amanidaz N, Shariatifar N, Khaneghah AM. Contamination and Prevalence of Histamine in Canned Tuna from Iran: A Systematic Review, Meta-Analysis, and Health Risk Assessment. J Food Prot. 2018 Dec;81(12):2019-2027. doi: 10.4315/0362-028X.JFP-18-301. PMID: 30476444. Trusted SourcePubMedGo to source
28. Kovacova-Hanuskova E, Buday T, Gavliakova S, Plevkova J. Histamine, histamine intoxication and intolerance. Allergologia et Immunopathologia. 2015. Volume 43, Issue 5, Pages 498-506, ISSN 0301-0546. https://doi.org/10.1016/j.aller.2015.05.001.
29. Schnedl, W.J., Schenk, M., Lackner, S. et al. Diamine oxidase supplementation improves symptoms in patients with histamine intolerance. Food Sci Biotechnol 28, 1779–1784 (2019). https://doi.org/10.1007/s10068-019-00627-3
30. Hagel AF, Layritz CM, Hagel WH, Hagel HJ, Hagel E, Dauth W, Kressel J, Regnet T, Rosenberg A, Neurath MF, Molderings GJ, Raithel M. Intravenous infusion of ascorbic acid decreases serum histamine concentrations in patients with allergic and non-allergic diseases. Naunyn Schmiedebergs Arch Pharmacol. 2013 Sep;386(9):789-93. doi: 10.1007/s00210-013-0880-1. Epub 2013 May 11. PMID: 23666445. Trusted SourcePubMedGo to source
31. Uchida K, Mitsui M, Kawakishi S. Monooxygenation ofN-acetylhistamine mediated by L ascorbate. Biochimica et Biophysica Acta (BBA) – General Subjects. 1989. Volume 991, Issue 2, Pages 377-379, ISSN 0304-4165. https://doi.org/10.1016/0304-4165(89)90131-1.
32. Johnston CS. The antihistamine action of ascorbic acid. Subcell Biochem. 1996;25:189-213. doi: 10.1007/978-1-4613-0325-1_10. PMID: 8821975. Trusted SourcePubMedGo to source
33. Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017 Apr;51(4):300-311. doi: 10.1097/MCG.0000000000000814. PMID: 28267052. Trusted SourcePubMedGo to source
34. Soifer LO, Peralta D, Dima G, Besasso H. Eficacia comparativa de un probiótico vs un antibiótico en la respuesta clínica de pacientes con sobrecrecimiento bacteriano del intestino y distensión abdominal crónica funcional: un estudio piloto [Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study]. Acta Gastroenterol Latinoam. 2010 Dec;40(4):323-7. Spanish. PMID: 21381407. Trusted SourcePubMedGo to source
35. Leventogiannis K, Gkolfakis P, Spithakis G, Tsatali A, Pistiki A, Sioulas A, Giamarellos-Bourboulis EJ, Triantafyllou K. Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth. Probiotics Antimicrob Proteins. 2019 Jun;11(2):627-634. doi: 10.1007/s12602-018-9401-3. Erratum in: Probiotics Antimicrob Proteins. 2018 Mar 28;: PMID: 29508268; PMCID: PMC6541575. Trusted SourcePubMedGo to source
36. Eslami M, Yousefi B, Kokhaei P, Jazayeri Moghadas A, Sadighi Moghadam B, Arabkari V, Niazi Z. Are probiotics useful for therapy of Helicobacter pylori diseases? Comp Immunol Microbiol Infect Dis. 2019 Jun;64:99-108. doi: 10.1016/j.cimid.2019.02.010. Epub 2019 Mar 5. PMID: 31174707. Trusted SourcePubMedGo to source
37. Demirel G, Celik IH, Erdeve O, Saygan S, Dilmen U, Canpolat FE. Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants. Eur J Pediatr. 2013 Oct;172(10):1321-6. doi: 10.1007/s00431-013-2041-4. Epub 2013 May 24. PMID: 23703468. Trusted SourcePubMedGo to source
38. Dinleyici EC, Eren M, Dogan N, Reyhanioglu S, Yargic ZA, Vandenplas Y. Clinical efficacy of Saccharomyces boulardii or metronidazole in symptomatic children with Blastocystis hominis infection. Parasitol Res. 2011 Mar;108(3):541-5. doi: 10.1007/s00436-010-2095-4. Epub 2010 Oct 5. PMID: 20922415. Trusted SourcePubMedGo to source
39. Besirbellioglu BA, Ulcay A, Can M, Erdem H, Tanyuksel M, Avci IY, Araz E, Pahsa A. Saccharomyces boulardii and infection due to Giardia lamblia. Scand J Infect Dis. 2006;38(6-7):479-81. doi: 10.1080/00365540600561769. PMID: 16798698. Trusted SourcePubMedGo to source
40. Sindhu KN, Sowmyanarayanan TV, Paul A, Babji S, Ajjampur SS, Priyadarshini S, Sarkar R, Balasubramanian KA, Wanke CA, Ward HD, Kang G. Immune response and intestinal permeability in children with acute gastroenteritis treated with Lactobacillus rhamnosus GG: a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2014 Apr;58(8):1107-15. doi: 10.1093/cid/ciu065. Epub 2014 Feb 5. PMID: 24501384; PMCID: PMC3967829. Trusted SourcePubMedGo to source
41. Lamprecht M, Bogner S, Schippinger G, Steinbauer K, Fankhauser F, Hallstroem S, Schuetz B, Greilberger JF. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Int Soc Sports Nutr. 2012 Sep 20;9(1):45. doi: 10.1186/1550-2783-9-45. PMID: 22992437; PMCID: PMC3465223. Trusted SourcePubMedGo to source
42. McFarlin BK, Henning AL, Bowman EM, Gary MA, Carbajal KM. Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers. World J Gastrointest Pathophysiol. 2017 Aug 15;8(3):117-126. doi: 10.4291/wjgp.v8.i3.117. PMID: 28868181; PMCID: PMC5561432. Trusted SourcePubMedGo to source
43. Mujagic Z, de Vos P, Boekschoten MV, Govers C, Pieters HH, de Wit NJ, Bron PA, Masclee AA, Troost FJ. The effects of Lactobacillus plantarum on small intestinal barrier function and mucosal gene transcription; a randomized double-blind placebo controlled trial. Sci Rep. 2017 Jan 3;7:40128. doi: 10.1038/srep40128. PMID: 28045137; PMCID: PMC5206730. Trusted SourcePubMedGo to source
44. Güvenç IA, Muluk NB, Mutlu FŞ, Eşki E, Altıntoprak N, Oktemer T, Cingi C. Do probiotics have a role in the treatment of allergic rhinitis? A comprehensive systematic review and meta-analysis. Am J Rhinol Allergy. 2016 Sep 1;30(5):157-175. doi: 10.2500/ajra.2016.30.4354. Epub 2016 Jul 20. PMID: 27442711. Trusted SourcePubMedGo to source
45. Dennis-Wall JC, Culpepper T, Nieves C Jr, Rowe CC, Burns AM, Rusch CT, Federico A, Ukhanova M, Waugh S, Mai V, Christman MC, Langkamp-Henken B. Probiotics (Lactobacillus gasseri KS-13, Bifidobacterium bifidum G9-1, and Bifidobacterium longum MM-2) improve rhinoconjunctivitis-specific quality of life in individuals with seasonal allergies: a double-blind, placebo-controlled, randomized trial. Am J Clin Nutr. 2017 Mar;105(3):758-767. doi: 10.3945/ajcn.116.140012. Epub 2017 Feb 22. PMID: 28228426. Trusted SourcePubMedGo to source
46. Gelardi M, De Luca C, Taliente S, Fiorella ML, Quaranta N, Russo C, Ciofalo A, Macchi A, Mancini M, Rosso P, Seccia V, Guagnini F, Ciprandi G. Adjuvant treatment with a symbiotic in patients with inflammatory non-allergic rhinitis. J Biol Regul Homeost Agents. 2017 Jan-Mar;31(1):201-206. PMID: 28337893. Trusted SourcePubMedGo to source
47. Toh ZQ, Anzela A, Tang ML, Licciardi PV. Probiotic therapy as a novel approach for allergic disease. Front Pharmacol. 2012 Sep 21;3:171. doi: 10.3389/fphar.2012.00171. PMID: 23049509; PMCID: PMC3448073. Trusted SourcePubMedGo to source

➕ Links & Resources

More About Histamine Intolerance:

Need help or would like to learn more?
View Dr. Ruscio’s additional resources

Get Help

How low-histamine foods can help tame allergies

Ever wonder why pollen, pet dander, and dust mites make you miserable with sniffles and itching? They can all spark the release of histamine: The chemical culprit behind the constellation of symptoms many of us experience when we’re exposed to common allergy triggers.

Histamine is a compound produced naturally in your cells that serves several key functions in the body. It’s generated by mast cells, a type of white blood cell, when we’re exposed to an allergen and our bodies attempt to get rid of it. (Cue the sneezing and watery eyes.) It’s also tasked with crucial roles in the digestive and neurological systems, helping regulate the production of stomach acid and keeping us alert during the day.

But histamine isn’t just produced by our bodies—it also occurs naturally in certain foods. If you suffer from histamine intolerance symptoms, such as headaches, nasal congestion, or fatigue, a low-histamine elimination diet may help you pinpoint and avoid specific foods that trigger your symptoms. But before you begin to overhaul your pantry, read on to learn more about histamine intolerance and how diet may help manage your symptoms.

Here’s the 411 on low-histamine foods and how they may benefit your health.

Photo: Getty Images/Tetra Images

What is histamine intolerance?

Most people tolerate the dietary histamines they consume on a daily basis without issue. However, approximately one percent of the population experiences histamine intolerance, either due to unusually high levels of histamine in the body or because they lack the enzymes necessary to remove it from the system.

Related Stories

When histamine builds up in excessive quantities or fails to break down properly, it may trigger a variety of responses, including headaches, anxiety symptoms, digestive distress, fatigue, and allergy signals such as sinus congestion, sneezing, hives, and difficulty breathing.

These symptoms occur throughout the body because histamine travels through the bloodstream. And, unfortunately, their non-specific nature makes diagnosis difficult. So if you have several seemingly unrelated health complaints—especially if you also take medications that restrict the production of enzymes that break down histamine; gastrointestinal disorders such as leaky gut syndrome or inflammatory bowel disease; or bacterial overgrowth—you should consider consulting with a dietitian.

Photo: Getty Images/Westend61

How to manage histamine-related food intolerances

At present, there are no reliable tests available to diagnose histamine intolerance. Because symptoms vary widely from person to person, it is important to rule out alternative conditions, including food allergies.

Once you’ve done that, follow the steps outlined below to find your body’s individual histamine sweet spot.

1. Begin a two- to four-week histamine elimination diet

Just as the name suggests, an elimination diet involves removing all foods within a given category and then slowly reintroducing them to see how your body reacts.

Rachel Gargiulo, a certified nutrition consultant, recommends that people dealing with potential histamine intolerance avoid high-histamine foods. Fermented foods should be first on your do-not-eat list—these include fermented dairy products (yogurt, sour cream, buttermilk, kefir), pickled or fermented vegetables (sauerkraut, pickles, kimchi), soy products (tempeh, miso, soy sauce), kombucha, alcohol, and fermented grains such as sourdough bread. You should also avoid aged cheeses, cured meats (sausage, salami), tomatoes (including ketchup), eggplant, spinach, and frozen, salted, or canned fish.

Additionally, it has been suggested that some foods, called “histamine liberators,” may cause your cells to release excess histamine into the body. In order to ensure your body’s histamine slate is wiped as clean as possible, avoid pineapples, bananas, citrus fruit, strawberries, papayas, nuts, spices, legumes, cocoa, seafood, egg whites, and food additives such as colorants, preservatives, stabilizers, and flavorings, which are suspected histamine liberators. (Yes, that means ditching most processed foods.)

As you can see, this elimination diet is super restrictive. This is why experts recommend limiting the elimination period to two to four weeks. Permanently eliminating such a large number of nutrient-dense foods could be both challenging and potentially unhealthy, as it increases the likelihood of nutrient deficiencies.

2. Load up on low-histamine foods

Completing an elimination diet requires some serious planning. To help soften the blow of a few weeks without ‘booch and sourdough avocado toast—and to reduce your likelihood of slip-ups—Gargiulo recommends stocking your pantry and refrigerator with your favorite low-histamine staples. These include rice, quinoa, all fruits and vegetables (other than those previously identified as being high in histamine), leafy herbs (thyme, cilantro, oregano), and meats and poultry. In order to maximize the likelihood of success on your program, consume the freshest food available, as fresh food has the lowest histamine content.

Finally, talk to your doctor or dietitian about supplements. They might be necessary to ensure you’re getting all the nutrients you need during your program.

3. Keep a diary as you reintroduce eliminated foods 

Once you’ve made it through the not-so-fun elimination period, it’s time to pat yourself on the back before proceeding with the reintroduction stage of your elimination diet. This is when you’ll start adding eliminated foods back into your diet, one at a time, in order to identify the ones that trigger your symptoms.

It is critical that you keep a detailed diary of the foods you reintroduce and the symptoms you experience, as this record will allow you to identify trigger foods that you may wish to eliminate on a permanent basis. Seek advice from your doctor or dietician regarding how often you should be reintroducing foods. Symptoms may not appear immediately, and you don’t want to risk overloading your system by reintroducing too much, too soon.

4. Consider taking supplements to further reduce histamine 

What happens if you’ve eliminated all high-histamine foods for a month, but you’re still experiencing symptoms? Gargiulo says that certain supplements—including quercetin, vitamin C, and stinging nettle—may lessen the effects of histamine build-up in the body. She also noted that local bee pollen has surprisingly positive effects on allergy symptoms. But check with your care team first to make sure they’re right for you.

Look, histamine intolerance is never pleasant, and it can be an especially bitter pill to swallow when getting rid of the symptoms requires major changes to your habits and lifestyle. If the elimination diet gets tough, just think about how empowering it’ll be to finally figure out your personal trigger foods. Because feeling better would be so much sweeter than any of the high-histamine foods you choose to kiss goodbye, no?

If you’ve got an autoimmune disorder, this Paleo-esque diet may help. And here’s how to *officially* know if you’ve got a lactose or gluten intolerance. 

Nutrition therapy for adverse reactions to histamine in food and beverages

Allergol Select. 2018; 2(1): 56–61.

Ernährungsberatung und -therapie, Munich

Correspondence to Dr. Imke Reese Ernährungsberatung und -therapie Schwerpunkt Allergologie Ansprengerstraße 19 80803 München, Germany [email protected]

Received 2010 Dec 28; Accepted 2011 Jan 13.

This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Adverse reactions to food are suspected in one third of the German population, but only 10% of these assumed hypersensitivity reactions can be clinically confirmed. While diagnosis of food allergies is fairly easy due to objective laboratory parameters, non-allergic hypersensitivity reactions are difficult to diagnose because these objective markers are lacking so far. Adverse reactions to histamine are often suspected to be the cause of a wide range of symptoms, especially when no allergic pathomechanism can be identified. In order to confirm such a suspicion, it is inevitable to validate a reproducible association between consumption of histamine-rich food and beverages and symptoms to identify causative agents and to exclude other disorders. Thereafter, avoidance tests should be performed on the basis of individual requirements. General advice with a lot of restraints is often unnecessarily strict. Nutrition therapy aims at a reduction of symptoms to a minimum while maintaining a high quality of life.

Keywords: adverse reactions to food, histamine, histamine-intolerance, diagnosis, diamine oxidase, nutrition therapy, quality of life

German version published in Allergologie, Vol. 34, No. 3/2011, p. 152-158

Introduction

Adverse reaction to histamine, frequently also termed “histamine intolerance”, is a widespread clinical picture, but diagnosis is difficult. To give consideration to all its varieties and diverse influencing factors the term “adverse reactions to histamine” will be used in this article. The assumption that adverse reactions to histamine might primarily occur due to an enzyme deficiency, like lactose intolerance or hereditary fructose intolerance, is contradicted by the fact that reported adverse reactions to ingested histamine are not always reproducible. The authors of a recently published double-blind, placebo-controlled multicenter study conclude from the results of provocation tests in patients with suspected adverse reactions to histamine “that the term histamine intolerance presumably represents a symptom complex that only in individual cases can be traced back to histamine alone” [14].

Functions of histamine

Histamine is a transmitter with manifold important functions in the human body. As some effects of histamine can lead to medical conditions and thus are perceived as negative, it is often forgotten that histamine performs a number of physiological functions in the body. Diagrams on the mode of action of histamine frequently show symptoms (), but do not impart its physiologically important effects. Its effects on the secretion of gastric acid, for example, are presented mainly by naming symptoms like abdominal pain, cramps, diarrhea or meteorism, while its positive effects in the sense of protein digestion are not mentioned.

Histamine-mediated symptoms (according to Maintz et al. [16]).

The finding that the intake of drugs inhibiting the secretion of gastric acid (proton pump inhibitors) can result in an incomplete protein digestion and thus in a reduced inactivation of allergens followed by an increased sensitization to allergens unstable to digestion [19, 28], illustrates the importance of taking into account all the effects of histamine.

Its effects on female hormones are also frequently described as pathological, while they are in fact physiologically important. In this context Maintz et al. [17] could show that during pregnancy there is an upregulation not only of the histamine-depleting enzyme diamine oxidase, but also of the histamine-producing enzyme histidine decarboxylase. The authors conclude that the balance between histamine and diamine oxidase (DAO) is crucial for a complication-free pregnancy.

Experiments in mice suggest that histamine plays an important role in the regulation of the energy balance too [7]. Mice that cannot synthesize histamine are characterized by visceral obesity, disturbed glucose tolerance, hyperinsulinemia and hyperleptinemia.

In the context of immune responses histamine is not only a mediator of acute allergic and non-allergic reactions, but also acts as immunomodulator and influences chronic inflammation [2, 9].

Histamine depletion

Adverse reactions to histamine are explained by an insufficient histamine depletion. Histamine is depleted extracellularly by DAO, which is stored in vesicles and released if necessary, or intracellularly by histamine N-methyltransferase (HNMT). It is suggested that exogenous histamine is mainly depleted by DAO, although some authors also consider the depletion by HNMT to be of importance [15]. The latter assumption is, however, contradicted by results from an experiment in pigs to which the description of adverse events to histamine is traced back [24]: in this experiment the administration of 60 mg of histamine resulted in severe symptoms or death in three pigs with specifically inhibited DAO. Pigs with normal DAO activity tolerated cheese without any problems. A second experiment showed that premedication with a combination of h2- and h3-receptor antagonists could prevent symptoms [25].

These experiments were the first basis for the assumption that an insufficient DAO activity was the most important factor for the negative effects of histamine. While in the beginning the focus was put on the inhibition of DAO activity by drugs [23, 25], an underlying enzyme deficiency, detectable by blood tests, was assumed later [18]. Today it is well known that the parameters of DAO activity in the blood do not correlate with those in the intestine [8] so that blood tests for the determination of DAO activity do not seem reasonable for the diagnosis of adverse reactions to histamine in food and beverages [13, 27].

Is the differentiation between endogenous and exogenous histamine necessary?

When the clinical picture and its diagnosis is discussed, there is frequently no differentiation between endogenously released and exogenously administered histamine. The fact that exogenous histamine below a toxic threshold is depleted and disposed of by intestinal DAO and perhaps also HNMT in healthy subjects as well as the lack of correlation between DAO in the blood and intestinal DAO suggest that the differentiation between an endogenous and an exogenous disturbance of depletion is reasonable or even necessary. A limited depletion capacity for endogenously released histamine (e.g., after an allergic reaction) is not necessarily associated with a limited catabolization of ingested histamine. Consequently, for diagnosis a clear and reproducible relation between ingestion of histamine-rich food and subsequent symptoms should be established [26].

Diagnosis of adverse reactions to ingested histamine

The key factor in the successful diagnosis of any adverse reactions is a thorough patient history. Beyond the documentation of the detailed information provided by the patient it is essential to systematically inquire and question the symptoms supposedly related to the adverse reaction and to establish an unambiguous relationship with the ingestion of histamine-rich food or beverages. The reproducibility of symptoms is of particular interest in this context. If the symptoms are not reproducible, it is advisable to identify possible concomitant factors (see below) that need to be present to trigger the symptoms and, on the other hand, to eliminate other causes (see Differential diagnosis). An important device for diagnostic work-up is a diet and symptom diary. The detailed daily documentation of consumed food and beverages including quantities and time specifications as well as the description of symptoms (also with time specifications) do not only complement the details provided in the patient history but can in some cases also invalidate them.

Differential diagnosis

A proper differential diagnosis is essential for successful therapy. The diet and symptom diary are also very useful in this context. First and foremost symptoms of toxic nature should be excluded. A histamine content of 100 mg/kg fish is already considered critical. This threshold can easily be exceeded in spoiled fish belonging to a family with high histidine content (e.g., scombridae, clupeidae, engraulidae, coryphaenidae, scomberesocidae). Therefore, the European Union has established a limit of 100 mg/kg (maximum of 200 mg/kg) (Commission Regulation (EC)No 2073/2005) [29]).

Even more important for differential diagnosis are changes in the gastrointestinal tract. They can influence the metabolization of ingested histamine by an increased permeability as well as by an impaired function of the depleting enzymes. A relationship between intestinal permeability and chronic urticaria could already be demonstrated in the 1990s [11, 12]. Bühner et al. [4] added to this knowledge by carrying out a study on the use of a pseudoallergen-poor diet (which is also poor in biogenic amines) in patients with chronic urticaria: they could show that those patients benefited most from the diet whose permeability of the gastroduodenal and intestinal mucosa had been increased before. Improvement or complete disappearance of symptoms after the diet was associated with the normalization of the gastroduodenal permeability. Kuefner et al. [15] demonstrated that the activity of both enzymes (DAO and HNMT) was reduced in patients with food allergy as well as in patients with colon adenoma. Unfortunately, it was not studied whether the reduced enzyme activity influenced the tolerability of histamine-containing food. Experience with patients also shows that the gastroduodenal tract plays a major role in the development of adverse reactions to the ingestion of histamine-rich food. Patients with concomitant impairment of carbohydrate utilization or untreated gluten-sensitive enteropathy frequently report adverse reactions to histamine that vanish or become rarer after successful therapy of the underlying disease. It is suggested that also the composition of intestinal bacteria, which is also influenced by the composition of ingested foods, plays an important role. All components of food are microbially fermented in varying degrees and thus influence the microbiotic composition in the small intestine as well as in the colon. This, on the other hand, can influence the pH value and the morphology of the gastrointestinal tract, and thus also its permeability [3].

When gastrointestinal symptoms are present it should, however, also be considered that symptoms can be triggered by endogenous histamine released, for example, by intestinal mast cells.

To date, no useful objective parameters for the diagnosis of adverse reactions to histamine have been found. To our current knowledge the determination of DAO in the blood is not really significant [13, 27]. The measurement of intestinal DAO activity might be a more reliable parameter [26], but as it requires a biopsy it is also more complicated.

The gold standard for the diagnosis of adverse reactions is a double-blind, placebo-controlled provocation test. Until now no sensible provocation regime has been developed and evaluated. Efforts to establish such a regime failed due to the fact that at a dose of 75 mg half of the controls without suspected adverse reactions to histamine developed symptoms [31]. Obviously this dose is so close to the toxic level that no differentiation between affected and unaffected persons is possible.

As a consequence, diagnosis can currently only be based on clinical criteria and thus to a large extent on establishing a clear relationship between patient history and reproducible reactions.

Therapy approach

If the diagnosis “adverse reactions to exogenous histamine” is reproducible and confirmed, therapy aims at limiting the symptoms to a minimum without reducing the patient’s quality of life. General histamine-poor diets, such as those found on the web and frequently recommended to patients, are usually inappropriate to achieve this therapeutic goal (see below). At most, they can be used as diagnostic tools in order to make sure that the symptoms are absent during this diet. However, it is important not to forget the possible placebo effect that might occur from the patient’s hope for improvement. Therefore, the improvement of symptoms during diet alone is not a proof for underlying adverse reactions to histamine.

General histamine-poor diets are not sensible

These kinds of diets are not suitable as a long-term therapy, mainly because they limit the range of food and beverages too much. The histamine contents of food can vary significantly: freshly caught fish, for example, contains almost no histamine, while the histamine content of cured, pickled or not really fresh fish can be more than 2,000 mg/kg [22]. The histamine content of cheese, another frequently cited histamine-rich food, can also vary significantly. Even Emmental cheese, Swiss mountain cheese or blue cheese can contain less than 5 mg/kg of histamine [1, 22]. Similar is true for sausages, wine, pickled vegetables and the like [1, 6, 20]. But not even the detailed knowledge of the histamine content of a certain food allows to draw conclusions about its tolerability. While increased amounts of histamine in fish can easily cause toxic reactions, considerably higher amounts of histamine are tolerated when consumed in the form of cheese [5]. Thus, the senate commission of the Deutsche Forschungsgemeinschaft (German Research Foundation) states that the maximum amount of 200 mg histamine/kg indicated in the hygiene regulation on fish cannot be applied to cheese. As a possible explanation they indicate a slower release of biogenic amines from cheese in the gastrointestinal tract.

This statement is supported by experience from nutrition therapy. The individual tolerability is obviously significantly influenced by the choice of food as well as by the composition and intervals of meals. Low-carbohydrate, protein- and fat-rich nutrition – as it is frequently applied in patients with impaired carbohydrate utilization – leads to a significant improvement of symptoms. The positive effect is probably based on an increased gastrointestinal passage time, a changed permeability and subsequently a longer period of action of the catabolizing enzymes, but also on the influence on the patient’s intestinal microflora. Possibly the too high amounts of carbohydrates in a bread- or starch-rich diet can also explain why many patients report not to tolerate bread very well. Patient guides often ascribe this effect to the yeast used in bread baking, but the detectable values for yeast are clearly below 10 mg/kg. Yeast extract, on the other hand, can contain significant amounts of histamine.

As histamine depletion is delayed due to the presence of other biogenic amines in food, also food with a high content of other biogenic amines is “banned” in many generalized diet lists. However, also the amounts of other biogenic amines vary according to ripeness, storage, preparation, deterioration, and the like, so that a general ban of food with a high content of biogenic amines that is not individually adjusted for each patient, is always associated with restrictions.

Furthermore, the frequently recommended total avoidance of so-called histamine liberators limits the patient’s choice of food significantly. Whether histamine liberators, that only contain small amounts of histamine themselves but are supposed to trigger a histamine release really exist, is controversially discussed [30].

A survey of patients with suspected adverse reactions to histamine showed that a number of supposedly relevant foods are indeed not tolerated by many, but by far not by all, affected persons, while others can consume them without any problems [10]. This observation shows how important individual therapeutic guidance is.

Individual therapy for a better quality of life

Therapeutically, a three-step approach, as also recommended by the Food Allergy Working Group of Deutsche Gesellschaft für Allergie und klinische Immunologie (DGAKI), has proven effective [21]. The initial avoidance phase of 10 – 14 days is primarily dedicated to symptom reduction by limiting the supply of biogenic amines. Additionally, the general choice of food, the composition of meals and the intervals between them are important. If the patient is used to a carbohydrate-rich diet, the addition of proteins and fat and the reduction of carbohydrates has proven to be an effective approach to support symptom reduction. After 2 weeks the avoided foods should be reintroduced (testing). This expands the variety of foods that can be consumed by the patient while taking into account individual factors (stress, hormone status, drug use and so on). The last phase is an individually adjusted continuous diet that warrants a high quality of life and does not limit the patient’s choice of food too much.

Conclusion

The subjective suspicion of adverse reactions to histamine is – similarly to other adverse/intolerance reactions – by far more frequent than their objective detectability. What makes diagnosis and therapy even more difficult is the fact that diagnosis can be made only based on clinical observations. For diagnostic work-up it is essential to establish an objective relationship between patients’ statements and reproducible reactions. Therapeutically, it is indispensable to advise the affected people individually in order to limit their nutritional restrictions to a minimum and, thus, to maintain their quality of life.

Table 1.

Diagnostic work-up when adverse reactions to histamine in food and beverages is suspected (modified from [26]).

References

1.
Askar A
Biogene Amine in Lebensmitteln und ihre Bedeutung.
Ernahr-Umsch.
1982;
29:
143–148.
[Google Scholar]2.
Bachert C
The role of histamine in allergic disease: re-appraisal of its inflammatory potential.
Allergy.
2002;
57:
287–296.
[PubMed] [Google Scholar]3.
Blaut M
Loh G
Aufbau und Funktion der intestinalen Mikrobiota des Menschen In:
Bischoff SC. Probiotika, Präbiotika und Synbiotika.
Stuttgart: Thieme;
2009.
2-22.
[Google Scholar]4.
Buhner S
Reese I
Kuehl F
Lochs H
Zuberbier T
Pseudoallergic reactions in chronic urticaria are associated with altered gastroduodenal permeability.
Allergy.
2004;
59:
1118–1123.
[PubMed] [Google Scholar]

5.
Eisenbrand G
Biogene Amine in Käse und Fisch. DFG Senatskommission zur Beurteilung der gesundheitlichen Unbedenklichkeit von Lebensmitteln (SKLM).
1998;

6.
Ekici K
Coskun H
Histamine contents in some commercial vegetable pickles.
Pak J Nutr.
2004;
3:
197–198.
[Google Scholar]7.
Fülöp AK
Földes A
Buzás E
Hegyi K
Miklós IH
Romics L
Kleiber M
Nagy A
Falus A
Kovács KJ
Hyperleptinemia, visceral adiposity, and decreased glucose tolerance in mice with a targeted disruption of the histidine decarboxylase gene.
Endocrinology.
2003;
144:
4306–4314.
[PubMed] [Google Scholar]8.
Jarisch R
Leserbrief
Allergologie.
2009;
32:
41–42.
[Google Scholar]9.
Jutel M
Akdis M
Akdis CA
Histamine, histamine receptors and their role in immune pathology.
Clin Exp Allergy.
2009;
39:
1786–1800.
[PubMed] [Google Scholar]10.
Kamp A
Ernährungstherapie der Histaminintoleranz.
EM (Pittsburgh Pa).
2009;
24:
78–81.
[Google Scholar]11.
Kanny G
Moneret-Vautrin DA
Schohn H
Feldman L
Mallie JP
Gueant JL
Abnormalities in histamine pharmacodynamics in chronic urticaria.
Clin Exp Allergy.
1993;
23:
1015–1020.
[PubMed] [Google Scholar]12.
Kanny G
Grignon G
Dauca M
Guedenet JC
Moneret-Vautrin DA
Ultrastructural changes in the duodenal mucosa induced by ingested histamine in patients with chronic urticaria.
Allergy.
1996;
51:
935–939.
[PubMed] [Google Scholar]13.
Kofler H
Aberer W
Deibl M
Hawranek T
Klein G
Reider N
Fellner N
Diamine oxidase (DAO) serum activity: not a useful marker for diagnosis of histamine intolerance.
Allergologie.
2009;
32:
105–109.
[Google Scholar]14.
Komericki P
Klein G
Hawranek T
Land R
Reider N
Strimitzer T
Kranzelbinder B
Aberer W
Oral verabreichte Diaminoxidase (DAO) bei Patienten mit Verdacht auf Histamin-Intoleranz.
Allergologie.
2008;
31:190
[Google Scholar]15.
Kuefner MA
Schwelberger HG
Hahn EG
Raithel M
Decreased histamine catabolism in the colonic mucosa of patients with colonic adenoma.
Dig Dis Sci.
2008;
53:
436–442.
[PubMed] [Google Scholar]16.
Maintz L
Bieber T
Novak N
Die verschiedenen Gesichter der Histaminintoleranz.
Dtsch Arztebl.
2006;
51-52:
A3477–A3483.
[Google Scholar]17.
Maintz L
Schwarzer V
Bieber T
van der Ven K
Novak N
Effects of histamine and diamine oxidase activities on pregnancy: a critical review.
Hum Reprod Update.
2008;
14:
485–495.
[PubMed] [Google Scholar]18.
Mayer I
Missbichler A
Wantke F
Focke M
Reichl H
Winter M
Jarisch R
Optimierter Radioassay zur quantitativen Bestimmung der Aktivität von Diaminooxidase (DAO) in humanem Serum und Plasma.
Allergologie.
2005;
28:
1–8.
[Google Scholar]19.
Pali-Schöll I
Herzog R
Wallmann J
Szalai K
Brunner R
Lukschal A
Karagiannis P
Diesner SC
Jensen-Jarolim E
Antacids and dietary supplements with an influence on the gastric pH increase the risk for food sensitization.
Clin Exp Allergy.
2010;
40:
1091–1098.
[PMC free article] [PubMed] [Google Scholar]20.
Pechanek U
Pfannhauser W
Woidich H
Untersuchung über den Gehalt biogener Amine in vier Gruppen von Lebensmitteln des österreichischen Marktes.
Z Lebensm Unters Forsch.
1983;
176:
335–340.
[PubMed] [Google Scholar]

21.
Reese I
Ballmer-Weber B
Beyer K
Erdmann S
Fuchs T
Kleine-Tebbe J
Lepp U
Henzgen M
Niggemann B
Saloga J
Schäfer C
Werfel T
Zuberbier T
Worm M
Vorgehen bei Verdacht auf Unverträglichkeit gegenüber oral aufgenommenem Histamin. Stellungnahme der AG NMA der DGAKI.
Allergo J. In press.

22.
Sarkadi L
Histamine in food In:
Falus A
Grosman N
Darvas Z
Histamine: biology and medical aspects.
Budapest – Basel: Springer Med Publishing Karger;
2004.
176-185.
[Google Scholar]23.
Sattler J
Häfner D
Klotter HJ
Lorenz W
Wagner PK
Food-induced histaminosis as an epidemiological problem: plasma histamine elevation and haemodynamic alterations after oral histamine administration and blockade of diamine oxidase (DAO).
Agents Actions.
1988;
23:
361–365.
[PubMed] [Google Scholar]24.
Sattler J
Lorenz W
Kubo K
Schmal A
Sauer S
Lüben L
Food-induced histaminosis under diamine oxidase (DAO) blockade in pigs: further evidence of the key role of elevated plasma histamine levels as demonstrated by successful prophylaxis with antihistamines.
Agents Actions.
1989;
27:
212–214.
[PubMed] [Google Scholar]25.
Sattler J
Lorenz W
Intestinal diamine oxidases and enteral-induced histaminosis: studies on three prognostic variables in an epidemiological model.
J Neural Transm Suppl.
1990;
32:
291–314.
[PubMed] [Google Scholar]26.
Schwelberger HG
Histamine intolerance: a metabolic disease?
Inflamm Res.
2010;
59:
S219–S221.
[PubMed] [Google Scholar]27.
Töndury B
Wüthrich B
Schmid-Grendelmeier P
Seifert B
Ballmer-Weber B
Histaminintoleranz: Wie sinnvoll ist die Bestimmung der Diaminoxidase-Aktivität im Serum in der alltäglichen klinischen Praxis?
Allergologie.
2008;
31:
350–356.
[Google Scholar]28.
Untersmayr E
Bakos N
Schöll I
Kundi M
Roth-Walter F
Szalai K
Riemer AB
Ankersmit HJ
Scheiner O
Boltz-Nitulescu G
Jensen-Jarolim E
Anti-ulcer drugs promote IgE formation toward dietary antigens in adult patients.
FASEB J.
2005;
19:
656–658.
[PubMed] [Google Scholar]

29. Verordnung (EG) Nr. 2073/2005 der Kommission vom 15. November 2005 über mikrobiologische Kriterien für Lebensmittel.

30.
Vlieg-Boerstra BJ
van der Heide S
Oude Elberink JNG
Kluin-Nelemans JC
Dubois AEJ
Mastocytosis and adverse reactions to biogenic amines and histamine-releasing foods: what is the evidence?
Neth J Med.
2005;
63:
244–249.
[PubMed] [Google Scholar]31.
Wöhrl S
Hemmer W
Focke M
Rappersberger K
Jarisch R
Histamine intolerance-like symptoms in healthy volunteers after oral provocation with liquid histamine.
Allergy Asthma Proc.
2004;
25:
305–311.
[PubMed] [Google Scholar]90,000 Sіm’ya + – is even more relevant in the Central Information Center!

Vaccination against Covid-19 in case of Rosy Sclerosis:

Rosy sclerosis is not a contraindication for vaccination against Covid-19. The treatment of MS is not a contraindication for vaccination against Covid-19.

Vaccination of such patients is possible. Vaccinate completely. Vaccination is recommended and recommended.

_________________________

RS with the invalidization of important Covid-19.

Immunosuppressive treatment for MS (ex., Rituximab, Ocrelizumab, Ublituximab, Alemtuzumab, Fingolimod, Ozanimod, Kladribin, Mitoxantrone, etc.) is developing the risk of important and lingering Covid-19.

Pulse therapy with steroids (Solu-medrol / Dexamethasone) to increase the risk of an important interruption of Covid-19.

Patients with developmental sclerosis on immunosuppressive therapy – a group of important Covid-19, re-infection and lethality. The tsei rizik is even greater in the context of the sutta innovation.

_________________________

On the background of the PC disease, due to the transferred Covid-19, there may not be a strong or sufficient immunity to Covid-19.

It is especially and highly relevant for vicoristan anti-CD20 therapy (for example, Rituximab, Okrelizumab). Chim is more trivial є likuvannya tim is more and more lack of immune response.

(low level, or visibility, anti-Covid-19 antibodies after transfer of infection on the background of such therapy).

In such non-vaccinated patients, after having transferred important Covid-19 infections, there may be re-infection due to an important change in the type of chronic infection due to repeated problems.

The problem of lack of immune responses may also be relevant to the problem, for example, S1P agonists (fingolimod etc.), mitoxantrone, cladribine, alemtuzumab.

_________________________

Deyak preparations reduce the effectiveness of vaccination. In the first place, anti-CD20 therapy (Rituximab, Ocrelizumab, etc.) (also in the case of S1P agonists, alemtuzumab, cladribine, mitoxantrone) is relevant.

Zahist and the immune responded to vaccination of the type of disease, but not after the transferred infection.

_________________________

If you vaccinate?

For the treatment of monoclonal antibodies (Rituximab / Ocrelizumab / anti-CD20 therapy / Alemtuzumab):
For eliminating * the optimal effect of vaccination
9 pulses 9000 for the duration of 3 to 4000 Medrol / Dexamethasone):
For eliminating * the optimal effect from the vaccination
minimum 2 months to 2 months of the given preparations

* although it is unwise in such hours of the frame, it is permissible earlier / later, but later

For example, glatiramer acetate, interferon is not infused for an hour and the effectiveness of vaccination;
teriflunomid, fumarati individually;
S1P agony, mitoxantrone, cladribine can be infused at the time of vaccination

_________________________

Yaka vaccine?

Two doses of vaccine and a short interval between them (Pfizer, Moderna, CoronaVac) should be taken more seriously.

The effectiveness of Moderna vaccine can be found in food.
CoronaVac performance can be lower.
Johnson & Johnson efficiency can be lower.

* in time of the continuation of the pandemic, there may be a re-vaccination / booster dose 6-9 months after the first vaccination for patients who are eligible for immunosuppressive therapy.

_________________________

The highest prognostic option in a (unvaccinated) patient, or an “ideal storm”:

Covid-19 infection on the background of a non-mediated pulse therapy (CD) ex., Rituximab, Okrelizumab).

Covid-19 infection in the background or without prior use of anti-CD20 therapy (Rituximab, Ocrelizumab) in a patient who will take anti-CD20 therapy trivially.

Covid-19 infection on the background, or without the need for pulse therapy with steroids (Solu-medrol) in a patient who will reject S1P agonist (phingolimod, ozanimod, carry).

_________________________

Tactics?

Vimagati vaccination for patients who receive immunosuppressive therapy.It’s still very quiet to get anti-CD20 therapy.
(also some other drugs that are injected onto the anti-immune diseases / div.)

For non-vaccinated patients, who accept courses of therapy internally or orally (such as anti-CD20 therapy, alemtuzumab, mitoxantrone, cladribine, and a course of pulse therapy without steroids) – before

_________________________

Inadmissibility of unvaccinated personnel from such patients.

Speed ​​up to the minimum of transferring such patients in a medical mortgage (one-day, outpatient).

Minimize contact with other patients and medical personnel.

Determination of necessary medical management in the surrounding area.

Zhorsky mask mode as a patient and medical staff for an hour to contact and transfer to a medical deposit.

_________________________

In case of death of an epidemiological situation:

Inadmissibility of unvaccinated patients before such therapy (course of immunosuppressive therapy, if necessary).

Histamine Intolerance: Causes and Symptoms

Reading Time: 2 Minutes A histamine intolerance or histaminosis is a reaction of the body that cannot break down histamine. The causes and symptoms are very varied. For example, patients suffer from migraines, gastrointestinal problems, cardiac arrhythmias, low blood pressure, asthma, itchy skin, or redness of the skin.

Histamine intolerance: causes and symptoms of intolerance reactions

Reading time: 2 minutes

Basically, histamine is indispensable for the human body, because it performs vital functions.It is produced in the body and enters the body through food.

Histamine intolerance: causes of intolerance reactions
Histamine intolerance is an intolerable reaction of the body. The reason is a deficiency or inhibition of the enzyme diamine oxidase (DAO). DAO is responsible for the breakdown of histamine. Low enzyme activity or enzyme inhibition leads to accumulation of histamine, which can lead to various symptoms.

There are several reasons for histamine intolerance.
The imbalance observed in histamine intolerance between histamine and the enzyme that is supposed to break it down can have several causes:

• Eating histamine-rich foods. The number of foods that are naturally very high in histamine is relatively small. However, some foods can be heavily loaded with histamine. This is mainly due to their further processing and the natural aging process. For example, wine, certain types of cheese, raw sausages, beer, sauerkraut or fish are prone to high histamine levels.
• Consumption of histamine liberators as a cause of histamine intolerance. Histamine liberators are substances that release and activate histamine in the body. Some foods, such as fish or alcohol, contain high concentrations of these histamine releasers.
• Consumption of other biogenic amines can also cause histamine intolerance. The reason should be seen in the fact that these substances are broken down earlier than histamine.
• Infection of the gastrointestinal tract may cause temporary histamine intolerance because the enzyme that breaks down histamine is found primarily in the lining of the small intestine.In the case of intestinal disease, there may be a temporary decrease in activity, which for a short time leads to histamine intolerance.
• A very rare cause of histamine intolerance is a congenital defect in the enzyme, which means that the enzyme is not produced in the required amount.

There are various symptoms of histamine intolerance.
In particular, with histamine intolerance, the following symptoms are possible: skin redness and Itching, nausea and vomiting, stomach cramps, palpitations, dizziness, asthma and headaches Migraines.

Figure 1: Possible symptoms of histamine intolerance

In the case of histamine intolerance, the most common symptoms are complaints from the gastrointestinal tract.However, it is not so easy to pinpoint the disease because it is impossible to establish a clear connection between food intake and the symptoms that arise.

The problem with correctly interpreting gastrointestinal symptoms of histamine intolerance is that often only certain parts of the intestine are affected.

If we put z. B. If you notice discomfort in the upper abdomen, nausea or vomiting soon after eating, these symptoms can be quickly associated with the meal. Unfortunately, however, abnormalities in the breakdown of histamine often manifest themselves in the deeper parts of the intestine, so that it may take several hours after ingestion of a food containing histamine and the onset of symptoms caused by histamine intolerance.

Histamine intolerance: Headaches and migraines are also common symptoms.
In cases of histamine intolerance, headaches and migraines are often prominent symptoms. Many migraines can feel much better after switching to a low histamine diet.

Recognizing histamine intolerance
For some time it was possible to measure the DAO activity in the blood. Since the activity of DAO in the blood correlates with the body’s ability to break down histamine, this can be used to diagnose histamine intolerance.The corresponding examination is even relatively inexpensive (less than € 50.00).

Histamine intolerance and its treatment
Symptoms associated with histamine intolerance can be significantly reduced by switching to a diet without histamine, or at least low in histamine. In addition to choosing the right foods, it is especially important to consume them as fresh as possible.

Please note that the VNR fee cannot replace medical advice!

PS: Quality management is important to us!

Please let us know how you like our post.To do this, click the stars below (5 stars = very good):

Please wait …

PPS: Did you particularly like the article?

Support our consultant portal:

90,000 Why does someone suffer with urticaria for two days, while others

Even a layman can diagnose urticaria. Indeed, red itchy rashes, slightly protruding above the skin, are so similar to a nettle burn that it is difficult to make a mistake. Another thing is that someone has urticaria in two days, and someone suffers from it all their lives.What does it depend on and how to deal with it?

Causes of urticaria

One of the reasons everyone knows hives is allergies. With skin rashes, the body reacts to:

• specific drug,
• food,
• cosmetics,
• house dust,
• plant pollen.

“Usually, allergens enter the body through the digestive tract,” says , a doctor at the Institute of Immunology Natalya Ilyina .- However, hives can also occur when the allergen is inhaled or in contact with the skin.

Treating such urticaria is simple and easy:

1. Install the allergen.
2. We exclude contact with him.

When done quickly and accurately, for many, the first attack of urticaria is also the last. And the acute period is removed in 1-2 days with the help of antihistamines.

Sometimes allergic urticaria can take a protracted nature – attacks follow one after another or with short interruptions.This happens when it is not possible to immediately identify the allergen, or when there is an allergy to several substances at once, and each of them can cause hives. “

But even such a disease is easier to treat than chronic urticaria. Doctors usually add the term “idiopathic” to its name. It literally means that the cause of the urticaria has not been found out.

“This happens when urticaria is based on problems with the digestive tract, endocrine system, infections or other diseases up to oncology,” continues Natalya Ivanovna.- To figure it out, you need to examine almost all human organs. And here it is very important that the doctor of such a patient is experienced and has knowledge in the field of allergology. “

Types of urticaria

There are several types of physical urticaria, depending on the factors that provoked it:

Chronic urticaria

With external similarity, chronic urticaria is fundamentally different from acute allergic. The mechanisms of development of the disease are tied to “mast cells” stuffed with biologically active components, like a barrel of gunpowder. “Exploding”, they emit all these substances, the main of which is histamine.

Photo healthislife. ru

It causes itching and increases the permeability of blood vessels, the liquid part of the blood seeps through the wall into the subcutaneous space and causes edema – these are rashes typical of urticaria.

Most often, the mast cell is opened by histaminoliberators, in common parlance – “histamine liberators”.Some substances in the composition have such a “liberal” character:

• chocolate,
• strawberries,
• fish and other products.

So when patients report that they are allergic to chocolate or strawberries, strictly speaking, they are wrong. There is no interaction between the allergen and the antibody, it is just that chocolate and strawberries have histaminoliberators.

But a real allergic reaction develops to nuts, they contain allergens.

Mild urticaria may resolve on its own, but antihistamines are commonly used to treat it. If necessary, patients are also prescribed glucocorticoid hormones.

Disclaimer : This content, including tips, provides general information only. This is in no way a substitute for a qualified medical report. Always consult a specialist or your healthcare professional for more information.

Add Pravda.Ru to your sources in Yandex.News or News.Google , or Yandex.Zen

Fast news in Telegram channel Pravda.Ru . Do not forget to subscribe to keep abreast of events.

Urticaria: overview, symptoms, diagnosis, treatment, prevention

90,000 Histamine Intolerance – Medicine – 2021

Histamine intolerance is an intolerance to histamine from food.Histamines are found in many foods and can cause allergic reactions in some people. Know the pain

Contents

Histamine intolerance is an intolerance to histamine taken from food. Histamines are found in many foods and can cause allergic reactions in some people. Find out more about the symptoms, causes and treatment of histamine intolerance here.

Synonyms

Histaminosis, histamine intolerance

definition

In case of histamine intolerance (histaminosis), the intake of histamine with food is not tolerated. Histamine intolerance is not an allergy or food intolerance. Rather, it is a breakdown disorder. The reason for histamine intolerance is a deficiency of enzymes that break down histamine. Doctors estimate that nearly 1 percent of the European population suffers from histamine intolerance. Middle-aged women are affected in 80% of cases.

Histamine is absorbed from food and produced in the body itself. It belongs to the group of biogenic amines. These are metabolic products that occur naturally in the cells of humans, plants and animals. Histamine plays a very important role in allergic reactions. It is one of the main triggers of itching, rash, nausea and circulatory reactions. In addition, histamine acts as a tissue hormone and nerve messenger (neurotransmitter) at various points in the body, such as regulating the sleep-wake cycle, body temperature, hormone balance, or gastrointestinal function.Since histamine is involved in almost all bodily functions, histamine intolerance also causes a wide variety of complaints.

Foods containing histamine

Some foods promote the release of histamine. This is done in three ways:

• The foods themselves are high in histamine.
• They contain substances that release histamine in the body (histamine liberators).
• They block the histamine-degrading enzyme DAO. These products include, but are not limited to:
• Red wine, beer
• Sauerkraut, pickled vegetables
• Mature cheeses
• Prepared fish products, such as canned food
• Smoked meats and sausages
• Citrus fruits 90, strawberries, pineapples and pineapples products, legumes and nuts of all kinds
• chocolate
• seafood
• Tomatoes and ketchup.

This list is far from complete. It is best to seek detailed advice on suitable foods from a nutritional consultant.

Drug and histamine intolerance

Some drugs can release histamine and are therefore not tolerated by many patients with histamine intolerance. These include primarily pain relievers such as mefenamic acid, diclofenac, indomethacin, and acetylsalicylic acid (ASA). Ibuprofen can be taken as an alternative because ibuprofen inhibits the release of histamine.

Symptoms

Symptoms of histamine intolerance are varied. Almost any symptom can indicate a histamine intolerance. From skin changes (such as redness, itching, or eczema) to menstrual cramps, anything is possible. Symptoms usually occur after a histamine-rich meal, but they can also be persistent.

Histamine intolerance sometimes causes severe symptoms during pregnancy or stress. Because hormonal changes promote the release of histamine.

Causes

Histamine is broken down in the body by so-called functional proteins (enzymes), namely diamine oxidase (abbreviated as DAO) and histamine-N-methyltransferase (HNMT). In the case of histamine intolerance, this breakdown is likely to be disrupted. As a result, there is too much histamine in the body. The body reacts to this excess with symptoms of intolerance. Tobacco smoking can contribute to histamine intolerance.

examination

Histamine is broken down in the body by so-called functional proteins (enzymes), namely diamine oxidase (abbreviated as DAO) and histamine N-methyltransferase (HNMT).In the case of histamine intolerance, this breakdown is likely to be disrupted. As a result, there is too much histamine in the body. The body reacts to this excess with symptoms of intolerance. Tobacco smoking can contribute to histamine intolerance.

treatment

The mainstay of drug treatment for histamine intolerance is the restriction of histamine intake. Therefore, those affected must eat a diet low in histamine.

If certain foods or medicines containing histamine cannot be avoided, antihistamines such as levocabastine, levocetirizine, fexofenadine, cetirizine, or loratadine can be taken.

Cromoglycic acid reduces the content of histamine in tissues and the release of histamine, and also reduces the symptoms of histamine intolerance.

Sometimes the symptoms are also relieved by taking vitamin C and vitamin B6.

There are also capsules and tablets containing diamine oxidase. Taken just before meals, diamine oxidase improves the breakdown of histamine. However, the effect of this meal does not last long.

Self-help for histamine intolerance

In principle, you should follow a low histamine diet recommended by your doctor in the long term.It is helpful to get some nutritional advice first to get accurate information on the histamine content of foods. Examples of foods with a low histamine content:

• Meat and fish (fresh, chilled, frozen)
• Fresh fruits: melon, blueberries, cherries, currants, apricots, apples.
• Fresh vegetables: green salad, cabbage, beets, pumpkin, radishes, radishes, rapunzel, peppers, carrots, broccoli, potatoes, cucumber, leeks, zucchini, corn, asparagus, garlic,
• Cereals and pasta (spelled , corn, rice noodles, yeast-free rye bread, corn and rice cakes, rice, oatmeal, rice cakes, corn, rice, millet flour)
• Fresh milk and dairy products (not long-aged cheeses!)
• Milk substitute like …Rice or coconut milk
• All non-citrus juices, all vegetable juices (except sauerkraut juice)
• Herbal teas and green tea.

prophylaxis

Unfortunately, histamine intolerance cannot be prevented.

90,000 Low Histamine Diet – Health

Contents

Histamine is a chemical known as a biogenic amine. It plays a role in several major systems in the body, including the immune, digestive, and neurological systems.

The body gets all the histamine it needs from its own cells, but histamine is also found in some foods.

People who have an allergic reaction to histamine-rich foods may have a condition known as histamine intolerance. This disease affects approximately 1 percent of the population. There may be people with genetic characteristics that increase their sensitivity to histamine.

Certain medical conditions may increase the risk of histamine intolerance.This includes:

• gastrointestinal disorders or trauma
• Crohn’s disease
• gastroesophageal reflux disease (GERD)
• liver disease
• chronic or extreme stress
• trauma
• microbial trauma
• microbial trauma
• trauma

  Certain prescription and over-the-counter medicines can interfere with an enzyme that breaks down histamine, for example:

  • theophylline
  • heart medications
  • antibiotics
  • antidepressants
  • antipsychotics
  • diuretics
  • muscle relaxants
  • pain relievers (aspirin, naproxen, indomethacin)

  gastrointestinal and indomethacin

  • drugs

  -diclofenac

  • tuberculosis

  People with histamine intolerance can experience a wide variety of symptoms that affect different systems and organs.

  For some people, histamine-rich foods can cause headaches, skin irritation, or diarrhea. Certain medications or conditions can increase the likelihood of histamine sensitivity.

  There are no reliable tests or procedures that doctors can use to diagnose histamine intolerance. However, some healthcare professionals recommend an elimination diet.

  This involves removing certain foods from your diet for at least 4 weeks and gradually adding them back in one at a time.An elimination diet can help you determine if the problem is histamine.

  Foods to avoid on a low histamine diet

  Histamine levels in food are difficult to quantify.

  Even in the same food, such as a chunk of cheddar cheese, histamine levels can vary significantly depending on how long it is aged, how long it is stored, and the presence of any additives.

  Fermented foods generally contain the highest levels of histamine.Lowest levels in fresh unprocessed foods.

  There is also a theory that some foods, although not rich in histamine, can cause the production of histamine in your cells. They are known as histamine liberators. However, this theory has not received scientific evidence.

  The following foods contain higher levels of histamine:

  • fermented milk products such as cheese (especially aged), yoghurt, sour cream, buttermilk and kefir
  • fermented vegetables such as sauerkraut and kimchi
  • pickles or
  • pickles

  kombucha

  • cured or fermented meats such as sausages, salami and fermented ham
  • wine, beer, alcohol and champagne
  • fermented soy products such as tempeh, miso, soy sauce and natto
  • fermented grains such as bread sourdough
  • tomatoes
  • eggplant
  • spinach
  • frozen, salted or canned fish such as sardines and tuna
  • vinegar
  • ketchup

  The pros and cons of a low histamine diet

  Diets low in histamine can be extremely restrictive and lead to malnutrition.

  Histamine intolerance is poorly understood and difficult to diagnose. There is no evidence that a diet low in histamine will improve quality of life in the long term if you do not have a true diagnosis.

  The main advantage of a low histamine diet is that it can serve as a diagnostic tool.

  By eliminating histamine-rich foods from your diet for several weeks (under the supervision of a doctor), and then slowly adding them back, you can learn more about your individual tolerance to foods containing histamine.

  Tolerance to histamine varies greatly from one person to another. When you re-add histamine to your diet, you can carefully evaluate which foods are causing the unpleasant symptoms, if any.

  Tips on a low histamine diet

  To avoid histamine-rich foods and follow a low histamine diet:

  • Prepare your own food
  • Eat foods as close to their original appearance
  • Record everything you eat , in a detailed food diary (be sure to include the time of day when you ate each food)
  • Record the time and date of the onset of unpleasant symptoms for comparison
  • Avoid unhealthy food or anything heavily processed (if there are a lot of ingredients and the product is ready to eat)
  • Do not be too hard on yourself as this diet is very strict
  • Do not plan on following this diet for more than 4 weeks
  • Eat only fresh food that has been stored in the refrigerator
  • Talk to your dietitian or dietitian about getting all the nutrients you need on time this diet
  • talk to St. from your doctor about vitamin and mineral supplements (think about DAO enzyme supplements, as well as vitamin B-6, vitamin C, copper and zinc)

  Conclusion and Outlook

  Before starting a low histamine diet, consult your doctor.

  Lack of nutrients can be harmful at any age, but such a diet is especially dangerous for children. If you suspect your child has food allergies or sensitivities, talk to your pediatrician about alternative treatments.

  If you experience dizziness, headaches or other complications, you should stop this diet immediately and consult your doctor.

  After you have eliminated or reduced the amount of histamine in your diet for 2–4 weeks, you can gradually start returning histamine-rich foods one at a time to your diet.Talk to your doctor or dietitian about the best way to resume using these foods.

  There is very little scientific evidence to support a low histamine diet that can lead to malnutrition. Typically, a diet low in histamine is not a long-term treatment plan for the general population. This is helpful in the diagnostic process and can help you rule out other types of food intolerances.

  Finally, you will need to determine your individual tolerance for different histamine-containing products.Certain medicines can increase the likelihood of a reaction to these foods.

  90,000 Antihistamines weaken the benefits of exercise

  Researchers at the University of Ghent in Belgium have found that taking antihistamines can affect exercise performance, namely, reduce the benefits of exercise.

  Anyone suffering from seasonal allergies knows what antihistamines are.These are drugs that block histamine: a substance that the body begins to actively produce in response to allergens (and not only). Basically, researchers are only studying this infamous function of histamine.

  At the same time, histamine performs many important functions in the body: it also affects the production of gastric juice, and works as a neurotransmitter (participates in the transmission of signals between neurons), and even affects sexual function in men.

  Curious, but not well understood, the role of histamine in human physical activity, especially its effects on skeletal muscle.Scientists are well aware that skeletal muscle is literally littered with histamine receptors (“histamine anchors”). They also know that histamine plays a role in the dramatic drop in blood pressure immediately after exercise.

  Therefore, the researchers decided to find out if the complete blocking of histamine receptors could somehow interfere with the beneficial effects of training.

  Eight people took part in the study. One day they trained under the supervision of scientists, taking a placebo, and on the second day they received antihistamines that block two types of histamine receptors (h2 and h3).

  Researchers noticed that anti-allergic drugs slowed down the blood flow to the muscles, which is usually seen after exercise. This mechanism is called post-workout muscle perfusion, and histamine receptor blockers have reduced its effectiveness by 35% compared to the first workout.

  In the second phase of the study, scientists investigated the long-term effect of disrupting this process. This time, 18 participants were divided into two groups, which performed the same set of exercises for six weeks.One group received histamine receptor blockers before each workout, and the second, the control group, received a placebo (normal saline).

  After six weeks, the control group underwent a normal adaptation to exercise: participants began to exercise better, their insulin sensitivity increased, and their cardiovascular system improved. At the same time, the bodies of the participants, who took antihistamines all this time, practically did not respond to regular exercise.

  Muscle biopsies of the participants in the experiment also showed that anti-allergy drugs reduced some of their aerobic capacity. This means that their muscles were not as successful at consuming oxygen during exercise as they could without histamine blocking drugs.

  Antihistamines also interfered with the participants’ increased glucose tolerance and vascular strength from exercise.

  Researchers were genuinely surprised at how markedly decreased the effect of training due to the blocking of histamine receptors in volunteers.These people tried as hard and sweated as the rest, but did not get any positive effect from this load.

  At the same time, scientists note that these findings do not mean that it is time for people to stop using antihistamines before exercise. The study used very high doses of drugs that are never used to combat allergies in real life.

  This study focused specifically on the role of histamine in exercise.Its results can be used in the future to develop methods for improving physiological performance during and after exercise.

  The study was published in Science Advances.

  More news from the world of science can be found in the section “ Science ” on the media platform “ Watching “.

  Histamine in what products

  What foods contain histamine and why is it dangerous to health

  Histamine is a substance necessary for the regulation of local blood supply, participating, as a mediator of inflammation, in protecting the body from foreign biological agents, as a neurotransmitter, counteracts sleep and keeps the brain awake …At the same time, an excessive intake of histamine in the blood leads to pathological reactions such as allergies, bronchial asthma, etc., up to anaphylactic shock – a formidable complication, often fatal, despite the development of medicine and the efforts of doctors.

  Histamine intolerance or pseudoallergy

  Food diathesis. Atopic dermatitis. Suddenly, spontaneously by itself, itchy red spots appear on the skin, blisters swell against the background of redness, they burst, a yellowish liquid leaks from under the rags of the skin.And incessant itching, forcing to scratch the already inflamed skin. A painful condition that almost everyone now experienced, if not in adulthood, then in childhood.

  Allergy? But allergic reactions occur to certain foods, and allergy sufferers know what to avoid to live in peace. And here – not so. “What did I eat?” – straining to remember your diet. Maybe strawberries? Or lemon? It seems that everything is the same as always, but here again blisters on the skin and unbearable itching.What is this elusive allergen? How to calculate it?

  Most likely, this is not a true allergy, but a histamine intolerance or pseudo-allergy.

  Excessive histamine causes reactions very similar to those of an allergy. It can be urticaria: a rash on the skin with redness, itching, the appearance of blisters, similar to burns, which open up, leaving long-term non-healing ulcers. Reactions from the respiratory tract may develop: nasal congestion, with sneezing, lacrimation, runny nose or bronchospasm with suffocation, coughing, and viscous phlegm.It can be a spasm of the intestines with abdominal pain and diarrhea. There may be headaches, dizziness, increased blood pressure, tachycardia (increased heart rate).

  The mechanism of development of both pseudo-allergies and true allergies is the same. The culprit is histamine, and the treatment for both conditions is the use of antihistamines that block histamine receptors. But prevention of true allergies and pseudo-allergies is different.

  Differences between pseudo-allergy and true allergy

  1. Specificity .A true allergy develops on the introduction of a strictly defined foreign substance. You can carry out laboratory diagnostics, determine the substance responsible for the occurrence of allergies and further avoid the use of this substance. With pseudo-allergy, allergy tests do not reveal the allergen. Pseudo-allergy is nonspecific, the reaction occurs to many products, and sometimes the culprit product cannot be identified, because it depends on other reasons, as discussed below.
  2. Dose dependence .With a true allergy, there is no proportional dependence of the severity and severity of the reaction on the amount of allergen that has entered the body. Sometimes a negligible dose is enough to cause a severe reaction, including anaphylactic shock. So, if you are allergic to peanuts, a person can die by biting off a piece of candy that contains “traces” of peanuts. With pseudo-allergies, the reaction occurs when a large amount of the “guilty” product is consumed. So, one strawberry flies by unnoticed, but a couple of kilograms will provide fun with blisters and itching for a couple of weeks.Sometimes people suffering from pseudo-allergies know how much of a problem product they can eat without harm to health, the trouble is that reactions can occur not only to one specific product, see paragraph 1

  The cause of pseudoallergy

  An excess of histamine in the body can occur for the following reasons:

  1. Lack of the histaminase enzyme, which breaks down the released histamine, which contributes to the accumulation of free histamine in the blood.An enzyme deficiency is usually a congenital condition, however, histaminase deficiency can be relative when excess histamine is ingested with food
  2. Eating foods that cause increased production of their own histamine. These products provoke the release of histamine from mast cells
  3. The intake of a large amount of exogenous histamine with some foods. The histamine contained in food is absorbed through the intestinal wall, and if there is too much of it, the enzymes do not have time to destroy it, it ends up in the blood and begins to do its dirty deeds.
  4. Synthesis of excess histamine by intestinal bacteria in dysbiosis. Histamine, which is produced by gut bacteria, is absorbed through the intestinal wall in the same way as dietary histamine, with the same effects.

  Listed below are foods that can trigger pseudo-allergic reactions in sensitive individuals. If you are prone to volatile, nonspecific “allergies”, these foods should be eaten with caution or completely excluded from the diet.The same products are not recommended to be given to young children, because due to the immaturity of the enzymatic system, they can cause food diathesis: various skin reactions from slight redness and thickening of the skin to the development of blisters similar to burns, with pain, itching, peeling of the skin with the formation of weeping, long-term non-healing ulcers.

  Foods that increase the production of own histamine :

  1. Wheat flour
  2. Strawberries
  3. Tomato
  4. Pineapple
  5. Citrus fruits: oranges, tangerines, pomelo, grapefruit

  , coffee

  6. Egg white
  7. Shrimp
  8. Alcohol
  9. Food additives: dyes, preservatives, etc.

  Most allergenic food additives

  Foods containing increased amounts of histamine
  

  • Sausages, especially raw smoked and other sausages: sausages, small sausages, smoked meats: carbonate, ham, neck, balyk, etc.
  • Aged cheeses
  • Fish and seafood: mackerel, herring, tuna, canned sardines, especially preserves stored in brine.
  • Yeast and yeast products
  • Sauerkraut
  • Bananas, avocados
  • Soybeans and tofu
  • Eggplant
  • Canned foods
  • Wine, especially red, some beers, sake.

  Fresh, unprocessed food contains little histamine, but the longer the food is stored or matured, the more histamine will accumulate in it. Its amount increases during processing, canning and freezing. Especially a lot of histamine is produced in long-term stored fish and meat, with incomplete long-term freezing and re-thawing. In spoiled protein foods, it accumulates in huge quantities, imparting a characteristic smell, for example, to rotten fish.The use of such products is dangerous, because it leads to histamine poisoning.

  Histamine is a persistent chemical compound; it is not degraded during cooking at elevated temperatures during cooking, frying or baking. Products with signs of spoilage should not be eaten, it will be more expensive for yourself.

  Histamine poisoning

  Histamine poisoning occurs when eating improperly stored fish. The most common cause of poisoning is fish of the mackerel family: tuna, mackerel, mackerel, etc., as well as other fish containing a large amount of histamine: horse mackerel, saury, herring, sprats, salmon. Certain other foods such as aged cheese, smoked meats, sauerkraut, beer, red wine, and champagne can also cause poisoning.

  Food contaminating bacteria form histamine from the histidine in food. Most of these bacteria multiply at temperatures above +15 ⁰ C, most intensively at +30 ⁰ C.The content of histamine in such products can reach huge concentrations, and, when consumed, cause poisoning.

  Increased intake of histamine in the body can cause histamine migraine (Horton’s syndrome), headache, and a decrease in blood pressure. In more severe cases, there is nausea, vomiting, loose stools, redness and itching of the skin, hives (blistering), swelling of the face.

  Usually, these symptoms go away quickly, since the liver breaks down histamine, however, people with liver disease (hepatitis, cirrhosis), as well as those taking anti-tuberculosis drugs (isoniazid) are more susceptible to the action of histamine, and their poisoning can be severe.

  Poisoning by improperly stored fish of the mackerel family is called scombroid (poisoning with scombroid toxins). The leading role in this poisoning is played by histamine, but the poisoning is of a more complex nature, because consuming pure histamine at any dose does not reproduce all symptoms.

  Symptoms of poisoning are as follows: throbbing headache, skin redness, peppery taste in the mouth (while the taste of the fish itself may not be changed), numbness around the mouth, intestinal cramps with abdominal pain, diarrhea, palpitations accompanied by anxiety …The disease occurs 10-30 minutes after eating stale fish.

  In most healthy people, symptoms go away on their own, but in the presence of cardiovascular diseases, dangerous complications can arise.

  Prevention of scombroid poisoning is keeping fish strictly at refrigerator temperature. Re-freezing of raw fish is not allowed! It should be remembered that the histamine accumulated in the product is not destroyed during heat treatment.

  Rationing of histamine in food

  Since the high content of histamine in food is hazardous to health, its content is regulated by Russian legislation.According to SanPiN 2.3.2.1078-01 “Hygienic Requirements for Safety and Nutritional Value of Food Products”, the maximum allowable histamine content in fish and fish products is 100 mg / kg.

  A pseudoallergic reaction can be caused by products with a histamine content of 5 to 10 mg / kg.

  When the content of histamine in the product is over 100 mg / kg. the product may show signs of poisoning: headache, redness of the face and neck, burning lips, urticaria.

  Scombroid poisoning occurs when the histamine content in fish exceeds 1000 mg / kg.

  Food List | Histamine Intolerance

  Stay on a Diet

  This list of foods will be the start of your path to symptom control. The dynamism of the food world means there are ongoing research projects that affect how foods are perceived, accepted and accepted. In the HIT Awareness campaign, we plan to keep you informed about changes related to food intolerances, in particular HIT.

  As a reminder, the Food List – or even any other food lists that you come across through various resources such as the Internet – should be viewed ONLY as a form of guidance and not as authoritative sources. This is due to the fact that many people HIT sufferers have to deal with multiple intolerances, therefore, switching to an elimination diet without a doctor’s diagnosis and consultation with a nutritionist is not recommended.

  If you follow this guideline, you should be able to see positive changes after about 4 weeks of the elimination diet.

  HIT patients have different thresholds, that is, tolerance levels, so the next step after completing a successful elimination diet is to determine the threshold so that it can gradually improve over a period of time.

  If you have checked all the boxes up to this point, then we believe it is safe to wish you all the best on your way to a better quality of life.

  It is important to eat foods that are low in histamine according to your threshold.Please always remember that there is no such thing as a “no histamine diet”!

  Here are some general pointers:

  • Avoid or reduce your intake of canned foods and prepared meals
  • Avoid or reduce your intake of ripe and fermented foods (older cheeses, alcoholic beverages, yeast-containing foods, stale fish).
  • Histamine levels in food vary depending on how ripe, ripe or hygienic the food is.
  • Buy and eat only fresh food whenever possible
  • Do not let food stay out of the refrigerator, especially meat
  • Make sure your cooking area (kitchen) is always clean – but not manic!
  • Each has its own threshold; You will need to find yours
  • Consult a Certified Nutritionist for a Balanced Diet
  • Learn to Cook! Once you get the hang of it, it can be a lot of fun.

  Foods reported to have lower histamine levels and are therefore preferred:

  • Fresh meat (chilled, frozen or fresh)
  • Fresh / frozen fish – hake, trout, flounder
  • Chicken ( chilled, frozen or fresh)
  • Egg
  • Fresh Fruit – Most fresh fruits, with the exception of bananas, are believed to have low histamine levels (seeAlso histamine releasers below)
  • Fresh vegetables – except tomatoes, eggplant and spinach
  • Grain – also products made from it, such as rice noodles, white bread, rye bread, rice chips, oats, puffed rice crackers, millet flour, pasta
  • Fresh pasteurized milk and milk products
  • Milk substitutes – goat, sheep
  • Cream cheese, mozzarella, butter (no rancid histamine)
  • Most cooking oils – check suitability before use
  • Most leafy advanced herbs –
  • Most fruit juices without citrus
  • Herbal teas – except those listed below

  Foods with higher histamine levels:

  • Alcohol
  • Eggplant
  • Pickled or canned cabbage
  • Ripe cheeses
  • Smoked meats – salami, ham, sausages….
  • Shellfish
  • Beans and legumes – chickpeas, soy flour
  • Nuts for long shelf life – e.g. peanuts, cashews, almonds, pistachios
  • Chocolates and other cocoa-based products
  • Seitan
  • Rice vinegar
  • Rice vinegar
  • Savory snacks, sweets with preservatives and colors

  Products reported to release histamine (releasing histamine):

  • Most citrus fruits – lemon, lime, oranges …
  • Cocoa and chocolate
  • G peanuts
  • Papaya, pineapples, plums, kiwi and bananas
  • Legumes
  • Tomatoes
  • Wheat germ
  • Most vinegars
  • Additives – benzoate, sulfites, nitrites, glutamate, , as food colors

  , as food colors 9000 , block the enzyme diamine oxidase (DAO):

  • Alcohol
  • Black tea
  • Energy drinks
  • Mate tea

  discussion:

  • Yogurt – depends on the bacterial culture used
  • Egg white – Theory releasing histamine was rejected.

  Other:

  • Yeast – even though it does not contain histamine per se, yeast catalyzes little or more histamine production during fermentation, depending on the product. There is no yeast in the final product. The relevance of yeast to HIT patients is debated.
  • Yeast extract is reported to be very high in biogenic amines and a DAO inhibitor and therefore not suitable for a low histamine diet.

  The elimination diet takes about 4 weeks and you should feel much better by then. Then it’s time to figure out your personal threshold.

  Sources include:

  Food Intolerances, Histamine, FODMAP and IBS Guidelines; online application from BALIZA

  nmi-Portal, (English version: Food Intolerance Network)

  Maintz L, Novak N: Histamine and Histamine Intolerance, American Journal of Clinical Nutrition 2007

  Jarisch, R.Histaminunverträglichkeit, Thieme Verlag, 2nd Edition

  .

  Histamine – Food and Intolerances

  Histamine is an important part of your body’s immune response, but high levels of this chemical can cause health problems.

  Histamine is a chemical produced in cells throughout the body as part of the body’s inflammatory response to an allergy, infection, or injury.

  When damaged or exposed to allergens, cells in the skin, nose, throat and lungs secrete histamine, causing pain, itching, redness, runny nose and wheezing.

  Histamine also plays an important role in digestion, promoting gastric acid production and regulating sleep.

  Histamine intolerance

  Histamine intolerance occurs when the body reacts to foods high in histamine or to the rapid release of its own histamine.

  Symptoms of histamine intolerance can vary from person to person.

  Histamine intolerance can mimic many of the symptoms of an allergic reaction and can range from mild to severe.

  Symptoms may include nasal congestion or runny nose, wheezing, headache, diarrhea, itching, hives or redness of the skin, low blood pressure, and anaphylaxis.

  Researchers estimate that approximately one percent of people have histamine intolerance. Most common in middle-aged adults.

  Histamine intolerance can be treated with a histamine-free diet and antihistamines.

  Histamine in food

  Long term or fermented foods, including aged cheeses, deli meats, sauerkraut and wine, contain high levels of histamine.

  Yeast foods such as beer and some breads are also rich in histamine. Certain fruits and vegetables, including tomatoes and spinach, also contain high levels of histamine.

  Some foods, although low in histamine, are known as histamine liberators, which means they help release histamine from other foods.

  Foods with histamine releasing properties include citrus fruits, peanuts, fish, shellfish and egg whites.

  People with histamine intolerance may be instructed by your doctor to eliminate or reduce histamine-rich foods and histamine-releasing foods from their diet.

  .

  Low Histamine Foods – Healthy Apple

  Before you dive into the content below, I created a video for you that explains what histamine is and how to follow a low histamine diet. Click the “PLAY” button below to get started.

  Many of my clients eat foods high in histamine such as red wine, citrus fruits, sauerkraut, bacon and aged cheese.Yes, these foods can be beneficial, but for many people they can cause health problems and symptoms ranging from anxiety, migraines, hives, acid reflux, chest pain, fatigue, confusion, irritability, low blood pressure, tissue swelling. digestive disorders, etc. nasal congestion and more Many Western medicine doctors do not understand the connection between foods high in histamine and these symptoms, however, if you experience symptoms like those listed above, you may be suffering from a common cause of food intolerances and a disease called histamine intolerance.

  Many people have not heard of histamine intolerance, but it is a food intolerance that is difficult to diagnose and is often confused with many other conditions. Skin problems, mental health problems, migraines and headaches are all common symptoms. Unfortunately, many doctors do not understand this food sensitivity very well.

  The difficulty of histamines is that the reaction to food is not instantaneous. Histamine intolerance is also closely associated with dysbiosis and SIBO (intestinal bacterial overgrowth) .My integrative doctors believe that the main cause of histamine intolerance is the overgrowth of harmful bacteria in the gut that produce histamine from foods that are not digested. This undigested food builds up in your body and suppresses it, leaving you with excess histamine.

  Which foods contain a lot of histamine?

  • Fermented foods (miso, kimchi, sauerkraut, kombucha, soy sauce, etc.)
  • Vinegar
  • Tomatoes
  • Spinach
  • Dried fruits
  • Berries
  • Most of the pies
  • Berries
  • Leftover meat
  • Sausages, smoked meats and sausages
  • Eggs
  • Seafood
  • Tea
  • Alcohol
  • Eggplant
  • Seasonings, such as seasonings, ketchup stick to a LOW histamine diet for some time until your body can again tolerate the use of histamine.

    I suggest you work with your Integrative MD for bowel treatment ( Leaky Gut ) and dysbiosis as well as SIBO

    .

    List of Low Histamine Foods – Mast Cells 360

    Hello! Welcome to the list of low and high histamine foods.

    This list should give you a starting point in your work on low histamine intake. There are many different histamine lists on the Internet.Some were created by listing all the products that someone has responded to. But these reactions might not have been due to histamines. Some listings include many processed, packaged foods. But processed foods can worsen mast cell activation syndrome and histamine intolerance over time.

    I wanted this list to be as reliable as possible. So I took the best research available on histamine foods to compile this list. I recommend including many nutrient-dense foods on this list.Foods like cauliflower, onions, and blueberries have antihistamine properties. So eat antihistamines!

    Remember that histamine levels work like a bucket. Maybe 1 strawberry or 1 pineapple slice will work for you. But if you combine multiple bites of foods high in histamine, your bucket can overflow.

    Your histamine bucket may be fuller due to exposure to seasonal allergens, mold, fluctuating hormones, dehydration, stress, and more.E. Keep this in mind when choosing your food.

    There are other types of foods that people with MCAS or histamine intolerance may respond to. These include lectins and oxalates. So try new foods slowly and carefully until you know how your body will react. This list is so you can make your own list. If you think you react to many foods that are low in histamine, you may have food sensitivities.If so, you can ask me for help. I can help you customize this list according to your own list.

    The long-term goal is to support the proper functioning of the histamine pathways and reduce the excessive reactivity of mast cells so that we can include more foods over time.