Chronic histamine intolerance: Overview of symptoms and causes

Chronic histamine intolerance (histaminosis, HIT) affects around one percent of the population and can severely limit the everyday life of those affected. The symptoms are reminiscent of allergy symptoms and can affect a wide variety of areas of the body - from the gastrointestinal tract to the skin. You can find an overview of chronic histamine intolerance, symptoms and signs as well as causes and treatment options below.

Histamine is a biological messenger , more precisely a biogenic amine, which occurs naturally in the body but is also contained in numerous foods. Basically, the substance is necessary for our body because it regulates blood pressure, controls the release of gastric juice and stimulates intestinal activity .

It also plays an important role in the functioning of memory and in a healthy sleep-wake rhythm.

The messenger substance is constantly broken down in the body by the enzymes DAO (diamine oxidase) and HNMT (histamine N-methyltransferase). While DAO is primarily active in the intestinal mucosa, liver, kidneys and white blood cells, HNMT is primarily found in the skin and bronchi.

In people with histamine intolerance, the breakdown process caused by DAO and/or HNMT is probably disturbed. For some of those affected, however, the breakdown process is completely normal, but the histamine intake from food is too high. If the organism can no longer cope with these quantities, a wide variety of symptoms occur .

It is difficult to determine exactly how high the histamine concentration is in a product because it depends on the degree of ripeness and the storage period , but also on the processing. Particularly large amounts of histamine are produced in protein-rich foods under the influence of bacteria and fungi, for example during the ripening of cheese and the production of sausage or sauerkraut.

Here is an overview of other foods that are high in histamine:

• alcoholic drinks (especially red wine, champagne)
• Salami, raw sausage, raw ham
• Chocolate and foods containing cocoa
• Fish (especially canned fish)
• tomatoes
• spinach
• sauerkraut
• certain fruits: strawberries, kiwis, citrus fruits
• nuts
  
  

Important to know : The substance cannot be destroyed by heating or storing food in the freezer. If you suffer from chronic histamine intolerance , you need to eliminate histamine-rich foods from your diet if possible in order to provide lasting relief from the symptoms.

There are many possible causes of histamine intolerance , of which we have summarized the most common ones for you below.

• Too little DAO
  
  

A deficiency of the enzyme DAO can have various causes. For example, you may have an inflammatory or degenerative intestinal disease, or you may be taking medication that lowers DAO levels. Frequent alcohol consumption can also be responsible for a DAO deficiency. If DAO levels are too low, histamine levels rise.

If histamine intolerance is caused by a DAO deficiency, the symptoms typically occur immediately after eating. Those affected often suffer from nausea or headaches. A red face after eating also occurs - the so-called flush.

• Too little HNMT

With HNMT deficiency, symptoms usually do not appear immediately after meals, but rather hours or days later. In contrast to a DAO deficiency, inner restlessness, muscle twitching, sleep disorders, dizziness and fatigue occur.

• Nutritional errors

One of the possible causes of histamine intolerance is an incorrect diet. Because: Even if DAO and HNMT are present in sufficient concentrations and carry out their work - breaking down histamine - smoothly, problems can arise. The reason is often an increased intake of the messenger substance through food. The body then simply can't keep up with the breakdown and the histamine level in the blood continues to rise.

• Medication

Some medications are suspected of interfering with the breakdown of histamine in the body .

These include, among others:

• Metamizole
• Metronidazole
• Metoclopramide
• Verapamil
• Amitriptyline

If you take medication regularly and suffer from symptoms after eating certain foods, this does not necessarily have to be a fruit allergy or a sudden food intolerance . If you have a red face after eating or are prone to gastrointestinal problems, you should take this seriously and get yourself examined in order to get rid of the chronic problem.

• Thyroid diseases

Patients who suffer from hypothyroidism often develop parallel intolerance to the messenger substance. If you have problems with your thyroid and react to certain foods with discomfort, it is best to speak to your doctor as soon as possible.

Chronic intolerance can result in a wide range of symptoms. Read on to find out more about the signs.

• skin

The messenger substance activates the so-called mast cells in the skin. These in turn release allergenic substances that can negatively affect the condition of the skin. Small wheals (swellings) on the skin indicate hives (urticaria). They usually disappear on their own within 24 hours - but if you repeatedly eat foods containing histamine, they will form again because the intolerance is chronic.

In addition to hives, chronic intolerance can also cause severe itching. Affected skin areas are often additionally reddened, which is because the messenger substance dilates the blood vessels so that more blood flows through.

• Heart and circulation

The effects of intolerance on the cardiovascular system are particularly stressful for many of those affected. The substance changes the width of the coronary arteries, which can lead to heart palpitations or palpitations. Although these cardiac arrhythmias are usually harmless, they can be very frightening. The same applies to so-called palpitations, i.e. clearly noticeable heartbeats. The blood vessels in the middle of the body can also be dilated by the messenger substance. This causes blood pressure to drop.

• stomach and intestines

As already mentioned, the messenger increases the production of stomach acid. At the same time, the muscles in the stomach wall are stimulated to contract. Typical symptoms include abdominal cramps, flatulence and diarrhea. These often occur immediately after consuming histamine-rich foods or drinks. The tongue can also be affected. Some sufferers complain of an unpleasant burning sensation on their tongue after eating foods rich in histamine.

• Uterus and ovaries

Excessively high histamine levels can increase the symptoms of menstruation in women - especially period pain. Because: The messenger increases the estrogen concentration, and this hormone is responsible for the uterus contracting at the beginning of menstruation, which is associated with cramp-like pain.

During pregnancy, however, many women experience that histamine-related symptoms decrease or temporarily disappear completely. This is probably due to the hormonal fluctuations typical of pregnancy .

If you suspect histamine intolerance, you should first rule out other causes, for example a fruit allergy or a previously unknown and sudden food intolerance . This is followed by various tests and examinations which, taken as a whole, can confirm the suspicion.

• Food diary
  
  

A nutrition and symptom diary is useful to uncover connections between the symptoms and foods containing histamine. In this diary you record your meals every day and write down when you suffered from which symptoms.

• Measurement of DAO enzyme activity
  
  

It is possible to test the activity of the DAO enzymes in the blood and/or intestines. However, as already indicated, this test alone is not meaningful, which is why it must always be combined with other tests.

• Measurement of histamine concentration
  
  

In addition to measuring DAO enzyme activity, it may be useful to check how high the histamine level is in stool or urine. Here too, however, there is a lack of clear data.

Ultimately, the diagnosis depends on the individual spectrum of symptoms and the assessment of the treating doctor and the specialists involved, whereby the individual medical history must always be taken into account.

If you are histamine intolerant, you can try different treatment approaches to relieve your symptoms and improve your quality of life. Below is an overview.

The therapy is always tailored to the patient and the respective complaints. Symptom-oriented nutritional therapy, consisting of three phases, is common.

Phase 1

Phase 1 of changing your diet is about giving your body fewer foods containing histamine. This is best achieved with a balanced, mixed diet that focuses on plant-based foods with a low histamine content. Vegan alternatives can also be a regular part of your menu during this phase. This phase takes on average 10 to 14 days.

Phase 2

Over the course of phase 1, your symptoms should gradually improve. If this is the case, the doctor will initiate phase 2, in which you will eat suspicious foods again as a test. So you no longer only have to eat plant-based foods or vegan alternatives , but you can also eat meat, fish or nuts.

It is important to observe your body's reaction. This is the only way to answer the question of whether there is actually an intolerance and - if so - what amounts of histamine your body can tolerate. However, individual influencing factors must always be taken into account, especially stress, the use of medication and, in women, menstruation. Phase 2 lasts up to six weeks.

Phase 3

At the beginning of phase 3, you have already learned a lot about your body and know which foods you should avoid. Now it's time to integrate a low-histamine or histamine-free diet into your normal everyday life - in such a way that you enjoy your food and have to do without as little as possible.

This is how you can cure histamine intolerance - but you have to listen to your body throughout your life and, if in doubt, avoid certain foods because the problem is chronic.

Intolerance can also be treated with medication - but only as an adjunct to therapy, because the medication only alleviates the symptoms but does not treat the histamine problem. Antihistamines are common and are also used successfully for allergies.

There are now also dietary supplements that contain the enzyme DAO. However, these should only be taken if a DAO deficiency has been proven. You should also note that studies have not yet been able to confirm its effectiveness.

Although allergy symptoms are typical of chronic intolerance, this complaint is not an allergy. Instead, the histamine breakdown in your body is probably disturbed, or you simply eat too many foods with a high histamine content , so that your organism is unable to process it.

If you suspect an intolerance, we recommend that you consult a doctor to rule out other illnesses. A change in your diet that is tailored to your individual needs can then alleviate your symptoms and help you regain a better quality of life.