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Histamine is a crucial molecule in the body. In healthy organism it plays the role of a neurotransmitter (from a group of bioamines) – a molecule that regulates brain centers in the cellular level. It is also present in almost all tissues regulating many processes, such as movement of the gut, microcirculation of blood in the skin and more.
An immune cell that is also critical for many organs’ functioning called mast cell has an abandon storage of the histamine. In allergic reactions this cell can release high levels of histamine which in turn causes itch, swelling and systemic anaphylaxis.
Histamine in food
Histamine is present in many foods, but our body is very smart about regulating and maintaining normal levels inside the body. Histamine breakdown in the gut happens very fast, so the level will always stay the same in the tissues. The byproducts are inactive, they cannot activate the cells anymore. That is how it works in a normal body for all biogenic amines we receive in the diet.
What Is Histamine Intolerance?
This is an interesting question, because while people use this medical term for various reasons. While internet is full of various interpretations of what histamine intolerance is, there is no such diagnosis recognized by doctors. Recently it was proposed that a true intolerance to dietary histamine is also possible. This is called histaminosis – an impaired ability to metabolize ingested histamine that was described at the beginning of the 21st century. It is also called histamine intoxication – an inability of certain individuals to metabolize histamine in the intestine, resulting in sensitivity to normal or even low histamine levels in food.
There are couple of true medical conditions connected with uncontrollable histamine release in the gut:
Mastocytosis
Scombroid – ingestion of the rotten fish
Leaky gut syndrome
Mast cell activation disorder
Tumors associated with high histamine content
Reactions to medications
Food allergy
Food intolerance
All these conditions are capable of producing symptoms that relate to histamine, and all of them usually have connection with food consumption and digestion. That is why people who believe they have histamine intolerance go for the various diets and try to figure out which foods exactly cause the problem.
Symptoms
Indigestion, bloating
Headache
Fatigue, not feeling well
Flushing, red face
Heart racing
Diarrhea
Rashes
Insomnia
Anxiety, panic attacks
Causes
Indeed, many things can cause these symptoms. That is why people end up visiting many different specialists trying to find the cause. One of the mechanisms of histamine intoxication is imbalance between its production and detox (breaking down by enzymes) Two main histamine metabolic pathways are known in humans, involving the enzymes diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT). DAO is located in certain tissues, mainly the small intestine, ascending colon, placenta and kidneys. HNMT is located inside the cells. So, the protection of the body from dietary histamine is dependent on the function of these enzymes. For example, a group of researchers from Italy found that impaired DAO activity, the degree of which can be correlated with the severity of mucosal damage.
Any disease of the gut that affects the intestinal barriers will affect person’s ability to eat the foods naturally or artificially ful of histamine.
Another problem is overproduction of histamine in the conditions causing inflammation. If a person already has high level of this bioamine, eating just a little more of it will cause high levels capable of causing symptoms.
Genetic Causes
More than 50 genetic mutations single-nucleotide polymorphisms (SNPs) in the DAO-encoding gene have been identified, some of which can produce a protein with altered activity and lead to symptoms of histamine intolerance.
It is still hard to tell if these genes are fully responsible for development of the symptoms, or they are simply present in certain people. Some researches found low enzyme production associated with DAO-encoding gene (rs2052129), as well as several genetic variations responsible for enzyme deficiency in people of Asian or African origin. As this condition is fairly new to medical science, more studies are needed to help clinicians recognize if histamine intolerance is inherited or appears with some predispositions from genes but caused by environment exposure.
Gastrointestinal Causes
As we discussed, any problem with intestinal barrier and inflammation can cause an imbalance in internal levels of histamine.
Scombroid and food poisoning
Historically, histamine intoxication has also been termed scombroid fish poisoning or the mahi-mahi flush because of its repeated association with the consumption of fish in the Scombridae and Scomberesocidae families (e.g., tuna, herring and mackerel). Histamine was first identified in 1946 as the causative agent of the toxic effects of consuming poorly transported tuna, and for a while histamine poisoning was associated almost exclusively with the consumption of spoiled fish. Over the years, the World Health Organization (WHO) has recommended the use of the term histamine intoxication to better designate this pathology, as it can be caused by marine species from other families (e.g., Clupeidae, Engraulidae, Coriphaenidae and Pomatomidae) and even other foods, such as cheese.
Foods to Avoid
In case when histamine intolerance is suspected, a trial of the diet excluding histamine-rich foods should be tried for at least 2 weeks. If symptoms disappeared, then the syndrome is clinically confirmed. You may want to see an allergist for a food skin test. It is possible you have true food allergy or intolerance. In such case it is a good idea to continue avoiding certain foods in your menu, or at least reduce the amount.
A low-histamine diet
A low-histamine diet plan can be prepared by a nutritionist or a natural doctor who is familiar with this syndrome. While you can try doing it yourself, still it is a good idea to find a specialist who can help you monitor your symptoms and explain how to balance the nutrients while of a diet. It is important to get the right diagnosis, as many other systemic diseases can mask themselves with similar symptoms. The histamine-low diet can also help many conditions while you need to know what exactly caused all problems to begin with.
Diet should provide you with all needed vitamins and microelements, proteins and fats. It is dangerous to exclude essential ingredients – you may end up with problems much worse that you already have. Often times self-treatment can lead to malnutrition and unnecessary limitations. A specialist to treats many patients with you problem will know well what to recommend and how to manage your condition.
High Histamine Foods List
Here are some approximate numbers for presence of the histamine in foods (mg per kg)
Fruits, vegetables and plant-based products
Fruits
136
Nuts
41
Vegetables
98
Legumes
11
Cereals
28
Chocolate
25
Spices
12
Alcoholic beverages
Beer
176
White wine
83
Red wine
260
Fish and seafood products
Fresh fish
136
Canned fish
96
Semi-preserved fish
49
Meat and meat products
Fresh meat
6
Cooked meat
48
Cured meat
23
Dry-fermented sausages
209
Dairy products
Unripen cheese
20
Raw milk cheese
20
Pasteurized milk cheese
20
Histamine Releasers
Histamine in foods is not necessarily the only reason for symptoms. Other biogenic amines have been reported in a variety of foods, such as fish, meat, cheese, vegetables, and wines. They are described as low molecular weight organic bases with aliphatic, aromatic, and heterocyclic structures.
The most common biogenic amines found in foods are tyramine, cadaverine, 2-phenylethylamine, spermine, spermidine, putrescine, tryptamine, and agmatine. Also, octopamine and dopamine have been found in meat and meat products and fish. The formation of biogenic amines in food by the microbial decarboxylation of amino acids can result in consumers suffering allergic reactions.
In patients with food hypersensitivity, exposure to the relevant antigens produces a cytokine (histamine-releasing factor) that interacts with IgE bound to the surface of basophils, causing them to release histamine.
Certain fresh plant foods, such as papayas, kiwis, strawberries, pineapples and plums, have been reported to trigger the release of histamine in the gut, although the mechanism responsible has not yet been proposed.
DAO Blockers
It has been estimated that approximately 20% of the European population regularly take DAO-inhibiting drugs, which significantly increases the number of people susceptible to the adverse effects of dietary histamine. A significant inhibition of the enzymatic activity has also been observed with the antihypertensive drug verapamil and the histamine H2 receptor antagonist cimetidine, although the clinical use of the latter is currently anecdotal.
Active Ingredient
Indication
Chloroquine
Antimalarial
Clavulanic acid
Antibiotic
Colistimethate
Antibiotic
Cefuroxime
Antibiotic
Verapamil
Antihypertensive
Clonidine
Antihypertensive
Dihydralazine
Antihypertensive
Pentamidine
Antiprotozoal
Isoniazid
Antituberculous
Metamizole
Analgesic
Diclofenac
Analgesic and anti-inflammatory
Acetylcysteine
Mucoactive
Amitriptyline
Antidepressant
Metoclopramide
Antiemetic
Suxamethonium
Muscle relaxant
Cimetidine
Antihistamine (H2 antagonist)
Prometazina
Antihistamine (H1 antagonist)
Ascorbic acid
Vitamin C
Thiamine
Vitamin B1
Foods to Enjoy
Low Histamine Foods List
Gluten-free cereals
Vegetables
Artichokes
Lettuce, collargs, mustard greens, kale, chard
Arugula
Cabbages, Bok choy
Asparagus
Garlic, onions, chives
Basil
Watercress
Rhubarb
Beets, turnip
Parsley
Mint
Broccoli
Leeks
Fennel
All squashes
Cucumber
Radishes
Carrots
Cilantro
Cauliflower
Fruits
Lime, lemon
Cantaloupe, watermelon
Apple, pear
Pomegranate
Meats
Chicken, Turkey, Quail
Duck, goose
Beef and bison not aged
Pork
Lamb
Rabbit
Food Purchasing and Preparation Tips
Bioamines are hidden in the preservatives and food enhancers. Do not buy processed, pre-packaged and frozen food. The more organic and fresh your food is the less chance you will have high histamine levels there.
Proteins are of most importance – fish and meat can produce bioamine levels in a process of aging (degradation). It is best to purchase a fresh non-aged meat from a local butcher, and fresh today’s catch from a local seafood market.
Freezing. If you need to freeze food or buy frozen meats, we recommend to use only fast-freeze method. You should not buy food that is chemically frozen.
Histamine Intolerance Diagnosis
Can I Get Tested to See If I Have Histamine Intolerance?
Yes, there are simple and more complex tests.
Most practitioners agree, that it is mostly a clinical diagnosis when tests are of questionable necessity (mainly used to rule out other diseases). Once it has been established that dietary histamine is responsible for the intolerance-associated symptoms, the diagnosis of this disorder is virtually confirmed.
The most studied, and possibly also the most controversial, is the determination of plasma DAO activity. This analytical test consists of measuring the amount of histamine degraded in a blood sample in a given time interval. Two types of commercial testing kits are currently available on the market, one consisting of an ELISA-type immunoassay, and the other a radioimmunoassay using radioactively labeled putrescine.
Both the determination of plasma DAO activity and the histamine 50-skin-prick test could be suitable tests to identify a DAO deficiency from genetic or pharmacological origin, but they would not be useful to determine a deficit secondary to certain intestinal diseases.
A variant of the intradermal skin allergy test called the histamine 50-skin-prick test was also proposed by Kofler et al. to diagnose histamine intolerance.
How much histamine is safe for those who are sensitive?
There is no such level. The tolerance for foods is very individual and should be determined by a trial of introduction of certain foods after a complete avoidance. The introduction is gradual and will need to be recorder in a diary – the amount of food that was eaten without the symptoms is your safe level.
Histamine diets
Histamine-free or low histamine diets are endless. A nutritionist is a good idea if you are not a good cook and cannot create a full menu for a month without anxiety. Nutritionists and holistic practitioners love helping people who have special food needs. Also, you can hire a personal chef or order a food basket from the companies who offer hypoallergenic gluten-free and organic meals.
A personal nutrition coach can help you with the shopping list, or a daily food list that will help you with planning and organizing. Many functional medicine clinics and natural medicine practitioners also offer a list of recipes, menu and a list of foods you should personally avoid (based on your testing).
Antihistamine diet list does not exist. Such a term simply describes a healthy organic eating that will lead to good digestion.
