Holistic nutritionists are taking to social media to spread the word about histamine intolerance (HIT). This is a somewhat controversial proposed diagnosis in which a person may have difficulty breaking down the compound histamine in food, leading to a range of symptoms, from bloating to brain fog. Read on to learn more about what histamine intolerance is, what mainstream medicine has to say about it, and whether a low-histamine diet can make a difference.
Overview Overview What Is Histamine Intolerance? Histamine intolerance is not an official diagnosis in mainstream medicine, but some complementary and integrative medicine practitioners support it. They define it as a condition in which a person has difficulty metabolizing histamine in food, leading to stomach problems, allergy-like reactions like hives, and other issues. Histamine is a naturally occurring molecule in the body that plays a key role in the immune system and digestion. Foods can also contain histamine. The thinking goes, if you eat too much high-histamine food (such as aged Parmesan, tomatoes, or processed meats), or your body can’t properly break down histamine, it can lead to problems. “When we balance the body and lower the histamine, these symptoms become more in control, and you just feel better,” explained Lisa Kilgour, a registered holistic nutritionist, on TikTok . As of now, mainstream medicine has not fully accepted histamine intolerance as a valid diagnosis. The American Academy of Allergy, Asthma, and Immunology, for instance, doesn’t currently recognize histamine intolerance as a condition.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295ce717f6-0f51-4402-8a87-0f841769d6fe “When patients first come to me to find out whether or not they have histamine intolerance, I explain that histamine intolerance is not a well-established disease, and there are no clear diagnostic criteria,” says Ross Tanis, MD , an allergist and immunologist at Loyola Medicine in Chicago. “I also discuss the fact that most food intolerances do not have clear diagnostic criteria, unlike food allergies that do,” says Dr. Tanis. There is research to suggest that what many people attribute to histamine intolerance may in fact be gastrointestinal problems, food allergies, or food sensitivities.e60dc2a1-f33c-4a05-9b50-8e3e8e597629027321eb-3ba5-471b-92e1-0e05464a30d2
Signs and Symptoms of Histamine Intolerance Symptoms The proposed symptoms of histamine intolerance can vary widely, and they may overlap with those of other conditions. Some nutritionists and advocates for the field assert that the following symptoms are potentially linked to histamine intolerance: Gastrointestinal (stomach) issues, including bloating, diarrhea, and nausea Skin symptoms, such as itchy skin, flushing, hives, and swelling Headaches or migraines Respiratory symptoms, including shortness of breath, stuffy or runny nose, sneezing, wheezing, or tightness in the chest Swelling of the lips, tongue, or throat Heart irregularities, such as racing heart or palpitations Low blood pressure or dizzinesse60dc2a1-f33c-4a05-9b50-8e3e8e597629effb6579-6e6d-4d36-81a5-3be3e21c7632 “Often people perceive having increased symptoms, particularly GI-related symptoms, after consumption of histamine-rich foods. However, the symptoms often do not abate [decrease or stop] when histamine rich foods are avoided, which would suggest against this diagnosis,” says Tanis. Additionally, there is a normal resting amount of histamine that the body naturally produces every day, so you could never eliminate all the histamine completely, he adds. If symptoms worsen or you experience severe reactions, consult your doctor immediately.
Causes and Risk Factors of Histamine Intolerance Causes The digestive system uses enzymes to help break down food, and the enzyme diamine oxidase (DAO) does this for histamine. People whose bodies make less DAO or produce less-effective DAO may be susceptible to histamine intolerance, though there haven’t been research studies to back this up.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296093c9b7-f930-41c4-8b36-bbdfbb4cfb88 If DAO problems are responsible for histamine intolerance symptoms, possible causes and risk factors include: Genetics Some people are born with genetic mutations that result in lower levels of or less effective DAO. Medications Certain drugs, such as blood pressure medications, may temporarily cause a DAO deficiency. Opioids and narcotics may potentially increase histamine levels. e60dc2a1-f33c-4a05-9b50-8e3e8e5976296093c9b7-f930-41c4-8b36-bbdfbb4cfb88 GI Disorders People with inflammatory bowel disease may have suppressed DAO activity. “To the best of my knowledge, there is no propensity for people with other existing allergies such as asthma , allergic rhinitis, or IgE-mediated food allergies to have a higher reported incidence of histamine intolerance,” says Tanis. IgE-mediated food allergies are a type of food allergy in which the immune system makes the immunoglobulin E (IgE) antibody in response to a specific food.e60dc2a1-f33c-4a05-9b50-8e3e8e59762935e11412-2321-41bc-853d-2a2514c40a50
Can a Low-Histamine Diet Help? Some foods are naturally high in histamine, while others may trigger the release of histamine from your body.e60dc2a1-f33c-4a05-9b50-8e3e8e597629228b2a88-8298-462e-9690-bf29aca2c9f6 Some nutritionists that are supportive of this potential diagnosis may recommend that people with histamine intolerance follow a low-histamine diet. That involves avoiding foods like:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ffb72c69-aecc-4850-a687-20b544f2e8d7 Aged cheese, such as Parmesan, manchego, and Gruyere Fermented foods, including sauerkraut, kimchi, and soy sauce Alcoholic beverages, including wine, beer, Champagne Processed meats, such as salami, pepperoni, and hot dogs Fish and shellfish, for example, mackerel, sardines, tuna, and herring Some vegetables, including tomatoes, spinach, and eggplant Tropical fruits, including bananas, pineapples, papayas, and citrus fruits Chocolate Nuts and peanuts Strawberries Avocados Food additives like colorants and preservatives Working with a nutritionist can help you craft a balanced, low-histamine diet trial that will still meet your nutritional needs to see if it helps your symptoms.
How Is Histamine Intolerance Diagnosed? Diagnosis To help determine if histamine intolerance may be at play, a healthcare provider will typically start by reviewing a patient’s symptoms and medical history. “It’s important to rule out all other medical conditions, including GI pathology [diseases affecting the digestive tract], celiac disease, and GERD [acid reflux], to name a few,” says Tanis. There are no reliable tests for identifying histamine intolerance, he adds. A histamine skin prick test and DAO activity test have been proposed as markers. “Unfortunately, the results are variable and histamine skin prick tests do not show differences in people without histamine intolerance and those with plausible or possible histamine intolerance,” says Tanis. In a prick test, a small amount of a suspected allergen is inserted into the skin to see if a person has any kind of negative reaction. When Tanis has patients who appear to have a food intolerance, he recommends they try eliminating potentially triggering foods to see if symptoms improve. “The best way to do this is to eliminate one food at a time, but this may be more difficult in the case of suspected histamine intolerance,” he says, because so many foods have some level of histamine. “There should be objective improvement in symptoms when eliminating these foods; otherwise you generally assume that it is not the culprit and we recommend these foods are reintroduced, particularly if not eating them impacts quality of life,” he says. Food elimination for suspected histamine intolerance in any child or adolescent requires caution due to the risk of developing food allergies or malnutrition, adds Tanis.
Treatment and Medication Options for Histamine Intolerance Treatment In addition to dietary changes, your healthcare provider or nutritionist may recommend certain medications to try for a period of time to see if they help with your symptoms. Medications Antihistamines These medications block histamine receptors in the body. Both H1 and H2 antihistamines may be helpful, with H1 antihistamines (like cetirizine and loratadine) targeting allergic reactions and H2 blockers (like ranitidine) helping with digestive symptoms. There is little downside to trying antihistamines due to their excellent safety profile, but keep in mind that improvement of symptoms after taking oral antihistamines doesn’t confirm you have histamine intolerance. “Additionally, there aren’t well=controlled randomized trials that show they are effective,” says Tanis. Mast Cell Stabilizers Drugs like cromolyn sodium prevent histamine release by mast cells, a type of immune cell that responds to “foreign” substances, including some foods, by releasing histamine.e60dc2a1-f33c-4a05-9b50-8e3e8e597629335c1532-78d4-45ee-bdb2-d9d170fafae5 Complementary and Integrative Therapies Supplements Some research suggests that nutrients like quercetin, and N-acetylcysteine (NAC) may help stabilize mast cells or support histamine breakdown. Supplements specifically tailored to DAO may help people with DAO deficiency. Supplementing with vitamin C, copper, zinc, and vitamin B6 may also help support the DAO enzyme and overall health.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298ddd8a44-a8a1-4b3e-bab6-9b94e131bb99 It’s important to discuss any supplements with your provider before you start taking them, and to recognize that this is an active area of research where the current evidence is lacking.
Prevention of Histamine Intolerance Prevention Because histamine intolerance hasn’t been established as a formal condition with a clear cause, there aren’t expert recommendations for avoiding it.
Outlook for Histamine Intolerance Outlook Many people with histamine intolerance are able to manage their symptoms with diet changes. If symptoms remain, medications may help. In some cases, symptoms can improve over time, and some people may even be able to go back to eating the foods they’ve been avoiding. If you suspect histamine intolerance is affecting your life, it’s a good idea to consult a healthcare professional to get a complete workup and the appropriate diagnosis. This may include a referral to an integrative allergy and immunology specialist or integrative gastroenterologist who is familiar with this proposed condition and can rule out other diagnoses. From there, you may be referred to a holistic or integrative nutritionist who has experience in this area and can help guide you through approaches like an elimination diet.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296f4c21b2-2697-4b5f-b4ff-ea34b3e16088
Related Conditions Related Conditions Some experts have observed that histamine intolerance can be accompanied by other diseases, including migraine and irritable bowel syndrome.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba2e58d9-d068-4485-a7ea-4df774762dfc Histamine intolerance also shares symptoms with mast cell activation syndrome. Mast Cell Activation Syndrome Mast cell activation syndrome (MCAS) is a condition that causes intense episodes of swelling, shortness of breath, hives, diarrhea, vomiting, and other symptoms. In severe episodes, it can cause life-threatening anaphylaxis (an extreme allergic reaction). It’s caused by mast cells mistakenly alerting the immune system that there’s something harmful in your body, which leads to an overreaction. Some people with mast cell activation syndrome may manage episodes with a low-histamine diet.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b522289e-5787-425c-8e87-da53fe0ecebe
The Takeaway Histamine intolerance (HIT) is a controversial proposed diagnosis involving difficulty metabolizing histamine from foods, leading to symptoms like bloating, headaches, skin rashes, and digestive issues. Histamine intolerance is not officially recognized by mainstream medical professionals, and some research suggests other conditions are responsible for symptoms. Managing histamine intolerance typically involves avoiding high-histamine foods and beverages like aged cheeses, alcohol, and fermented items like soy sauce. If you think you have symptoms that fit with those of histamine intolerance, it’s best to see a specialist like an allergist-immunologist or gastroenterologist to evaluate you and guide your next step, which may include consulting with a nutritionist.
Resources We Trust Cleveland Clinic: Histamine IntoleranceJohns Hopkins Medicine: Low Histamine DietAmerican Academy of Allergy, Asthma and Immunology: Histamine Intolerance: Fact or Fiction?Nutrients: Histamine Intolerance: Symptoms, Diagnosis, and BeyondMedlinePlus: Histamine: The Stuff Allergies Are Made Of
