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Histamine harmony

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Table of Contents

Histaminosis or sensitivity to dietary histamine, commonly known as histamine intolerance (HIT), is associated with the metabolism of histamine.1 The body is unable to metabolise histamine which may present a confusing and hard to pinpoint causation. Individuals may be experiencing multiple symptoms with nonspecific clinical presentation. Symptoms may include itching, diarrhea, constipation, headache, cough, nasal congestion and breathing difficulties, amongst others.2,3

Histamine can be synthesised and released from many cells, the most common are mast cells, which are abundantly present, found in the skin, gastrointestinal and respiratory systems. Mast cells may be influenced by infections, or allergic reactions, consequently triggering the immune response. It is not uncommon for a person with HIT to experience symptoms in any or all these systems. 1,3,4

A diet and lifestyle approach offers an opportunity for the burden on the body to be relieved, providing room for the individual to isolate and reduce symptoms.1 An effective mechanism to assist someone suffering HIT or compromised histamine metabolism is to address and realistically evaluate one’s diet. The process may uncover knowledge of histamine containing foods being mistakenly ingested or overconsumed, especially if prepackaged food is a component of meal preparation.5 

There are multiple food apps available to use as a guide with foods containing histamine of low, medium, and high. Although, this is not a complete blanket approach, as one can react more to a food than the next. A person with HIT is encouraged to choose from the low histamine containing foods, along with scrutinising the ingredients list on packaged foods as this is often where the hidden dangers may hide.4

It is good practice to prepare food using a wholefood approach and cooking from scratch as much as possible. This is often easier said than done, especially if the person has been experiencing HIT for some time and they are now experiencing fatigue. A loved one may be able to step in and prepare food initially, until they are able to return to cooking for themselves.6

Another area of importance is recognising that some foods are histamine liberators which can cause mast cells to release histamine, e.g. mango, kiwi, and avocado.7,8

Diet tips

High histamine foods to limit/avoid:

  • Seafood - anchovies, herring, mussels, mackerel, sardines, tuna.
  • Meat - Deli meats, smoked foods e.g. bacon.
  • Fruit - strawberries and dried fruits e.g. sultanas, prunes, peaches.
  • Vegetables - eggplant, sauerkraut, tomatoes.
  • Spices and condiments - chilli, cayenne pepper, vinegars, fish sauce, yeast extract.
  • Dairy products - brie, blue cheese, camembert, and aged cheeses.
  • Additives – sulphites.
  • Fermented foods and beverages - alcohol, kombucha, sauerkraut. 9

Foods to be enjoyed:

A large range of vegetables including: asparagus, beetroot, broccoli, brussel sprouts, cauliflower, chicory, dandelion greens, fennel, leek, lotus root, onions, parsley, cooked pumpkin, savoy cabbage and sweet potatoes.9

Exercise and lifestyle

Gentle exercise is paramount for the individual experiencing ongoing and unresolved HIT. This may be as simple as a walk in the outdoors with fresh air or a walk along the shoreline at the beach. The sand providing some resistance exercise. This may be all that this person can realistically manage.

Of equal importance is staying well hydrated to not overload the body any further10 along with focusing on quality sleep and stress reduction.11 Histamine is naturally released at night and that itself may cause sleep issues with symptoms of allergy e.g. sneezing, nasal congestion and sleep issues.12,13

Environmental triggers

Classic environmental triggers are windy days, pollution, smoke from bush fires or chimneys, dust, and pollens. These can all trigger or increase the histamine load for a person with HIT.14

Nutrients and histamine

Quercetin is a natural flavonoid that helps relieve symptoms of mild allergies and provides anti-inflammatory support, whilst Vitamin C maintains healthy immune system function, both are found in a multitude of low histamine containing fruits and vegetables including apples, celery, chives, onions, kale, broccoli, Brussel sprouts and asparagus.

Diet and lifestyle focus are only one approach for the individual, providing relief and symptom reduction, whilst working alongside a practitioner for a targeted and multidisciplinary approach as part of a therapeutic treatment plan.

References

1 Zhao Y, Zhang X, Jin H, Chen L, Ji J, Zhang Z. Histamine intolerance a kind of pseudo allergic reaction. Biomol. 2022 Mar 15;12(3):454.

2 Schnedl WJ, Lackner S, Enko D, Schenk M, Holasek SJ, Mangge H. Evaluation of symptoms and symptom combinations in histamine intolerance. Intest Res. 2019 Mar 7;17(3):427-33.

3 Kovacova-Hanuskova E, Buday T, Gavliakova S, Plevkova J. Histamine, histamine intoxication and intolerance. Allergo Immunopathol (Madr). 2015 Sep 1;43(5):498-506.

4 Tuck CJ, Biesiekierski JR, Schmid-Grendelmeier P, Pohl D. Food intolerances. Nutrients. 2019 Jul 22;11(7):1684.

5 Razeghi Jahromi S, Ghorbani Z, Martelletti P, Lampl C, Togha M, School of Advanced Studies of the European Headache Federation (EHF-SAS). Association of diet and headache. J Headache Pain. 2019 Dec;20(1):106.

6 Han Y, Xiao H. Whole food–based approaches to modulating gut microbiota and associated diseases. Ann Rev Food Sci Technol. 2020 Mar 25;11:119-43.

7 Shulpekova YO, Nechaev VM, Popova IR, Deeva TA, Kopylov AT, Malsagova KA, Kaysheva AL, Ivashkin VT. Food intolerance: The role of histamine. Nutrients. 2021 Sep 15;13(9):3207.

8 Hrubisko M, Danis R, Huorka M, Wawruch M. Histamine Intolerance—The More We Know the Less We Know. A Review. Nutrients. 2021 Jun 29;13(7):2228.

9 Sánchez-Pérez S, Comas-Basté O, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Low-histamine diets: is the exclusion of foods justified by their histamine content. Nutrients. 2021 Apr 21;13(5):1395.

10 Luttrell MJ, Halliwill JR. The intriguing role of histamine in exercise responses. Exerc Sport Sci Rev. 2017 Jan;45(1):16.

11 Eutamene H, Theodorou V, Fioramonti J, Bueno L. Acute stress modulates the histamine content of mast cells in the gastrointestinal tract through interleukin‐1 and corticotropin‐releasing factor release in rats. Physiol. J. 2003 Dec;553(3):959-66.

12 Thakkar MM. Histamine in the regulation of wakefulness. Sleep Med Rev. 2011 Feb 1;15(1):65-74.

13 Christ P, Sowa AS, Froy O, Lorentz A. The circadian clock drives mast cell functions in allergic reactions. Front. Immunol. 2018 Jul 6;9:1526.

14 Benedé S, Blázquez AB, Chiang D, Tordesillas L, Berin MC. The rise of food allergy: Environmental factors and emerging treatments. EBioMedicine. 2016 May 1;7:27-34.