Histamine intolerance: when food makes you ill

What is histamine intolerance?

Histamine intolerance is an intolerance to the body's own messenger substance histamine. Histamine occurs naturally in many foods, especially in fermented products such as cheese, wine and sauerkraut. The body normally breaks down histamine without any problems. In the case of histamine intolerance, however, this breakdown is impaired, which can lead to various symptoms.

Symptoms of histamine intolerance

The symptoms of histamine intolerance can be very varied and usually occur immediately after eating histamine-rich foods. The most common symptoms include

• Gastrointestinal problems such as diarrhoea, abdominal pain and flatulence
• Headaches and migraines
• Skin reactions such as itching, redness and hives
• Cardiovascular symptoms such as low blood pressure and palpitations
• Respiratory symptoms such as nasal congestion and asthma

The intensity of the symptoms can vary greatly from person to person, from mild discomfort to severe allergic reactions.

Causes of histamine intolerance

The exact causes of histamine intolerance are not yet fully understood. It is assumed that several factors can play a role:

• A deficiency or reduced activity of the enzyme diamine oxidase (DAO), which is responsible for the breakdown of histamine
• An increased permeability of the intestinal mucosa, which leads to, more histamine entering the bloodstream
• An increased release of histamine from the body's own mast cells, for example due to stress or certain medications

Genetic factors also appear to play a role in the development of histamine intolerance.

Diagnosis of histamine intolerance

Diagnosing histamine intolerance is not always easy, as the symptoms can be very unspecific and also occur in other diseases. The gold standard is an elimination diet, in which all histamine-rich foods are avoided for a few weeks. If the symptoms improve during this time, this indicates a histamine intolerance.

In addition, the activity of the DAO enzyme can be determined in the blood. A low value can be an indication of histamine intolerance, but is not conclusive. Provocation tests with histamine can also be carried out, but are controversial due to the side effects.

Treatment of histamine intolerance

The most important measure for histamine intolerance is to follow a low-histamine diet. This includes avoiding histamine-rich foods such as:

• Long-aged cheeses such as Parmesan, Emmental and cheddar
• Processed meat products such as salami and ham
• Fish and seafood, especially if they are not completely fresh
• Fermented foods such as sauerkraut, vinegar and soy sauce
• Alcoholic drinks, especially red wine and beer
• Chocolate, nuts and citrus fruits

Instead, fresh, unprocessed foods should be prioritised in the diet. It is also important to ensure good kitchen hygiene and to prepare food as fresh as possible.

In some cases, the additional intake of DAO capsules can help to alleviate the symptoms. However, these should only be taken after consulting a doctor. The use of antihistamines can also be useful in individual cases.

Living with histamine intolerance

Histamine intolerance does not mean that you have to avoid all histamine-rich foods forever. As a rule, tolerance improves if the body is relieved for a while. Many sufferers can eat small amounts of the problematic foods again after a while without experiencing symptoms.

Keeping a food diary in which you record which foods are tolerated and in what quantities can also be helpful. This allows you to keep track and customise your diet.

Histamine intolerance and other illnesses

Histamine intolerance often occurs together with other illnesses, for example food allergies, neurodermatitis or chronic inflammatory bowel diseases such as Crohn's disease. In these cases, it is particularly important to plan your diet carefully and tailor it to your individual needs.

Mental factors such as stress can also exacerbate the symptoms of histamine intolerance. Relaxation techniques such as yoga or meditation can help to better deal with stress and alleviate symptoms.

Conclusion

Histamine intolerance is a complex condition that can severely affect quality of life. With the right diagnosis and treatment, however, the symptoms can usually be managed well. A low-histamine diet, good kitchen hygiene and customising the diet are the most important building blocks. With a little patience and discipline, sufferers can lead a largely symptom-free life despite histamine intolerance.