Histamine Intolerance: What happens in the body and what resources are available

A well-ripened cheese, an exquisite glass of red wine and a piece of delicate bitter chocolate – for many a real treat, but for some, it can become the purest torment. Because after consuming these delicacies, they suffer suddenly from a runny nose, dizziness, skin reddening (erythema) – particularly in the face, hot flashes or headaches.  These alarm signals in those cases should be taken seriously. An excess of biogenic amines may be the trigger – and the best known of which is histamine.

Histamine intolerance – disproportion between the histamine produced and its degradation by the DAO

Histamine intolerance describes an overloading of the body with a protein substance that cannot be broken down. Specifically, it is a breakdown disorder of histamine – caused by the deficiency of the histamine-degrading enzyme diamine oxidase (DAO). Histamine passes through the intestinal mucosa into the bloodstream and from there into the organs where it irritates the cells. What is interesting is that women are much more often affected by intolerances such as histamine intolerance, than men. Possible causes – although not yet scientifically proven – could be related to the female hormone balance. During pregnancy, more DAO is formed in the placenta, so the typical histamine intolerance symptoms often do not appear as strongly.

Histamine is a biogenic amine which the body produces itself but is also found in food. The histamine contents in food vary greatly because they are dependent on the respective protein or histidine content, the microbial colonization, the storage temperature, the maturation and fermentation times as well as the hygiene conditions during production. The more of the amino acid histidine is contained in a food, the more histamine can be produced. Foods that frequently cause histamine intolerances include smoked/marinated fish, salted meat, long-ripened cheese, alcoholic beverages such as red wine or sparkling wine and bacterially preserved foods such as sauerkraut but also ready-to-eat meals, special types of fruit such as bananas, oranges and soya products. So-called histamine liberators can also boost histamine production in the body and increase the symptoms of histamine intolerance. These are substances that release histamine in the intestine or inhibit DAO activity – without requiring a reaction of the immune system. These include Tomatoes, legumes, nuts, pineapples, papaya, kiwi, cocoa, chocolate as well as alcohol and some medicines (e.g. various pain medications, cough remedies).

The longer a food is stored or matured, the higher its content of histamine and other biogenic amines.

Tips regarding histamine intolerance

• Use fresh food as much as possible
• Histamine is also not destroyed by heating – therefore perishable dishes (such as fish or spinach) should not be warmed up a second time, as bacterial activity already develops strongly after the first preparation.
• Avoid alcohol – this increases the effect of biogenic amines and increases the permeability of the intestinal wall. This facilitates the entry of histamine into the bloodstream. Additionally, alcohol contains a lot of histamine, which stimulates the body’s own histamine formation and further inhibits the DAO.

And yet – without histamine some things would not function in the body. It plays an important role as a neurotransmitter, a mediator substance and a tissue hormone in many physiological processes (e.g. sleep-wake rhythm, appetite control, defense against foreign substances). Among other things, it controls allergic reactions, stimulates the formation of gastric juice and is involved in the regulation of body temperature and blood pressure as well as pain perception – to name just a few of the essential tasks. In contrast to a real allergy, which describes a qualitative, dose-independent reaction, a pseudoallergic hypersensitivity disorder of a histamine intolerance is characterized by a quantity-dependent reaction, which can be very different from individual to individual.

Enzymes and vitamins to test for with histamine intolerance

As already mentioned, histamine is broken down in the body by the enzyme DAO (diamine oxidase), which is formed in the intestinal mucosa. This enzymatic process requires special micronutrients as co-factors, in particular vitamin B6, vitamin C, copper and zinc. In addition to its function as a cofactor, zinc also contributes to a normal protein synthesis in the body. The body’s own enzymes, such as diamine oxidase (DAO), are also proteins. If the necessary co-factors of the copper-containing diamine oxidase are missing, no optimal enzyme activity can be achieved. The administration of the co-factors can lead to a significant increase in DOA activity in such a situation and is an important therapeutic measure.

Particular attention is paid to a very special amino acid: L-glutamine serves the cells of the intestinal mucosa and the immune system as a source of energy. It is therefore essential for maintaining the mucous membrane barrier – especially in the case of inflammation. A deficiency can lead to functional or permeability disorders. In addition to the lack of co-factors, intestinal bacteria producing biogenic amines can also lead to reduced DAO activity. An overgrown rot flora caused by malnutrition or the displacement of acidification flora can produce significant concentrations of histamine.

In healthy people DAO is continuously released into the intestinal lumen, whereas in people with histamine intolerance the rate of degradation is reduced by the reduced activity of diamine oxidase. Exceeding the individual histamine intolerance threshold triggers concentration-dependent, histamine-mediated symptoms (e.g. itching, migraine, digestive problems, tachycardia, etc.) in those affected. Even small amounts of histamine can be enough in histamine intolerant patients, because they usually have a genetic DAO deficiency or too little DAO activity. Warning: Even a normal DAO level may not be enough in case of excessive flooding of histamine from food.

Therapeutic measures

The presence of histamine intolerance all too often correlates with a lack of DAO. This deficiency can be seen through the level of DAO in the blood. Additionally, the examination of histamine in stool samples as well as a detailed nutritional analysis, stress anamnesis and allergy diagnosis are recommended. If the results are positive, a diet with the intake of DAO cofactors (vitamin B6, vitamin C, copper and zinc) and/or the DAO enzyme should be taken as a remedy. A deficit of DAO can also be interpreted as an indication of a damaged intestinal mucosa. If histamine intolerance is diagnosed, it is important to take a closer look at intestinal health – possibly an inflamed intestine or Leaky-Gut syndrome could be causally related.