Histamine intolerance involves a disparity between the supply and the breakdown of histamine. This imbalance gives rise to a wide variety of symptoms, which are primarily treated by a low-histamine diet. In Switzerland an estimated one per cent of the population is affected by histamine intolerance.

Causes and triggers

It is suspected that histamine intolerance arises as a result of a disparity between the supply of histamine and the limited activity of the histamine-degrading enzymes diamine oxidase (DAO) and histamine N-methyltransferase (HNMT). This impaired degradation is caused by various factors, which are currently still being investigated further. It is already known that middle-aged women are most commonly affected by histamine intolerance.

A high intake of histamine through the diet is the main trigger of symptoms. Histamine is found in animal and vegetable foodstuffs in varied concentrations,  but it is also produced by the body itself. Thus histamine plays an important role as a messenger in allergic reactions. However, this histamine produced naturally in the body is very unlikely to have an influence on histamine intolerance.

Symptoms

Histamine intolerance is a clinical picture with a wide variety of symptoms. These frequently non-specific symptoms mainly occur during and after meals. The following are mentioned as typical symptoms:

  • Sudden skin redness (flush symptoms)
  • Itching and redness on the body
  • Digestive complaints such as nausea, vomiting, diarrhoea, abdominal pains
  • Drop in blood pressure, dizziness, palpitations
  • In women: menstrual problems
  • Running nose, chronic runny nose
  • Headaches, migraine
  • Red eyes, swollen lips

Diagnosis

There are no clear diagnostic criteria for histamine intolerance. First of all, food allergies as well as reactions to lactose, gluten or fructose and other gastrointestinal diseases must be excluded. If histamine intolerance is still suspected, a low-histamine diet (four to six weeks) is recommended. If the symptoms improve during this period, the diagnosis of histamine intolerance can be made.

Measurement of diamine oxidase or histamine in the blood has not proved scientifically conclusive  
and is not recommended for establishing the diagnosis.

Treatment/Therapy

A low-histamine diet comes first. This involves a three-step change of diet:

  1. Strictly low-histamine diet (elimination phase)
  2. Test phase with specific reintroduction of histamine-rich foods to determine individual tolerance
  3. Long-term diet which is geared to the histamine tolerance of each and every individual. As a supportive measure, the enzyme diamine oxidase may be taken, if required.

A low-histamine diet needs to be followed for four to six weeks in order to find out how much the diet relieves the symptoms. After a strict elimination diet has been followed, it is important to take stock with an allergy specialist and nutritionist of how much the symptoms have improved and whether histamine intolerance has been confirmed.

However, a long-term, general restriction should be avoided. If no improvement in symptoms could be detected, all foods should be re-introduced. There may be a different approach that can be discussed with the experts.

If there has been an improvement, foods containing histamine should be slowly re-introduced. Some of the foods mentioned might actually be tolerated. It is therefore important to gauge where a person’s individual tolerance threshold lies. A professional can provide support when foods are being re-introduced.

Histamine-rich foods

The following foods should generally be avoided: GFermentation or maturation products (for example, everything with alcohol, vinegar, yeast and bacteria). Tinned foods, convenience foods, semi-processed products, meals kept warm or reheated, products stored for a long time. The more perishable the food and the higher the protein content, the more important it is to consider freshly preparing meals. 

Meat: any type of sausage, including fried sausage, cervelat, smoked sausage, cold cuts, salami, air-dried beef, Mostbröckli (smoked beef), uncooked ham, ham, smoked ham, Landjäger (spicy raw sausage), etc.

Fish: tuna, mackerel, sardines, anchovies, herring, mahi-mahi; these fish tinned, marinated, salted or dried; seafood, fish sauces

Cheese: all types of hard, soft and processed cheese

Vegetables: pickled cabbage, spinach, tomatoes, tomato juice, ketchup, aubergine, avocado

Tolerable alternatives

The following foods are tolerable alternatives: Meals that are prepared from fresh, unprocessed or less processed raw materials. Careful preparation to retain the vitamins (specifically vitamin C). Quickly cool and freeze leftovers, thaw them rapidly and consume at once.

Meat: fresh or frozen meat and poultry such as thin steaks, chops, strips of meat, mince, fillet, etc.

Fish: fresh or frozen fish such as cod, trout, etc.

Dairy products:  unripened cheese, e.g. cottage cheese, quark and other dairy products such as milk, yoghurt, cream, etc.

Vegetables: all vegetables not listed above, fresh or frozen.
 

Editors: This information has been prepared in cooperation with the Zürich University Hospital nutritional advisory service

 

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