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Histamine Allergy: Symptoms, Causes and Treatment

Histamine allergy refers to adverse reactions triggered by histamine in food or released in the body. Common symptoms include skin reactions, headaches, and digestive complaints.

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Things worth knowing about "Histamine allergy"

Histamine allergy refers to adverse reactions triggered by histamine in food or released in the body. Common symptoms include skin reactions, headaches, and digestive complaints.

What is a Histamine Allergy?

The term histamine allergy is commonly used in everyday language, but medically it more accurately describes a condition known as histamine intolerance. Unlike a classic allergic reaction involving the immune system, histamine intolerance is a sensitivity to histamine, a biogenic amine found in many foods and naturally produced by the body. In affected individuals, the body has a reduced ability to break down histamine, leading to a range of symptoms.

Causes

The most common cause of histamine intolerance is a deficiency or reduced activity of the enzyme diamine oxidase (DAO), which is responsible for breaking down histamine in the gut. Other contributing factors include:

Genetically reduced DAO activity
Intestinal diseases such as Crohn's disease or coeliac disease that impair enzyme production
Certain medications (e.g., some antibiotics, pain relievers, or paradoxically antihistamines in overdose)
Alcohol consumption, which inhibits histamine breakdown
High histamine content in foods (e.g., aged cheese, red wine, tinned fish, fermented foods)

Symptoms

Symptoms of histamine intolerance can affect multiple organ systems and vary widely between individuals:

Skin: Redness, itching, hives (urticaria), flushing
Digestive system: Abdominal pain, bloating, diarrhoea, nausea
Respiratory system: Runny nose, sneezing, asthma-like symptoms
Cardiovascular system: Rapid heartbeat, drop in blood pressure
Nervous system: Headaches, migraines, dizziness, sleep disturbances

Diagnosis

Diagnosing histamine intolerance can be challenging as there is no single definitive test. The diagnostic process typically involves:

Detailed medical history and a symptom diary
Elimination diet: Avoiding histamine-rich foods for several weeks
Provocation test: Controlled reintroduction of histamine under medical supervision
Blood test: Measurement of DAO enzyme activity (indicative but not conclusive)
Exclusion of other conditions such as mastocytosis or true food allergies

Treatment

There is currently no cure for histamine intolerance. Treatment focuses on symptom relief and reducing histamine load in the body.

Dietary Measures

The most important step is following a low-histamine diet. Foods high in histamine or those that trigger histamine release (histamine liberators) should be avoided or reduced. These include:

Red wine, beer, and alcohol in general
Aged cheeses (e.g., Parmesan, Camembert)
Canned and smoked fish
Fermented products (sauerkraut, vinegar, soy sauce)
Certain fruits (strawberries, tomatoes, citrus fruits)

Medical Treatment

Antihistamines (H1 blockers): Help relieve acute symptoms such as itching and skin reactions
DAO enzyme supplements: Diamine oxidase supplements may support histamine breakdown
Vitamin B6 and Vitamin C: May help enhance DAO enzyme activity

General Recommendations

Keeping a food diary is highly recommended to identify individual triggers. Stress, overexertion, and certain medications can worsen symptoms and should be avoided where possible.

When to See a Doctor

Anyone experiencing recurring symptoms after eating that may suggest histamine intolerance should seek medical advice. Severe reactions such as a significant drop in blood pressure, rapid heartbeat, or difficulty breathing require immediate medical attention, as these may also be signs of other serious conditions.

References

Maintz L., Novak N. - Histamine and histamine intolerance, American Journal of Clinical Nutrition 85(5):1185-1196 (2007), PubMed PMID: 17490952
Reese I. et al. - Guideline of the German Society for Allergology and Clinical Immunology (DGAKI): Non-allergic food hypersensitivity, Allergo J Int (2017)
World Allergy Organization (WAO) - Histamine Intolerance: Overview and current knowledge, www.worldallergy.org

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