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HIT – Histamine Intolerance: Causes, Symptoms and Treatment

HIT stands for histamine intolerance, a condition in which the body cannot properly break down histamine from food, leading to symptoms such as headaches, skin reactions, and digestive issues.

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HIT stands for histamine intolerance, a condition in which the body cannot properly break down histamine from food, leading to symptoms such as headaches, skin reactions, and digestive issues.

What is Histamine Intolerance (HIT)?

Histamine intolerance (HIT) is a condition in which the body is unable to adequately break down histamine absorbed through food. Histamine is a biogenic amine that occurs naturally in many foods and also acts as a chemical messenger in the human body. When the breakdown capacity is impaired, histamine accumulates in the bloodstream and triggers a wide range of symptoms across multiple organ systems.

Causes

The most common underlying cause of HIT is a deficiency or reduced activity of the enzyme diamine oxidase (DAO), which is responsible for breaking down histamine in the intestine. The enzyme histamine N-methyltransferase (HNMT) may also be involved. Factors that can impair DAO activity include:

Chronic inflammatory bowel diseases (e.g., Crohn's disease, ulcerative colitis)
Certain medications (e.g., some antibiotics, non-steroidal anti-inflammatory drugs, antihistamines)
Alcohol consumption, which inhibits DAO activity
Genetic predisposition leading to reduced enzyme production
Estrogen dominance, as estrogen can negatively influence DAO activity

Symptoms

The symptoms of HIT are diverse and can affect various organ systems. Common complaints include:

Skin: Flushing, itching, hives (urticaria), eczema
Gastrointestinal tract: Bloating, diarrhea, abdominal pain, nausea
Cardiovascular system: Heart palpitations (tachycardia), low blood pressure, dizziness
Respiratory system: Nasal congestion, runny nose, asthma-like symptoms
Nervous system: Headaches, migraines, sleep disturbances, fatigue

The severity of symptoms depends on the amount of histamine consumed and individual factors such as stress levels, hormonal status, and the simultaneous intake of histamine-liberating substances.

Diagnosis

Diagnosing histamine intolerance is challenging because there is no single definitive laboratory test. Diagnosis is typically made through a combination of:

Detailed medical history: Assessment of symptoms and their relationship to food intake
Food diary: Recording of meals and symptoms over several weeks
Elimination diet: Avoiding histamine-rich foods for 4 to 8 weeks, followed by controlled reintroduction
DAO activity test: A blood test measuring diamine oxidase activity in the serum
Exclusion of other conditions: Ruling out mastocytosis, food allergies, or irritable bowel syndrome

Treatment

Dietary Adjustment

The most important treatment approach is a low-histamine diet. Foods with a high histamine content or those that trigger the release of histamine in the body (histamine liberators) should be avoided or reduced. These include:

Aged cheeses (e.g., Parmesan, Gouda, Camembert)
Fermented products (e.g., sauerkraut, yogurt, vinegar)
Alcohol, especially red wine and beer
Smoked and processed meat and fish products
Tomatoes, spinach, eggplant, avocado
Citrus fruits, strawberries, pineapple

Enzyme Supplementation

Taking DAO supplements (diamine oxidase as a dietary supplement) can help support histamine breakdown. These are typically taken before histamine-rich meals.

Medication

Antihistamines (H1 and H2 receptor blockers) can be used to relieve acute symptoms. They block the effects of histamine at its receptors but do not break it down.

Treating the Underlying Cause

If an underlying bowel condition or medication is impairing DAO activity, it should be specifically treated or adjusted in consultation with a healthcare professional.

High-Histamine vs. Low-Histamine Foods

As a general rule, the longer a food has been aged, fermented, or stored, the higher its histamine content. Fresh, unprocessed foods such as fresh meat, fresh fish, most vegetables (excluding those listed above), and most fruits (excluding citrus fruits and strawberries) are typically low in histamine and well tolerated.

References

Maintz L, Novak N. Histamine and histamine intolerance. American Journal of Clinical Nutrition, 2007; 85(5): 1185-1196.
Reese I et al. Guideline on the management of suspected intolerance to orally ingested histamine. Allergologie, 2017; 40(5): 201-214.
European Food Safety Authority (EFSA). Scientific Opinion on risk based control of biogenic amine formation in fermented foods. EFSA Journal, 2011; 9(10): 2393.

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