Ms. K. is sitting down to dinner, with a glass of red wine beside her and a piece of aged cheese on her plate. A short time later, her face begins to flush, her heart starts beating faster, and her head throbs. This could be a case of histamine intolerance. Many people experience similar episodes without immediately recognizing the connection between food, their bodies, and their symptoms. It is only after several such episodes that they begin to suspect there is more to the symptoms than a single food they are intolerant to.
What is histamine, and what role does it play in the body?
Histamine is a naturally occurring neurotransmitter that the body produces from the amino acid histidine. As a tissue hormone, histamine performs numerous functions in the body and plays a role in inflammatory responses, digestion, and the regulation of blood pressure. Histamine also influences the body’s sleep-wake cycle, which is why impaired histamine breakdown can affect not only the stomach and intestines but also concentration and fatigue.
Histamine as a Neurotransmitter and Tissue Hormone
Histamine is stored in the body's cells and released as needed. Among other things, it regulates immune responses and ensures that the body can react to external stimuli. This role makes histamine indispensable.
An Overview of Important Bodily Functions
Functions in which histamine plays a role include the regulation of stomach acid production, the dilation of blood vessels, and effects on the skin. If this system becomes unbalanced, symptoms often first appear in the gastrointestinal tract or on the face.
How does histamine intolerance develop?
Histamine intolerance is not a classic allergy; rather, it is best classified as a metabolic disorder. It occurs when the body cannot break down ingested or endogenously produced histamine quickly enough. This causes histamine levels in the body to rise, leading to symptoms that vary depending on the amount of histamine and the individual’s sensitivity.
Diamine oxidase (DAO)
The most important enzyme for breaking down histamine from food is diamine oxidase (DAO), which is primarily active in the gastrointestinal tract. Low DAO levels are therefore considered a major cause of histamine intolerance. In addition, certain medications can affect DAO levels. DAO supplements available in capsule form are intended to support histamine breakdown; however, their effectiveness has not yet been conclusively and sufficiently proven by scientific evidence.
Histamine N-methyltransferase as a second degradation pathway
In addition to DAO, the enzyme histamine N-methyltransferase contributes to the breakdown of histamine in the body’s cells. Both enzymes work in combination, so a deficiency in either system can be enough to significantly increase the amount of histamine in the body and thus trigger reactions.
Causes and Triggers of Histamine Intolerance
The causes of histamine intolerance are varied and range from genetic factors to gastrointestinal disorders. External factors, such as stress, can also worsen symptoms and increase sensitivity to histamine.
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Biogenic amines, histamine releasers, and aging
Histamine is a biogenic amine, a group of substances that are primarily produced during the ripening and prolonged storage of food. Some foods contain very little histamine themselves but act as histamine liberators—that is, substances that release histamine. This causes the histamine level in the body to rise further, even without direct intake through food.
Foods High in Histamine in Everyday Life
Foods high in histamine include, among others, aged cheeses, canned fish, and alcoholic beverages such as red wine. Tolerance to these foods varies from person to person: Some people react even to small amounts, while others can tolerate small portions without any problems.
Typical Symptoms of Histamine Intolerance
Symptoms of histamine intolerance usually appear within 15 minutes to about four hours after eating. This is often confusing for those affected, as the symptoms cannot always be clearly linked to a specific food.
Gastrointestinal symptoms and skin reactions
Gastrointestinal symptoms such as bloating, diarrhea, and a feeling of fullness are often the main symptoms. The skin may show signs of redness and itching.
Headaches, dizziness, and other symptoms
In addition to the symptoms mentioned, many people report headaches, dizziness, heart palpitations, and fatigue. Histamine intolerance can also manifest as a runny or stuffy nose after eating. Because the symptoms are so varied, histamine intolerance often goes undetected for a long time.
Diagnosis: From Suspicion to Clarity
If you suspect you have histamine intolerance, the first step is to see a doctor. To date, there is no single, reliable test that can definitively diagnose histamine intolerance. Various tests each provide only indications of a possible intolerance.
Elimination Diet and Food Diary
The elimination diet is considered the most important diagnostic tool: Foods high in histamine are strictly avoided for several weeks to see if the symptoms improve. A food diary helps determine individual tolerance levels and identify specific triggers.
Treatment: Dietary Changes and Medical Treatment
Treatment for histamine intolerance primarily involves a targeted dietary change. The goal is to give the body time to recover while also determining the amount of histamine that each individual can tolerate.
The Waiting Period and Individual Adjustment
During the so-called elimination phase, foods high in histamine are avoided for about two to four weeks. Afterward, the low-histamine diet is tailored to the individual, as sensitivity varies greatly from person to person. Alcoholic beverages should generally be avoided during this phase, as they further hinder the body’s ability to break down histamine.
Medications and Additional Support
Antihistamines can relieve acute symptoms by reducing the effects of histamine in the body. Probiotics are being considered as a way to reduce histamine production in the gut, but here, too, scientific evaluation is still in its early stages.
Living with Histamine Intolerance: What Helps Those Affected
With a little practice, it’s possible to manage daily life with histamine intolerance. Many people with this condition report that being mindful of their diet brings significant relief after just a few weeks. Fresh, minimally processed foods generally contain less histamine than products that have been stored for a long time or aged. By specifically choosing fresh foods when shopping and avoiding heavily aged items such as long-aged cheese or canned fish, you can reduce your histamine intake. When cooking at home, it’s also easier to control histamine levels than with processed ready-made products, for which the exact storage and aging conditions are usually unknown.
Since sensitivity to histamine varies from person to person, there is no one-size-fits-all amount that applies to everyone affected. A food diary therefore remains a helpful tool in the long term for identifying situations in which the body needs extra care—such as during stressful periods or when dealing with additional gastrointestinal conditions that can further hinder the breakdown of histamine.
