Histamine intolerance


Histamine intolerance, sometimes called histaminosis, is an over-accumulation of histamine in the human body. Histamine intolerance is sometimes informally called an allergy; however, the intolerance is technically caused by the gradual accumulation of extracellular histamine due to an imbalance.
Roughly 1% of the population has histamine intolerance; of those, 80% are middle-aged.

General

The imbalance in histamine intolerance is between the synthesis and selective release of histamine from certain granulocytes, versus the breakdown of histamine by the enzymes which metabolize it, such as diamine oxidase and histamine N-methyltransferase.
In contrast, allergic reactions involving an immediate allergic response to an allergen are caused by anaphylactic degranulation, which is the abrupt and explosive release of "pre-formed mediators", including histamine, from mast cells and basophils throughout the body.

Symptoms

Possible symptoms after ingestion of histamine-rich food include:
In the human body, histamine is metabolized extracellularly by the enzyme diamine oxidase, and intracellularly by histamine N-methyltransferase and aldehyde oxidases. In histamine intolerance, the activity of DAO is limited, and histamine taken up by the diet and formed in the body is only partially metabolized. The consumption of histamine-containing food leads to a pseudoallergic reaction. It is unclear how histamine passes through the intestinal wall during absorption and enters the blood without coming into contact with the aldehyde oxidases expressed in intestinal cells and histamine N-methyltransferases. Active or passive exposure to tobacco smoke is suspected of favouring histamine intolerance, but has not been adequately studied.

Potentially harmful foods

The following food categories have been quoted in literature as histamine rich:

Meat and fish

.

Drug interactions

Active ingredientDrugs containing the active ingredient
Mefenamic acidParkemed
DiclofenacDedolor, Deflamat, Diclo B, Diclobene, Diclomelan, Diclostad, Diclovit, Dolo-Neurobion, Neurofenac, Tratul, Voltaren
IndometacinFlexidin, Indobene, Indocid, Indohexal, Indomelan, Idometacin, Indoptol, Luiflex, Ralicid
Acetyl salicylic acidAspirin

List from page 126 in:
Active ingredientDrugs containing the active ingredient
FenbufenLederfen
LevamisoleErgamisol
IbuprofenAvallone, Brufen, Dismenol new, Dolgit, Ibudol, Ibumetin, Ibupron, Ibuprofen Genericon, Kratalgin, Nurofen, Tabcin, Ubumetin, Urem



For a diagnosis, the case history is essential. However, since many complaints such as headaches, migraines, bronchial asthma, hypotension, arrhythmia and dysmenorrhea may be caused by something other than histamine intolerance, it is not surprising that half of suspected diagnoses are not confirmed.
The diagnosis is usually made by intentionally provoking a reaction. However, since histamine can potentially cause life-threatening conditions, the following procedure is preferred: take blood samples before and after a 14-day diet, and measure changes in histamine and diamine oxidase levels. Rather than increase histamine during the test diet, eliminate it. This procedure does not endanger the patient. Quite the contrary: in the presence of histamine intolerance, the symptoms have improved or disappeared completely. At the same time, the histamine blood level halves and the DAO increases significantly. If there is no histamine intolerance, the blood levels do not change and neither do the symptoms. Simultaneously, food allergy, cross-reactions with pollen, fructose malabsorption, lactose intolerance, and celiac disease should be excluded.

Therapy

The basis of treatment is a reduction of the dietary histamine through a histamine-poor diet. An extreme variant is the "potato rice diet" that has been successfully used by dermatologists for decades in the treatment of hives, i.e. only potatoes, rice, salt, sugar and water. Certain foods and certain medicines which do not contain histamine per se are also to be avoided, because they are known to release histamine stored in the body.
If eating histamine-containing foods is unavoidable, antihistamines and cromolyn sodium may be effective. The intake of diaminoxidase in capsule form with meals may reduce the symptoms of histamine intolerance.
In cases of high blood glutamate, such as can occur in some cases of eczema and histamine intolerance, Reinhart Jarisch recommends vitamin B6 treatment. This promotes the body's own synthesis of DAO and thus fights the effects of histamine intolerance. The reference ranges for blood glutamic acid are 20-107 in infants, 18-65 in children and 28-92 μmol / ml in adults.

Literature