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Histamine intolerance                    

What does Histamine Do?

Histamine is well known to be associated with allergic reactions and at Dermal Aesthetics we see it often when performing skin needling and especially electrolysis.  When the skin perceives it is wounded it will sometimes generate a histamine response.  This can look like watery bumps that are itchy and hot. When provoked as part of a treatment it is generally controlled and short term.

When it is a long term response in the skin and body it becomes a problem. The histamine response is part of a complex system of immune response and regulators that are linked to inflammation, allergies, asthma, and auto immune diseases.  Histamine is a chemical mediator that is stored in mast cells, and causes vasodilation and vascular permeability.  It becomes an issue when immune responders overreact to histamine when it is released to maintain homeostasis. It’s doing its job and releasing immune messenger molecules to protect against allergen invasion. It is known to be involved in over 23 different physiological functions. Histamine exerts its effects by binding to its 4 receptors: H1R, H2R, H3R, and H4R on target cells in various tissues.

  • H1 receptors: Smooth muscle and endothelial cells affecting skin; blood vessels (Benadryl and Claritin block activity of these receptors)
  • H2 receptors: Cells in the intestines control acid secretion, abdominal pain, and nausea; heart rate
  • H3 receptors: Central nervous system controlling nerves, sleep, appetite and behavior
  • H4 receptors: Thymus, small intestine, spleen, colon, bone marrow and white blood cells; inflammatory response

Histamine has also been found to play a role in epidermal differentiation and skin barrier function by disrupting tight junctions.

Total Allergen Threshold

Sometimes you might have a reaction to something you have never reacted to before.  This is because your body is fighting more than one allergen at a time.  It could be you have an infection, as well as emotional stress, combined with hormonal, food allergen, pollutants and chemical toxins all at once.  That final thing has pushed your body to its peak.  Spring can cause a reaction in some people as the hayfever triggers a reaction to something completely unrelated but it was just the final block in the stack before it all crumpled.

How is it controlled in the body?

When histamine is formed, it is broken down by specific enzymes. In the central nervous system, it is metabolized by histamine N-methyltransferase (HNMT), while in the digestive tract it is broken down by diamine oxidase. (DAO) is the major enzyme involved in histamine metabolism and is responsible for maintaining a steady level to balance numerous chemical reactions taking place in the body.  It degrades histamine regardless of whether it originated from allergy-induced processes  or  consumed in food. The DAO gene is also involved in the metabolism of glutamate, an excitatory neurotransmitter found to be elevated in those with schizophrenia and bipolar disorders.

Histamine becomes a problem when we have metabolic disturbances that do not allow us to effectively metabolize histamine properly specially for DAO. If DAO is inhibited, histamine will accumulate in the blood and would result in intolerance. DAO deficiency can be caused by genetic factors which lead to significantly reduced DAO enzyme activity. Individuals with a DAO gene mutation may have a tendency towards high histamine. In these cases, we need to be careful what we’re consuming every day.

 What to eat for DAO?

The DAO enzyme is dependent on vitamin B6, B12, iron, copper and vitamin C, so it makes sense to increase the intake of these compounds. Copper and Vit C are crucial components of the DAO enzyme and B6 is a key cofactor that enables DAO to degrade histamine.

.Vitamin C is well-known for its antihistaminic working. In some cases intake of vitamin C will lead to less histamine in a matter of days. It functions as a cofactor of DAO, just like vitamin B6 does. Vitamin C can be taken at doses of up to 3,000 mg to reduce histamine levels.

  • DAO depends on vitamin B6 to function. If there is shortage of B6, the enzyme is practically useless. The intake of vitamin B6 often leads to a higher DAO activity. According to the NIH, doses of up to 2 mg should suffice for lactating mothers.
  • Magnesium is important in the histamine metabolism. A shortage increases the activity of histidine decarboxylase in some tissues. Histidine decarboxylase is the enzyme that makes histamine from histidine. While at the same time, a lack of magnesium intake leads to reduced DAO. The NIH recommends doses of up to 400 mg and Magnesium can be bought over the counter as 500 mg tablets.
  • Copper is another cofactor of DAO and able to reduce histamine levels. However, It’s not often recommended to supplement. Copper deficiency is another possible cause for low DAO activity, as copper is a central atom of the DAO and thus essential for its function. Because copper is essential to DAO function, copper levels should be monitored in patients with low DAO activity to avoid further DAO deterioration
  • Zinc inhibits the release of histamine from mast cells. Supplementation is recommended. Zinc can also prevent intestinal copper absorption.
  • Manganese also inhibits the release of histamine from mast cells much like zinc.

Other factors that may alter DAO

  • Small Intestinal Bacterial Overgrowth (SIBO): some gut microbes produce high amounts of histamines as a byproduct of their metabolism. Bacteria grows when food isn’t digested properly, causing hustance overproduction.  Normal levels of DAO enzymes cant break down the increased levels of histamine in your body, causing a reaction.
  • Leaky Gut Syndrome: Intestinal permeability creates major inflammatory stress in the body which can contribute to poor DAO function.
  • GI inflammatory conditions: Crohn’s, Inflammatory bowel disease (IBS), colitis Bacterial overgrowth is another contributing factor for developing histamine intolerance.
  • Celiac disease and those with gluten intolerance
  • Drugs: NSAIDs (ibuprofen, aspirin), acid-blocking medications, anti-depressants, immune suppressants, antihistamines and histamine blockers such as Pepcid and Zantac. Diuretics, HRT drugs can also cause “medication induced SNP.” This kind of SNP can happen in the absence of an actual gene SNP, because the medication is acting worse than the homozygous polymorphism.

Foods High in Histamines:

  • Fermented alcoholic beverages, especially wine, champagne and beer, Fermented foods: sauerkraut, vinegar, soy sauce, kefir, yogurt, kombucha, vinegar-containing foods: pickles, mayonnaise, olives, Cured meats: bacon, salami, pepperoni, luncheon meats and hot dogs, Soured foods: sour cream, sour milk, buttermilk, soured bread, Dried fruit: apricots, prunes, dates, figs, raisins, Most citrus fruits, Aged cheese including goat cheese, Nuts: walnuts, cashews, and peanuts, Vegetables: avocados, eggplant, spinach, and tomatoes, Smoked fish and certain species of fish: mackerel, mahi-mahi, tuna, anchovies, sardines, Processed foods of all types – Preservatives are high in histamines

Low Histamine Foods:

Freshly Cooked Meat & Poultry, Freshly Caught Fish, Extra Virgin Olive Oil, Pasture-Raised Eggs, Gluten-Free Grains: brown rice & quinoa, Fresh Fruits: Other than citrus, avocado, tomato, pineapple, bananas and strawberries, Fresh Vegetables (except spinach and eggplant), Coconut milk, Rice milk, Hemp milk, Almond milk, Coconut oil & Grass-fed Butter/Ghee, Organic coffee, Almond butter, Leafy herbs, Herbal teas

Histamine-Releasing Foods:                 

(These foods do not necessarily contain histamine but they block the action of DAO and therefore they potentiate the effects of elevated histamines)

Alcohol, Energy drinks, tea- black and green,  Bananas, Chocolate, Cow’s Milk, Nuts, Papaya, Pineapple, Shellfish, Strawberries, Tomatoes, Wheat Germ, Many artificial preservatives and dyes

References:,  healthline, APAN journal

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