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Dr Janice Joneja, a world expert on histamine intolerance, has created an easy-to-read guide to help you understand whether you might be histamine intolerant, and, if so, what you can do about it.
Buy the paperback from Amazon here is the US – and from Amazon here in the UK. For elsewhere in the world, just 'search' your local Amazon store.

Buy the e-book from Amazon here in the US and from Amazon here in the UK. For elsewhere in the world, just 'search' your local Amazon store.


Histamine intolerance – Q and A with Dr Janice Joneja

Dr Janice Joneja

Dr Joneja, whose detailed article on histamine intolerance you can read here, will answer your questions.

However, please be aware that Dr Joneja cannot diagnose or provide consultations for individuals. What she will do is to answer the questions in a general fashion in order to provide the best answer based on evidence-based research.

Please email FoodsMatter with your queries (including your gender and your approximate age) and we will pass them on to Dr Joneja.

Here for more articles and reports on research on histamine intoelrance.

Questions:

A low histamine diet reduced my anxiety and deep fear but I still have many symptoms including nausea and 48 hour headaches. I know I have food allergies but how do I tell the difference between food allergies and histamine/tyramine intolerance?

Urticaria and PUPPS in pregnancy – is there a histamine connection?

Is it possible to have an allergic reaction to vaginal secretions during intercourse?

Can taking probiotics help a histamine

intolerance?

Information on DAOSIN.

Histamine, stress, depression and chronic hives that get worse at night – is there a connection?

What are the histamine levels of freeze-dried meat?

Facial rash, low energy, burning eyes, anxiety attacks, hair loss, weight loss  and poor sleep…  Could these all be as a result of histamine intolerance?

Could a fecal transplant help re-establish DAO?

* Functional dyspepsia – a histamine connection?

Can pregnancy inprove a histamine problem?

More on anxiety, panic attacks and histamine intolerance?

Burning mouth syndrome, the unlikelihood of a histamine connection - and supplements and histamine sensitivity.

Histamine and hormone fluctuations

There is no such thing as an antihistamine containing food...

Histamine, IBS and the LEAP (Lifestyle Eating and Performance) program

Histamine and pregnancy

Histamine, antihistamines, and inflammation

Questions related to histamine – on fish oils, on quercetin and Vitamin C, on caffeine, on Benadryl, on ketotifen and on tinnitus....

Histamine and diabetes

High histamine foods as indicators of histamine intolerance

Histamine, copper, hives and leaky gut. Could histamine and excess copper could be implicated in severe and chronic hives?

Could histamine intolerance cause vaginal irriation which is exacerbated by intercourse?

I found out that my secretory IgA is 6X the normal range.
How can I lower secretory IgA?

Could my anxiety and panic attacks be cause by a histamine intolerance?

Are these foods OK on a low histamine diet?

Could damp and mould be making my histamine intolerance worse?

Is cottage cheese allowed on a low histamine diet?

I have recently been looking into histamine as a cause for a few of my problems and I would like to get your take on it.

• Could help me get additional information for diagnosing histamine intolerance.

I have been reacting at evening meal times – usually involves my face turning bright red in the cheeks....

Could histamine intolerance affect Alzheimer's disease? 


N.B.
You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

How to tell the difference between food allergy and histamine/tyramine intolerance

Question:

I'm a 40 year old women. Food issues started at a very early age after my mother stopped breast feeding. I wouldn't drink cows milk and was a fussy eater. I had to give up red meat at 16 as it became problematic. In my early 20's I became vegetarian but still I had issues, always nauseous and anxious. In my mid 20's I had a psychosis and have had several recurring episodes mainly centred around extreme anxiety and fear. I currently have a myriad of symptoms which include, nausea, anxiety, fear, headaches - behind right eye, build up of intense pressure in solar plexus and burping releases it. It's not normal burping it's painful before I burp and the burp releases the pressure, Itchy jaw line, tingling face, rash on neck and chest, aching joints - especially knees, waking at night feeling dizzy. 

After doing a low histamine diet for the past month several symptoms have reduced, mainly the deep fear and anxiety which feels like a miracle. I still feel sick after I eat and I have crippling headaches which last around 48 hours but I feel much better and like I'm making progress towards understanding my triggers and the ways in which I can heal.

My question is how do I tell the difference between food allergies and histamine intolerance as I feel I have both. And how would I treat both issues going forward as I already have a limited diet and I want to make sure I'm getting enough nutrition.

Dr Joneja says:

As you know, it is not possible for me to comment on specific cases in this forum, so I will answer your questions in a general discussion.

It is certainly possible for a person to have both histamine intolerance and food allergies.  From the information you have provided regarding your symptoms and their onset it is also possible that you may have tyramine intolerance.  I have discussed these issues at length in previous questions, and would suggest that you will find help in this answer.

Here is a summary of the most important differences between food allergy and histamine intolerance:

Food Allergy:

  • Food allergy is due to an immunological reaction in which the body makes antibodies specifically against food molecules, called food allergens
  • These specific antibodies can be detected in blood and their identification aids greatly in the diagnosis of allergy and determination of the foods responsible
  • Symptoms of food allergy occur when a person eats the food to which they have previously been sensitised (i.e. to which they have produced antibodies)
  • The symptoms result from the action of inflammatory mediators (reactive chemicals) that are released mainly from white blood cells called mast cells within tissues
  • Mast cells produce (synthesise) the mediators and store them within granules ready for release when triggered by the immunological response to the allergen
  • This response typically occurs immediately after the allergic person eats their allergenic food, so it is often easy to suspect the identity of the food trigger
  • In most cases eating even a small quantity of the food results in a reaction: it does not depend on the amount of food consumed (i.e. it is said to be non-dose dependent)\
  • Although the immediately obvious symptoms are due to the activity of histamine, which is preformed and released immediately as the mast cell is activated, the distinguishing feature of allergy is that other symptoms in addition to those caused by histamine are evident; different types of enzymes, leukotrienes, and prostaglandins, among others, produce their own set of symptoms
  • An allergic reaction to a food, mediated by the antibody, known as IgE, can produce a severe reaction that in extreme cases case be life-threatening
  • Determination of the food responsible, which is typically supervised by an allergist.  The process involves:
    • A concise medical history
    • Tests such as skin tests, which reveal which foods placed on the skin result in a local reaction and blood tests designed to detect food-specific antibodies
    • Elimination and challenge test: Avoidance of the suspect food for a prescribed period, followed by challenge with the food, which should elicit the development of symptoms if the food is the allergen responsible. You will find detailed information about all of this in Dr Joneja’s book, “Dealing with Food Allergies” which contains detailed information about this process. You can buy all of Dr Joneja's books here in the UK or here in the US.

Food Intolerance

  • Intolerance to a food does not involve the immune system and antibodies are not produced against food molecules
  • Symptoms result from a reduced ability of the body to process components of the food, often due to a deficiency in the enzymes required for their metabolism, absorption, or utilisation
  • The reaction occurs when the level of the metabolite (the food component) exceeds the body’s ability to process it; this is called the person’s limit of tolerance, above which symptoms develop.  This level is different for each individual
  • The reaction is dose dependent: in other words, symptoms develop only when the amount of the food component exceeds the person’s limit of tolerance
  • It may take several hours for this level to be reached as the amount of the unprocessed food builds up over time.  The reaction is not immediate such as we see in an allergic reaction
  • A food intolerance is not life-threatening
  • In the case of histamine intolerance diamine oxidase (DAO) is the enzyme that is usually inadequate in breaking down excess histamine quickly enough to avoid the level of histamine reaching symptomatic levels
  • In tyramine intolerance, or sensitivity, monoamine oxidase (MAO) is the enzyme that may be deficient

 

Management of both food allergy and histamine and tyramine intolerance involves avoiding the offending foods and obtaining complete balanced nutrition from alternate sources.

The first stage for management of your symptoms should be the determination of any food allergies that you might be experiencing, using the criteria above.

Since there are no reliable tests for histamine and tyramine intolerance the best way of managing the conditions is to follow my histamine and tyramine-restricted diet, making sure that you consume all of the allowed foods in order to risk any nutritional deficiencies.  Detailed information for the foods allowed and those restricted on this combined diet can be found in my books. You can buy all of Dr Joneja's books here in the UK or here in the US.

The Mastocytosis Canada website provides my complete histamine and tyramine restricted diet on-line here
A registered dietitian will be able to help you with this and I urge you to enlist one’s assistance promptly.

 

Urticaria, PUPPS and pregnancy – is there a connection?

Question:

My doctor and I are playing with the possibility that I have developed Histamine Intolerance.
I am 42 years old and have never had hives like this before, except once. When I was pregnant with my first child I had Puppps, which has very similar symptoms.

About 2 months ago, I started getting welts (hives). It started out slowly and after about a month the hives covered nearly all of my body and were huge welts. They have always been terribly itchy.

My first question is: Can a person develop this problem/disease later on in life? My chiropractor was under the impression that this was something that some children tend to have and either get better or it continues through their adult life. About a month ago, I started taking steroids to try and get rid of the symptoms while we took tests to figure out what caused it. While on steroids, the hives went away, but when we started reducing the steroids they came back. I am no longer on steroids. I have started following your histamine restrictive diet.

My 2nd question is: Since so many citrus fruits are NOT allowed on the diet, is citric acid that has been included in other foods allowed or is that ALSO restricted.

My 3rd question is regarding all soy products that have been added into other foods, like soy lecithin and others. Are ALL soy products added into other things supposed to be avoided?

Dr Joneja says:

PUPPP is short for pruritic urticarial papules and plaques of pregnancy.  In the UK it is known as polymorphic eruption of pregnancy (PEP).  The condition involves an annoying itchy hives-like rash that develops in some women during pregnancy.  It usually starts on the abdomen and may spread to the chest, neck, arms, legs and feet.  It poses no risk for either the mother or fetus.  It is estimated to occur in about 1 in 200 pregnancies, mostly developing during the third trimester of a first pregnancy.  The rash usually disappears within a week after delivery.  The cause is unknown.  Some reports indicate that when the mother stops all milk and milk products the rash tends to resolve, although no correlation between the rash and milk allergy has been proven.  Some researchers have suggested that there may be some connection to between the condition and the hormones of pregnancy, but this has yet to be determined.

With the hormone connection in mind it is possible that your present outbreak of hives may be associated with premenopausal changes in the levels of your hormones.  We often see such changes preceding any indications of menopause in women in your age group. Oestrogen and progesterone levels can profoundly affect the release and activity of histamine in some women   Please see this article and this one for more information. Because histamine is the most important mediator in urticaria (hives), such a change in levels is often sufficient to trigger the onset of hives such as you have described.  It is quite probable that your experience with PUPPP is an indicator that you are more than normally “sensitive” to such changes.

To answer your specific questions:

  1.  Actually, the reverse is true:  histamine intolerance is more frequently diagnosed in adults than in children.  In contrast, food allergy is more prevalent in children compared to adults and is frequently outgrown, only occasionally persisting into adulthood. I would think that your chiropractor was referring to food allergy rather than histamine intolerance.  If diamine oxidase (DAO) deficiency is the underlying cause of histamine sensitivity rather than other conditions that result in excess histamine such as allergy, mast cell activation disorders (MCAD), or autoimmune disease, among others, it is unlikely to be outgrown. 
  2. Oral corticosteroids such as Prednisone are often prescribed to control inflammatory conditions.  The corticosteroid suppresses the immune system and as a result the inflammatory mediators, including histamine, that are responsible for the reaction are not released.  In the case of urticaria (hives), release of histamine is inhibited and therefore the symptoms of its excess are prevented.  Long-term use of corticosteroids is strongly contraindicated, so other methods of control of excess histamine are preferable.  It is good to hear that you are following my histamine restricted diet, which will reduce the amount of histamine entering from external sources, thus reducing your total body level of histamine significantly, hopefully below your personal limit of tolerance (the level above which you will develop symptoms). See the bottom of this article for foods to avoid.
  3. Citric acid as an ingredient in manufactured foods is allowed.  Although citric acid can be derived from citrus fruits, much of the citric acid in food products is actually made from corn sugar derivatives.  The sugar is exposed to a mould called Aspergillus niger which feeds on the sugar, metabolising it via the citric acid cycle of fermentation.
  4. Yes: avoid all sources of soy, especially soy lecithin, tofu, and of course, fermented soy products such as soy sauce and miso.

Information on DAOSIN please.

Question:

I am a 65 year old male suffering from GERD, high blood pressure, high cholesterol and prostate enlargement for which I am taking medicines.  I have been taking Daosin (3 capsules a day, all of them before breakfast, lunch and dinner) for my histamine intolerance for the last 15 days. 

Could you please let me know the answer to the following....
1. How long should I continue to keep taking Daosin for maximum efficacy?
2. Are there any adverse side effects of the medicine that I should be aware of?
3. Is there any prevention / precaution to be taken?

Dr Joneja says:

I am presuming that you are taking DAOsin based on a confirmed diagnosis, or strong indicators that you are histamine intolerant as a result of a DAO deficiency.  If you are assuming that you are histamine intolerant based only on your own observed symptoms I would urge you to ensure that your histamine excess is not due to another underlying condition that might be treated more appropriately.

In order to reduce your histamine level from whatever cause, you will need to follow a histamine-restricted diet in addition to taking DAOsin.  Supplement diamine oxidase (DAO) is just that – an additional aid in reducing all sources of exogenous histamine (histamine from outside the body).  You cannot reduce your histamine level by simply taking DAOsin while still consuming a “regular diet” that might be high in histamine-containing foods and beverages.

DAO must be taken shortly before meals.  It has a short “half-life” - the time it takes for the enzyme to become inactive.  I would suggest 5 minutes before a meal would be optimal.  The enzyme is mixed with the food in the digestive tract and acts by breaking down any histamine within the content of the meal so that it will not be absorbed.  You are therefore reducing the amount of histamine entering your body from that source.  DAO itself is not absorbed into the body from the digestive tract, so in that respect acts only outside the body.  Its maximum effect is limited to the degree of breakdown of histamine in the dietary components with which it is mixed for a fairly short period of time as the food passes through the digestive canal.  It cannot be compared to medications or supplements that are absorbed into the body, so the answer to your question about how long you should take DAOsin for maximum effect is – take it whenever you wish to reduce the histamine content of whatever you are about to consume.

Because DAO is not absorbed into the body it has no adverse effects.  Furthermore, DAOsin is not a medication – it is a supplement comparable to lactase (the enzyme that breaks down lactose in milk) in supplements such as Lactaid and Lacteez.

Your query about prevention and precautions must be applied to determining the source of your excess histamine.  As I mentioned above, excess histamine can arise from a number of conditions, which you should discuss with your medical advisers.  If these have been addressed and treated appropriately, follow a histamine-restricted diet and take DAOsin without risk as an adjunct in the management of your histamine sensitivity. Please see my histamine-restricted diet in Dealing with Food Allergies.

You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

Freeze dried meat.

Question:

What are the histamine levels of freeze-dried meat?

Dr Joneja says:

A quick answer is:  the same as before the meat was freeze-dried.

Freeze-drying is a process involving fast freezing and dehydration.  It was developed as a laboratory technique, originally called lyophilisation or cryodessication, for preserving perishable substances, for example, biological matter such as blood serum, to be transported without decomposition.  The process involves rapid freezing of the material followed by reducing the surrounding pressure to cause the water to pass directly from the solid (ice) to the gaseous phase.  It is now used widely in the medical, pharmaceutical, food and agricultural industries as an extremely efficient method of preserving and transporting perishable materials.  I used this process frequently when I worked as a scientist in the lab.

A freeze-dried substance may be safely stored at room temperature without refrigeration for a long period of time, as long as it is sealed to prevent the reabsorption of moisture.  The greatly reduced water content inhibits the action of microorganisms and enzymes that would normally spoil or degrade the substance.

Freeze-dried products can be rehydrated more easily and quickly than other dehydrated materials because the ice crystals leave tiny pores which rapidly fill with water when the material is reconstituted.  Because there is no degradation involved, the nutrient content of foods is preserved for an extended period of time. 

Freeze-dried foods are used in a variety of situations when the maximum ease of storage and transport is required.  For example, meals used in the space programs; food for hikers and others needing light-weight, easily carried nutrition; instant coffee and other beverages that need an extended shelf-life to preserve flavour and colour; fruit for children’s snacks; fruit in breakfast cereals; herbs and vegetables where flavour and nutrients need to be preserved. 

In summary, freeze-drying will neither increase nor decrease the histamine content of any food. It will remain exactly the same as it was before the freeze-drying process.

Facial rash, low energy, burning eyes, anxiety attacks, hair loss, weight loss and poor sleep…  could these all be as a result of histamine intolerance?

Question:

I am a relatively healthy 43 year old female who has had ongoing problems for the last year.  It started last August, 2014 with a few bumps around and under my right nostril resembling poison ivy, which I'm highly allergic to!  I started putting rubbing alcohol on it, but after a few days the bumps never filled with fluid.  I stopped the alcohol, but the rash never went away.  I went to a walk-in clinic in September and was diagnosed with Seborrheic Dermatitis, and was given a steroid cream to put on it.  In November, 2014 the rash was still there, and I was frustrated enough that I went to a dermatologist.  She said it wasn't Seborrheic Dermatitis, but rather it was Perioral Dermatitis.  She gave me an oral antibiotic that made me very ill, and an antibiotic lotion that I believe I'm allergic to.  I used it for a few months anyway, but the rash very obviously became worse - it spread around my mouth and chin.  

In December, my family started noticing that when I was eating meals, I had a bright red ring that appeared around my mouth...basically from my nostrils around my lips and chin.  It looked as though someone had drawn a ring on my face with red lipstick.  It disappeared within 15 minutes at first, and I had no feeling of this whatsoever.  That changed in January when the red ring appeared and started burning my skin.  My lips tingled, my face was red and burning.  This disappeared after 20 minutes or so.  Two days later, I had 3 sips of white wine before dinner....the same white wine I had had for a very long time.  My face immediately flushed and burned and tingled for 45 minutes. 

My doctor told me to stop eating dairy, soy, sugar, gluten, wheat, most fruits, processed foods, condiments, etc. etc.  I have gone to several doctors since January.  I have been tested for Candida and Adrenal Fatigue, I've been told I'm perimenopausal (I haven't had a period since February, 2015, and I have frequent migraines), I've been called crazy and told to see a psychiatrist.  I've had an Organic Acid test for leaky gut syndrome - my oxalates were off the chart, and I had zero Vitamin C present.  Several blood tests have been done, and the only thing that came back abnormal was my cortisol level.  I have low energy, my hair is falling out, and my body aches for no apparent reason.  My eyes burn quite a bit and I can't tell you the last time I slept through the night - I usually wake up 3-4 times.  I've also been having frequent anxiety attacks.  I have lost 30 pounds since January.....I'm 5'8" and now 121 pounds.  I have been eating fresh meats and vegetables only until just about 6 weeks ago.  I have tried pineapple which makes me itch terribly, as does anything with vinegar.  I've tried 2 very small glasses of wine and it makes me congested and makes the rash under my nose itch.  I've changed my shampoo, conditioner, toothpaste, skin care, body soap, lotion.....basically everything I can think of.  I take a Vitamin B+C supplement and Calcium D3 supplement daily.  I feel like a science experiment!!

All of this being said, do you think this could be a histamine intolerance?  I do eat A LOT of strawberries since they are low in sugar, and spinach, but I plan on stopping both of these immediately to see if it helps.  I would love to hear your thoughts and suggestions.

Dr Joneja says:

There is certainly strong evidence that your symptoms are mediated by histamine.  Whenever there is inflammation, rash, reddening, burning, or itching, histamine is involved.  However, the question is, what is the cause of the excess histamine?

You mention that you are in perimenopause, which involves a significant change in hormone levels.  We know that oestrogen, and especially progesterone, have a direct effect in histamine control mechanisms, so it is very likely that this is an important factor in the triggering of your symptoms.

I am alarmed that your doctor directed you to avoid a long list of foods, apparently without any evidence of their involvement in your condition.  No health care provider should indiscriminately advise a patient to avoid foods without (1) Evidence of their role in the condition and (2) Provision of a diet that will supply all nutrients from alternate sources.  In my practice I see this too often and it causes me great concern as it puts the patient at risk for nutritional deficiency and tends to direct attention away from other causes.  Furthermore, if a person avoids foods for a prolonged period of time they run the risk of losing tolerance to those foods and finds that they react adversely when they try to eat them again later.  So many “doctors” do not appreciate the fundamental role of food in health and disease, and tend to toss out directives about diet without being adequately qualified to do so.  The fact that you have lost 30 lbs in 6 months is very worrying.

I wish that I could direct your treatment at this stage, but unfortunately I am not in a position to do so right now.  The best I can offer is to advise you to follow my histamine-restricted diet closely, making sure that you avoid all the “restricted” foods and eat all of those “allowed”.  You will find detailed lists of these in my book, “Dealing with Food Allergies”, and in the Consumer handouts associated with my book, “The Health Professional’s Guide to Food Allergies and Intolerances”. (You can buy Janice’s books here in the UK or here in the US.)

Whatever the underlying cause of your symptoms, reducing all sources of histamine in your diet should allow you some relief of your symptoms until a definitive cause can be determined.  I would also suggest that you enlist the help of a registered dietitian in formulating a diet that will avoid the histamine-associated foods but provide complete balanced nutrition from alternate sources. 

The dietitian should also be able to suggest an appropriate nutritional supplement if this is necessary.  I am a little concerned about your daily vitamin B+C, which could have an adverse effect:  B vitamins are typically derived from yeast (Saccharomyces species), and vitamin C might be citric acid, both of which are contra-indicated on a histamine-restricted diet.  You might tolerate the B vitamins, many people do, but make sure that the vitamin C is ascorbic, rather than citric acid.  Your calcium and D3 supplement should be fine.

Functional dyspepsia – a histamine connection?

Question:

I have been told I may have functional dyspepsia following an upper endoscopy 5weeks into my indigestion symptoms (burning sensation in the stomach, motility issues in stomach and guts, heartburn, acid reflux and flushed face, ears, neck, sore throat. What led to my symptoms were a 6-month course of Naproxen 250mg x 2 daily and a ten-day course of Flagyl yearly for Blastocystis hominis which has been living in my guts for at least 3 years. The Naproxen was for hypersensitivity in the vaginal/urinary area following repeated candida/bacterial vaginosis/urinary tract infections. My functional medicine doctor thinks that one of the causes can be histaminosis and has put me on a antihistamine diet and Daosin. Do you agree with his diagnosis?

Dr Joneja says:

As you are no doubt aware, dyspepsia with symptoms such as acid reflux, heart burn, and sore throat can have several different causes.  It sounds as if your doctors have explored most or all of them.  Intestinal infection, such as Blastocystis hominis and the medications used to treat it frequently precede dyspepsia, which can persist for months after the infection has been cleared.  Both Flagyl and Naproxen can alter the microbial flora of your digestive tract whose effects can influence motility and function leading to the symptoms you describe.  Again it may take several months for your intestinal microflora to be re-established and you will likely experience discomfort until this happens.  Sometimes excess histamine is involved, whatever the initial cause, and could explain the symptoms you describe, especially flushing. 

I would agree with your doctor that a trial on a histamine-restricted diet would be indicated.  Follow the dietary directives closely for 2-4 weeks.  If you experience no improvement in your symptoms, histamine excess or histaminosis is an unlikely cause of your symptoms.  However, if you do obtain relief, it would be advisable for you to follow the diet for the long term in order to remain symptom-free. 

DAOsin (a diamine oxidase supplement) will increase the amount of DAO in your digestive tract and will help to break down any residual histamine in the food you are eating.  (You can buy DAO supplements here in the UK or here in the US.) However, in your case you need to exclude all sources of histamine in your diet to determine whether histamine is contributing to your symptoms; DAOsin will act as an additional aid in the process.

For more questions and Dr Joneja's answers see the top of the page.

Can pregnancy improve a histamine problem

Question:

The only time in my life that I felt like a normal person was the four times that I was pregnant.  I was never sick.  I was never even tired.  I got all my work done and felt wonderful.  Six weeks after the birth, my old tiredness and weakness came back to stay.   This seems unusual and I have told doctors for years about this with no response.
 Also, at times, my ears get red and very hot.  No one has any explanation for this either.
Could these things possibly have any connection to a histamine problem?

Dr Joneja says:

Most definitely:  the placenta makes a significant amount of diamine oxidase (DAO) which is the most important of the enzymes that break down excess histamine in the body.  DAO is made in several different organs, including the jejunum and ileum in the small intestine, kidneys, and thymus.  It is thought that the DAO made by the placenta is nature’s way of protecting the developing foetus in utero.  The mother benefits from this additional source of DAO while she is pregnant, and many women with histamine sensitivity as a result of DAO deficiency report feeling extremely well during their pregnancy.  However, sadly their symptoms of histamine intolerance return to their pre-pregnancy intensity once the DAO from the placenta is no longer available to them.  Similarly, some women find that their allergies improve significantly while they are pregnant, as the increased level of DAO breaks down the excess histamine released in the allergic response.  One of my colleagues who suffered from allergies and DAO deficiency was always delighted when she became pregnant as she could look forward to nine months of allergy relief, which she was unable to achieve at any other time.

Your red, hot ears are another sign that you are experiencing excess histamine.  Histamine is a vasodilator, which means that the blood vessels widen in response to the histamine, increasing the flow of blood, often to the peripheries of the body.  In your case, your ears.  We see this phenomenon often in allergic children.  Their red ears indicate an allergic reaction with the release of histamine affecting the area.

You will definitely benefit from following a histamine-restricted diet.  I feel sure that you will experience an increase in energy and well-being once your whole body histamine falls to a “normal” level.  You may benefit from taking a DAO supplement to increase your body’s ability to break down excess histamine.  (You can buy DAO supplements here in the UK or here in the US.) However, DAO supplements alone will not lower your histamine level sufficiently to allow you to become symptom-free without a corresponding reduction in your total load of histamine, which you can achieve by restricting your intake of histamine-rich and histamine-releasing foods.

Please read my articles on histamine intolerance and the histamine-restricted diet here.

For more questions and Dr Joneja's answers see the top of the page.

More on anxiety, panic attacks and histamine intolerance

Question:

I am female, aged 43 years. Here is a brief synopsis of my health history:

Anxiety as young child with no major trauma — repeating behaviors/rituals, nightmares
Digestive issues during childhood— cramping with dairy
Repeated sinus infections, strep throat and yeast infections during 20s — lots of antibiotic usage
External vaginal itching beginning in teenage years – still continues and seems to be connected to foods consumed:  corn, dairy, wheat seem to cause it
Early 30s: diagnosed with systemic yeast infection
Identified multiple food sensitivities: dairy, gluten, corn — eating gluten causes puffy, red skin on my face; sinus congestion from dairy, corn, and gluten
Drinking alcohol also causes puffy, red skin on my face regardless of the alcohol type
Continuing, reoccurring vaginal infections: beta strep, mersa, yeast — treated with multiple rounds of antibiotics
Early 40s: diagnosed with SIBO — followed treatment plan, digestion improved — all vaginal infections ended for first time in 20 years
Age 36 developed intense period cramps that continue to today — intense pain during menstruation
Increasing anxiety beginning at age 30 – steadily progressed
Age 43 developed panic attacks and anxiety to a level that interferes with daily life — doesn’t seem directly related to circumstances — extreme dizziness with tingling and burning in head, heart racing
For the last 10 years I have followed a good diet that is mostly gluten free and includes lots of vegetables. 
Could this be histamine intolerance?  I am desperate to find a solution that works to reduce my anxiety.  If you think it may be histamine intolerance, how would I go about identifying root causes as you recommend?  Would you recommend I begin following the low histamine eating plan?

Dr Joneja says:

You mention a diverse array of conditions that may be contributing to a level of histamine in your body that exceeds your individual limit of tolerance (the level above which symptoms develop).  Some of the reactions are likely to be allergies to food components; an allergic reaction will always lead to the release of histamine.  Other reactions may be a result of an overgrowth of certain strains of micro-organisms in your digestive tract as a result of frequent use of oral antibiotics (sometimes referred to as colonic dysbiosis).  An infection will also release histamine as the immune system fights the invading micro-organism with an inflammatory response, which again releases histamine. Furthermore, whenever itching is a symptom we can be fairly confident that excess histamine is involved. So it would seem that over the years you have been experiencing fairly high levels of histamine from a variety of sources.

Your major concern at the moment is frequent panic attacks and anxiety.  Several years ago I reported the observation that a number of my patients in the Allergy Nutrition Clinic at Vancouver Hospital reported a surprising relief from their panic, or anxiety episodes while following a histamine-restricted diet.  This was an unexpected finding as the connection between histamine excess or sensitivity and anxiety had not been reported previously.  Please see my published article here.

At the present time we have no way to measure a person’s sensitivity or intolerance of histamine.  The only effective approach is to carefully follow a histamine-restricted diet for a prescribed period, 2-4 weeks is usually adequate, to determine whether the panic attacks resolve.  My publications, such as my book, Dealing with Food Allergies, Histamine Intolerance, Chapter 19, pages 241-244 gives detials of what is allowed on a histamine-restricted diet. Also see my article here. If you find that are you free from these panic episodes while following the diet you can be reasonably certain that histamine excess is indeed contributing to the condition.  You will then need to follow a histamine-restricted diet for the long-term to remain symptom free.

You may also find taking supplement of DAO helpful.

Also see Dr Joneja's longer article on anxiety and histamine intolerance here.

N.B.
You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

For more questions and Dr Joneja's answers see the top of the page.

13th July 2014

Histamine and hormone fluctuations

Question:

I have been able to get my histamine level and symptoms under control with the exception of the few days around ovulation and right before my period starts. Diet and supplements aren't enough to prevent the increase in symptoms and I am wondering if there are any tips, tricks or advice that addresses the hormonal fluctuations that occur at those times of the month. I would so happy if I could avoid those monthly flare ups.

Answer:

It is good to hear that you have been able to manage your symptoms by controlling your histamine level. As you are aware, hormonal fluctuations contribute quite significantly to histamine sensitivity, as oestrogen and progesterone influence histamine metabolism. Both hormone levels change at ovulation and just prior to the onset of menstruation and many women experience an increase in histamine, and therefore occurrence or worsening of symptoms, at those times. Often, a histamine-restricted diet is not adequate in keeping histamine levels below a person’s limit of tolerance (the level above which symptoms appear) when endogenous histamine (histamine produced within the body) rises significantly. At these times you might try controlling your symptoms of histamine excess with an antihistamine. The most effective antihistamine for an acute reaction is Benadryl; however, this tends to be sedating and may not suit your lifestyle. You might find that one of the long-acting, non-sedating antihistamines such as Claritin, Sudafed or Reactine will answer your purpose. In addition, if you are not taking a diamine oxidase (DAO) supplement as part of your histamine-controlling regimen, you might try it as an adjunct during your “reactive” periods. However, DAO acts on histamine in the digestive tract - it is not absorbed into the body, and therefore it will have very little effect in controlling endogenous histamine. Nevertheless, the enzyme might breakdown any histamine within the digestive tract, and thus add another level of histamine control. If you are taking DAO regularly, you might try increasing the dosage at times when you expect symptoms to appear.

Unfortunately, until we know a great deal more about histamine production and breakdown than we do at present, there is not a lot more that you can do to control your monthly histamine increase.

N.B.
You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

For more questions and Dr Joneja's answers see the top of the page.

11th July 2015

There is no such thing as an antihistamine containing food...

Question:

I'm an Indian male, 49 from Durban, South Africa. I've recently heard of histamine intolerance and I don't think there's advanced treatment here.
Most of my life I've suffered with facial skin problems like acne, cysts, red bumps, hyperpigmentation, specifically affected by nuts, cheese, cream, ice cream, caffeine, chocolate, cola, herbal tea(green). Now all these are high in histamine. Last year I had folliculitus as well but it was treated quickly. My nose gets congested and runny and my face flushes after certain meals as well.
I had a few cysts a few weeks ago. I was drinking a lot of red wine and eating viennas and polony during that two weeks. These are high histamine so I'm sure that's the cause. I've tried the low histamine diet since then and it seems to help a lot.
I tried a cetirizine antihistamine once but it caused severe constipation so I'm afraid. There's no DAO supplements available locally.
I've been searching for natural antihistamines but now I'm very concerned and confused. Many foods that are restricted on your HIT diet are listed as antihistamines, eg, tomatoes, citrus fruits, strawberries, spinach, tea, wine, beans, bananas, fish, etc. How can these foods be high in histamine and antihistamines at the same time? Please elaborate.
I make my own sauerkraut and fermented veggies but I have just a teaspoon every morning. It doesn't seem to affect me, so is it okay? Isn't it unhealthy not to have probiotics, and won't it cause more serious health problems? I heard that supplements are okay.
Is apple cider vinegar okay? Its an antihistamine but vinegar is high histamine. Is there a guideline to how much histamine foods contain and how much is allowed per day?

Answer:

It is clear from your question that you misunderstand the terms, “histamine” and “antihistamine”. Contrary to your statement, there are no antihistamine containing foods. The term “antihistamine” was coined as a name for the chemicals developed in a laboratory to counteract the effects of histamine. Antihistamines have the same structure as histamine and like a key in a lock, block histamine receptors on cells so that histamine cannot gain access to the cell and “turn on” the histamine effects. In simple terms, antihistamines lock the door and don’t allow histamines to get in to do their work. As a result, symptoms of histamine excess are prevented.

The foods you claim as “listed as antihistamines” are in fact all high in histamine and are not allowed on a histamine-restricted diet. I do not know where you obtained this “list of antihistamine foods”, but wherever it came from, it is entirely wrong!

Sauerkraut and fermented vegetables all contain histamine and will contribute to the total level of histamine in your body, regardless of how much you consume. In order to reduce your total body histamine to a tolerable level you need to avoid all sources of histamine in your diet. This includes all the foods you have erroneously listed as containing antihistamines as well as any vinegar and any food that is made by a process of fermentation.
Probiotics contain live micro-organisms, some of which may have the ability to convert histidine in residual food in the colon to histamine, which may contribute to the level of histamine in the body, so on a histamine-restricted diet at this stage in our knowledge, no probiotic is allowed. It is certainly not “unhealthy” not to take probiotics; is fact it is positively unhealthy to take the wrong ones.

The amount of histamine “allowed per day” is entirely an individual measure and depends on the person’s unique “limit of tolerance”, in other words, the amount of histamine above which symptoms develop. A histamine-restricted diet is designed to avoid all sources of histamine so that the person’s level of histamine does not exceed their tolerable level. We all have a certain amount of histamine in our bodies, which is constantly being made and stored to ensure adequate levels to perform essential functions in the brain, digestive system, and immunological protection. The foods and beverages we consume can add on top of that to put a person into the symptom range, so a person at risk for histamine intolerance, or overload, should avoid all dietary sources of histamine-containing and histamine-releasing foods in order to remain as symptom-free as possible.

For more questions and Dr Joneja's answers see the top of the page.

27th May 2015

Histamine and pregancy

Question:

I recently came across Dr. Joneja's article on histamine intolerance. She describes my symptoms to a T. I've been suffering from these strange and what've seemed like inconsistent symptoms for most of my life. I've been told I have IBS. I've had allergy tests, but no one has ever connected all things together. I'm allergic to aspirin, I get migraines, I have a very sensitive stomach that is sometimes linked to asthma episodes, I seem to be allergic to alcohol, I have heat flushes, I have reactions that vary depending on time of year. I could not believe how accurate her article was.

Leaves me in the dilemma on where to go from here. I'm hoping that she can please recommend an allergist to see in the Boise area. I realize this is a long shot but I couldn't let this opportunity pass be by. The possibility of having these symptoms under control after 20 years would be a dream.

I also lost a baby due to HELLP syndrome. At the time my doctor had described this as my body reacting to being pregnant in the same manner as an allergy. Has she seen any correlation between histamine intolerance and HELLP syndrome?? I read in another how sometimes symptoms improve during pregnancy because of hormone levels or something to do with placenta. That's what made me think of my case. I just can't help but think this seems to be all part of a connected problem.

Dr Joneja says:

The symptoms you describe would suggest that you would definitely benefit from a histamine-restricted diet.  Without further medical history I cannot, of course, diagnose a histamine intolerance or sensitivity, but if this is the case, closely following the dietary directives will lead to a resolution of your symptoms. (See my article here.)  You will find details about which foods to avoid, and those allowed in my book, Dealing with Food Allergies pages 236-244.

Unfortunately, not many allergists in North America are familiar with histamine intolerance so I am unable to suggest a practitioner in the Boise area who might be able to assist you.

There is a possible connection between pregnancy and histamine levels.  The placenta produces a high level of diamine oxidase (DAO), the principle enzyme that breaks down excess histamine and keeps it at a normal level.  Presumably this is a natural device to protect the developing foetus.  Interestingly, I have heard from many women who normally suffer from allergies and histamine intolerance that during their pregnancies they are blissfully free from symptoms, probably as a result of the increased level of DAO available in their body to break down the problematic histamine.

It is difficult for me to see where either allergy or histamine may be implicated in HELLP.  We have no research to indicate a possible connection between these conditions.

As you are no doubt aware, HELLP stands for:
           
H – haemolysis (the red blood cells break apart)
EL – elevated liver enzymes (the liver produces much higher levels of enzymes than normal)
LP – low platelet count (blood platelets that, among other things, promote clotting of blood, are reduced in number)

HELLP is reported to occur in 1-2 out of every 1,000 pregnancies and is most common in women with eclampsia or preeclampsia (indicated by high blood pressure and protein in the urine).  Unfortunately, the cause is still unknown.

HELLP is essentially a liver disorder involving red blood cells and platelets rather than the white blood cells that are involved in allergy and histamine release. I think that your doctor was referring to the fact that agents produced by your body (haemolytic enzymes, for example) were attacking your red blood cells and platelets, rather than describing a literal allergy in which inflammatory mediators are released, mainly from mast cells (white blood cells found principally in tissues throughout the body) and act on other body cells to produce the symptoms typical of allergy.  The two processes are quite different.  Histamine is one of the mediators involved in allergy, but since HELLP does not involve an allergic reaction, there is no evidence that elevated histamine levels are involved in the condition.  As we know so little about the cause of HELLP, regrettably there is very little we can do to prevent it.

N.B.
You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

For more questions and Dr Joneja's answers see the top of the page.

22nd May 2015

Histamine, antihistamines, and inflammation

Question:

I heard that Phosphatidylcholine has the capacity to mop up histamine but I wanted to check with the experts to make sure.
Can you tell me if it does wipe out histamine in a crisis and if it is safe to take long term? If so, what should be the dosage?

Dr Joneja says:

Phosphatidylcholines are a group of phospholipids (lipids, or fats, that contain phosphate) and are essential components of cell membranes. Lecithin is probably the most well-known. We obtain it from our diet. Lecithin is especially rich in foods such as egg yolk, soya beans, other legumes, wheat germ, fish, and meat, especially organ meats. Supplemental phosphatidylcholine has been suggested as a support for increasing brain function, retarding aging, improving skin, and several other conditions. It is hoped, that by increasing the body's supply of phosphatidylcholine (PC), cell structure will be improved. More recently, research has been investigating the role of PC in inflammatory bowel disease, specifically, ulcerative colitis (UC). Usually PC acts as an anti-inflammatory agent in the digestive tract, protecting the surface from invasion by micro-organisms in the area. However, people with UC tend to have lower than normal levels of PC in the mucus secretions, and thus are unprotected. Hence, they develop the inflammation that causes the disease.

So here is the misconception: an anti-inflammatory agent is not necessarily an antihistamine. Although inflammation does involve high levels of histamine, not all inflammation is primarily caused by high histamine levels. In the case of UC, supplemental PC protects the bowel by suppressing some inflammatory agents (for example, TNF-alpha – a pro-inflammatory cytokine) and enhancing the structure of the cell membrane so that it is not vulnerable to the effects of others.

So, in summary, anti-inflammatory agents such as PC act by a variety of mechanisms that suppress inflammatory agents, or protect cells from them.
Histamine is an inflammatory mediator in many types of inflammation, but PC will not act as an antihistamine. Antihistamines prevent histamine from entering the cell, by blocking the receptor that allows histamine access (you can find details of this activity in several of my articles). PC does not have this capability. So – no – phosphatidylcholine will not 'mop up histamine'.

I have tried to make this answer as simple as possible, but some science is necessary in order to make the process clear. Hope it is helpful.

You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

For more questions and Dr Joneja's answers see the top of the page.

10th April 2015

Questions regarding histamine intolerance:

Thank you for these questions.  Although they seem straightforward, some of the answers involve rather complex science.  I will try to simplify them as much as possible.

Q. Is fish oil supplement OK on a low histamine diet?

A. Histamine is poorly soluble in fat, so any histamine that may have been present in the fish from which the oil is derived is unlikely to contain histamine.  So, fish oil is safe on a histamine-restricted diet unless, of course, the person is allergic to fish; in the latter case fish oils should be avoided.

Q. What supplements can be helpful for HIT other than Dao capsules? Do you recommend quercetin or c-vitamin?

A. Quercetin and vitamin C act quite differently from DAO.  The latter is an enzyme that breaks down excess histamine and removes it from the body, thus aiding the return to normal levels of the amine. Supplemental DAO is most useful when the cause of histamine intolerance is a deficiency of the enzyme. 
Quercetin is an antioxidant and anti-inflammatory agent that is useful in reducing inflammation.  If the excess histamine is released in an inflammatory response such as infections, or other threats to the body, quercetin may help in reducing the inflammation, and thus the release of histamine.  However, it is unlikely to help if the cause of histamine intolerance is a deficiency of DAO and the symptoms develop in the absence of inflammation.
Vitamin C has been shown to help in reducing the release, and aids in control, of histamine, so taking a vitamin C supplement in a form that will not increase histamine, such as ascorbic acid, is fine. Ascorbic acid lowers the histamine level, but is also a slight DAO-inhibitor. It seems that ascorbic acid has a positive effect in mast cell diseases but may have negative effects in those concerned with histamine intolerance.

Q. Can caffeine affect mast cells and cause symptoms?

A. Caffeine is a methylxanthine, related to theophylline and aminophylline, which are drugs used in conditions such as asthma.  They are bronchodilators (widen the small respiratory vessels called bronchioles), combatting the effects of inflammatory mediators such as leukotrienes which constrict the bronchioles and cause the typical symptoms of asthma.  Drinking coffee with high levels of caffeine may help asthmatics during an attack.  The effect of caffeine in the release of histamine from mast cells has been investigated in rats, where the evidence indicates that rather than increasing histamine release, caffeine decreases the release of inflammatory mediators, including histamine. (1)  However, theophylline, and therefore possibly caffeine, can block the effect of DAO (2), so although it does not trigger the release of histamine from mast cells it may reduce the break-down of excess histamine and thereby increase the likelihood of excess histamine accumulating.

Q. Can Benadryl really block HNMT? I've read it on websites like this one.

A.  Benadryl is an antihistamine.  Antihistamines are similar in structure to histamine and act by blocking receptors on cells that would normally be available for coupling to histamine.  As a result, histamine cannot attach to the receptor and is unable to enter the cell and “turn on” its activity.  Histamine N-methyltransferase (HNMT) is the enzyme that uncouples histamine from the cell after histamine’s effects have occurred and the amine is no longer needed. So the effects of Benadryl and HNMT do not actually influence each other directly.  Benadryl stops histamine from reaching the cell.  HNMT uncouples the histamine after it has interacted with the cell – which of course, it could not do if the receptor had been blocked by Benadryl beforehand.  A bit of a circuitous answer – but I hope you follow the explanation.

Q.  Could ketotifen help people with histamine intolerance?

A.  That depends on the cause of the histamine intolerance.  If excess histamine is a result of increased release of histamine from mast cells in conditions such as allergy and mast cell disorders, ketotifen will stabilize the mast cell and reduce or block the release of inflammatory mediators, including histamine.  If the histamine intolerance is a result of DAO deficiency, stabilizing mast cells is unlikely to solve the problem as histamine will be coming from other sources such as foods and the products of microbial activity in the digestive tract.

You can buy DAO supplements here in the UK or here in the US.

Q. Is tinnitus a common symptom for HIT?

A. Tinnitus has many different causes.  Some of these may involve inflammation, which is always associated with an increase in histamine.  So, histamine excess can result from the condition that is the cause of the tinnitus.  Tinnitus can be one of the symptoms associated with allergy in the upper respiratory tract, which, of course, involves the release of histamine.  It is suggested that histamine resulting from the allergic reaction causes swelling in the small semi-circular canals in the ear, which in turn may affect the adjacent nerves and cause tinnitus.  So, although it is certainly a possible symptom of the effects of histamine, tinnitus is not a common symptom of histamine intolerance.

1.Teraoka H1, Akiba H, Takai R, Taneike T, Hiraga T, Ohga A. Inhibitory effects of caffeine on Ca2+ influx and histamine secretion independent of cAMP in rat peritoneal mast cells. Gen Pharmacol. 1997 Feb;28(2):237-43.
2.Fritzsche, D.  GU Kompass Nahrungsmittel Intoleranzen, Laktose, Fruktose, Histamin, Gräfe und Unzer Verlag, 1. Auflage 2009.


You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

For more questions and Dr Joneja's answers see the top of the page.

4th April 2015

Question:

I am 72 female, diagnosed Type 1 Diabetes six years ago, following Chicken Pox and what I thought were Food Allergies.

Following manic itching, aches and pains, glands under my arms very swollen and a horrendous rash in hot countries, my GP prescribed 200 mg of Antihistamine ongoing for about three months now, including my holiday in Sri Lanka.  The Antihistamine seems to do the trick at that dose.

I wonder if I need more specialist care.  I am seeing a new London based Diabetic Specialist next week.  Also, would a low Histamine diet be very useful?   I am already on a restricted diet for diabetes and don't want more restrictions unless it would make a big difference.

Dr Joneja says:

The fact that antihistamines are helping you definitely suggests that excess histamine is playing a significant role in your symptoms. However, before reaching any conclusions as to the desirability of you following a low histamine diet we need to look at the situation further.

Itching and rash are almost invariably associated with excess histamine.  However, the excess often comes from the immune system releasing inflammatory mediators in fighting threats to the body, such as infection, trauma, and autoimmune disease, among others. You do not provide details of when you had chicken pox, nor the nature of the “food allergies”, so it is not possible for me to reach any conclusions as to whether these events might have been triggers for release of the excess histamine.  If you have no previous history of symptoms that would indicate histamine intolerance prior to the chickenpox, it is likely that excess histamine could result from that source and would be properly controlled by the use of antihistamines rather than diet.

 Furthermore, there is no scientific evidence for an association between Type I diabetes and histamine sensitivity.

I would suggest that over time your symptoms will diminish and that in the meantime antihistamines would be the best method of control.  However, if after several months your symptoms have not abated, a time-limited trial on a histamine-restricted diet will definitely tell you if a dietary approach will allow you to remain symptom-free without the need for antihistamines.  You will need the help of a registered dietitian to develop a diet that will avoid the histamine-associated foods and incorporate the foods allowed on the histamine-restricted diet into your diabetic meal plans.  It is not a difficult process, but does require careful planning to achieve a diet that provides all the nutrients you require in the appropriate quantities and at the times indicated by your insulin intake, while avoiding those foods that could trigger a reaction.

You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

For more questions and Dr Joneja's answers see the top of the page.

30th March 2015

Question:

I have intermittently (noticeable over the past 20 years) suffered with bouts of severe fatigue, akin to iron deficiency, but I felt that something was 'up' - my glands felt swollen around my neck and at the back, shooting pains in my head sometimes. This has a very physical reality for me and has periodically effected my work. A few years ago it was so severe that, after successive blood tests showing nothing I was about to be sent down the route of CFS diagnosis - although I was constantly told it was probably depression and that I should take ADs.

I have always thought it might be food related but was told that my symptoms didn't match allergy. However, through trial and error I identified the following triggers (still working on it): soy (when I was really bad I was drinking soy milk each day and my favourite food was miso based anything); cinnamon; smoked salmon; Parma ham; certain cheeses; some dessert wines and prosecco.

Does this sound like it could be a response to histamine?

Dr Joneja says:

There are two distinct parts to your question: the first relating to your clinical symptoms; the second to your observations regarding your response to specific foods.  In neither case is it possible for me to answer definitively because I do not have details of your medical history, nor the results of any tests you may have undergone.  Having said that, I will discuss both questions in light of their possible relationship to histamine intolerance.

Severe fatigue, swollen glands and shooting pains in your head as isolated symptoms do not suggest either food allergy or histamine intolerance.  I am assuming that your doctors have considered other diagnoses.  Sometimes blood tests alone are inadequate and more extensive investigations are required to determine possible causes.  I would encourage you to seek further help in looking for the underlying mechanism for these symptoms.  Too often “depression” or “psychosomatic illness” are suggested as causes for conditions that are not identifiable by standard blood tests.  Continue to pursue a definitive diagnosis and do not accept this facile dismissal without further investigations if your symptoms continue to be a significant problem.

You have  stated that “through trial and error” you have determined soy, miso, cinnamon, smoked salmon, Parma ham, cheeses, prosecco and some wines to be triggers for your symptoms.  These foods, as you are aware, are all likely to increase histamine, and if you are indeed histamine sensitive, you could expect your symptoms to increase after consuming these foods.  However, histamine sensitivity or intolerance is unlike allergy in that an immediate reaction to a histamine-containing or releasing food is not to be expected.  The level of histamine in the body builds up over time (usually hours) and when it exceeds your individual “limit of tolerance” (the level above which you develop symptoms) you will experience signs of histamine excess, a list of which you can find in my various publications. Consuming a single histamine-rich food will not result in immediate symptoms, as one would expect with a typical food allergy.
 
To find out whether your symptoms are related to histamine intolerance, you need to follow my histamine-restricted diet closely for 2 to 4 weeks.  If your symptoms remit you may assume that indeed you are histamine sensitive and will need to follow a histamine-restricted diet for the long term.  It is not possible to make a diagnosis of histamine intolerance merely on the observations that histamine-associated foods seem to trigger a reaction.

I do hope that this is helpful in your quest for good health.


You can buy all of Dr Joneja's books here in the UK or here in the US and you can buy DAO supplements here in the UK or here in the US.

For more questions and Dr Joneja's answers see the top of the page.

27th March 2015

Question:

I'm an Indian male, 49 from Durban, South Africa. I've recently heard of histamine intolerance and I don't think there's advanced treatment here.
Most of my life I've suffered with facial skin problems like acne, cysts, red bumps, hyperpigmentation, specifically affected by nuts, cheese, cream, ice cream, caffeine, chocolate, cola, herbal tea(green). Now all these are high in histamine. Last year I had folliculitus as well but it was treated quickly. My nose gets congested and runny and my face flushes after certain meals as well.
I had a few cysts a few weeks ago. I was drinking a lot of red wine and eating viennas and polony during that two weeks. These are high histamine so I'm sure that's the cause. I've tried the low histamine diet since then and it seems to help a lot.

I tried a cetirizine antihistamine once but it caused severe constipation so I'm afraid. There's no DAO supplements available locally.
I've been searching for natural antihistamines but now I'm very concerned and confused. Many foods that are restricted on your HIT diet are listed as antihistamines, eg, tomatoes, citrus fruits, strawberries, spinach, tea, wine, beans, bananas, fish, etc. How can these foods be high in histamine and antihistamines at the same time? Please elaborate.
I make my own sauerkraut and fermented veggies but I have just a teaspoon every morning. It doesn't seem to affect me, so is it okay? Isn't it unhealthy not to have probiotics, and won't it cause more serious health problems? I heard that supplements are okay.
Is apple cider vinegar okay? Its an antihistamine but vinegar is high histamine. Is there a guideline to how much histamine foods contain and how much is allowed per day?

Dr Joneja says:

It is clear from your question that you misunderstand the terms, “histamine” and “antihistamine”.  Contrary to your statement, there are no antihistamine containing foods. The term “antihistamine” was coined as a name for the chemicals developed in a laboratory to counteract the effects of histamine.  Antihistamines have the same structure as histamine and like a key in a lock, block histamine receptors on cells so that histamine cannot gain access to the cell and “turn on” the histamine effects.  In simple terms, antihistamines lock the door and don’t allow histamines to get in to do their work.  As a result, symptoms of histamine excess are prevented.

The foods you claim as “listed as antihistamines” are in fact all high in histamine and are not allowed on a histamine-restricted diet.  I do not know where you obtained this “list of antihistamine foods”, but wherever it came from, it is entirely wrong!

Sauerkraut and fermented vegetables all contain histamine and will contribute to the total level of histamine in your body, regardless of how much you consume.  In order to reduce your total body histamine to a tolerable level you need to avoid all sources of histamine in your diet.  This includes all the foods you have erroneously listed as containing antihistamines as well as any vinegar and any food that is made by a process of fermentation.
Probiotics contain live micro-organisms, some of which may have the ability to convert histidine in residual food in the colon to histamine, which may contribute to the level of histamine in the body, so on a histamine-restricted diet at this stage in our knowledge, no probiotic is allowed. It is certainly not “unhealthy” not to take probiotics; is fact it is positively unhealthy to take the wrong ones. 

The amount of histamine “allowed per day” is entirely an individual measure and depends on the person’s unique “limit of tolerance”, in other words, the amount of histamine above which symptoms develop.  A histamine-restricted diet is designed to avoid all sources of histamine so that the person’s level of histamine does not exceed their tolerable level.  We all have a certain amount of histamine in our bodies, which is constantly being made and stored to ensure adequate levels to perform essential functions in the brain, digestive system, and immunological protection.  The foods and beverages we consume can add on top of that to put a person into the symptom range, so a person at risk for histamine intolerance, or overload, should avoid all dietary sources of histamine-containing and histamine-releasing foods in order to remain as symptom-free as possible.

Response:

Thank you for your quick response.
Dr Joneja I did not misunderstand anything. Simply Google natural antihistamine. I found it the same way I found histamine intolerance. Let's take a tomato as an example. Its high histamine but also high in vitamin C, which is a natural antihistamine (lowers or blocks histamine activity). So all the websites listing antihistamine foods are fictitious? So who do we believe?

Dr Joneja says:

I do not think there is anything one can do to counteract the information abundantly available on the internet. All we can do is to provide the scientific evidence from well-researched studies. There are numerous different types of treatments based on herbalism, naturopathy, homeopathy, ayurveda, etc., etc., which in some cases may seem to contradict Western drug-based medicine. It is up to the "believer" to choose their own path.

I am a scientist and base my information and practice solely on evidence-based research. I have answered the query regarding antihistamines from that standpoint. Antihistamines were named for the chemicals designed to block histamine reaching the cell, exactly as I described in my answer. If practitioners of alternative medical modalities have used the term to mean anything that might reduce histamine in the body, we cannot argue with it. I doubt the term is patented.

There is belief that vitamin C might reduce histamine, with very limited scientific basis. However, if a person should wish to consume vitamin C as an antidote to histamine, it would be prudent for them to consume it in a form that would not increase histamine. Obviously, not as a histamine-containing or releasing food. Rather, for example, as ascorbic acid, which some formulations already prescribe. Ascorbic acid will provide vitamin C without adding to the total histamine load. As I have repeatedly said it is important that the consumer understands the different ways that supplements and ingredients in foods interact in the body and does not indiscriminately consume anything and everything recommended on the internet without sufficient knowledge.

For more questions and Dr Joneja's answers see the top of the page.

 

12th March 2015

Question:

I recently took a stool test and found out that my secretory IgA is 6X the normal range. I also checked for leaky gut and that came back normal. How can I lower secretory IgA?

Dr Joneja says:

First of all it is important that you understand the function of secretory IgA (sIgA).  It is a major antibody which is found in all mucus secretions in the body.  It is the first line of immunological defence against noxious materials, including pathogenic (disease-causing) micro-organisms and toxins that enter the body from any orifice and threaten the body’s health.  There would be no reason for you to be concerned about reducing your sIgA level per se: on the contrary, you would be more at risk if you had a deficiency of sIgA.  An abnormally high level of sIgA tells me that for some reason your immune system has been activated to increase protection in a mucus secreting area; in this case, the gastrointestinal tract since the high level of sIgA has been detected in stool.

There are several reasons for an elevated level of sIgA in stool.  It may indicate an inflammatory reaction in the digestive tract from any number of causes, such as infection by bacteria, viruses or parasites; inflammatory bowel disease of one type or another; or an autoimmune condition.  You should consult a gastroenterologist for further investigations to determine whether any pathology may be the underlying cause for your elevated sIgA.

An increase in sIgA in the digestive tract can also be a result of a diet high in fibre.  In fact, a high fibre diet is recommended for people who have a sIgA deficiency in order to boost their immune defence in the area.  Furthermore, there is preliminary evidence to suggest that sIgA may play a role in promoting the formation of biofilms (webs of microorganisms joined together) of beneficial bacteria such as lactobacilli and bifidobacteria (typically included in probiotics) and attach them to cells lining the wall of the digestive tract so that they remain within the bowel and are not so readily removed in the usual movement of material through the gut.

So, a simple answer to your question:  An elevated level of sIgA will not produce any dysfunction; it is an indicator of possible disease or imbalance, but by itself will not cause any harm to the body.  If your gastroenterologist rules out any pathological cause for your elevated sIgA, the antibody will work in your favour in enhanced protection against infection and other threats in your digestive tract. It is far better to have increased sIgA than sIgA deficiency.

You can read more about sIgA in this Foods Matter article.

For more questions and Dr Joneja's answers see the top of the page.

2nd March 2015

Question:

There is so much info on the different sites I find it confusing. I have seen a few recommendations of your site but just wanted to check if these are OK on low histamine diet

Sunflower seeds
Cashews
Figs
Dry beans – such as chickpeas
Bananas
Coconut milk

Dr Joneja says:

Unless the person is allergic to them, the following are generally safe on the histamine-restricted diet as long as they are free from any additional ingredients::

• Pure nuts and seeds, which includes sunflower seeds, cashew nuts and coconut and their derivatives such as coconut or cashew milk. The only seeds restricted are pumpkin seeds.
• Fresh figs. Dried figs are likely to contain sulphites, so are restricted. Check labels
• Legumes, including as dried beans, peas and lentils are allowed. Only soy beans and red beans in this category are restricted
• Bananas

Question:

Do you consider kale, arugula (rocket) and saskatoon berry safe to eat on a lo histamine diet?

Dr Joneja says:

Arugula (rocket) and kale are OK. Saskatoon berry: Best to avoid as many berries have a high level of benzoate, which can mediate histamine release. To my knowledge this particular berry has not yet been analysed, so best not to take the risk.

For more questions and Dr Joneja's answers see the top of the page.

23rd February 2015

Question:

I have histamine intolerance which I can usually control with careful diet and anti histamines but am now working in a building that is damp and mouldy and am feeling as if my histamine is out of control, maybe as a result of the mould.

I have a sore throat, chest pain, headaches, chills mainly in the day time and evening, hot flushes through the night, restless legs, and often cannot sleep for hours at night because I cannot switch off my brain however hard I try to relax.
 
Is there any antihistamine which would be most effective in combatting reactions to mould spores which I assume I am reacting to or any other treatment you can recommend.

Dr Joneja says:

As you will see from my previous discussions, histamine can arise in the body from a number of sources and overwhelm the enzymes that break down the excess and reduce it to a normal level. This results in an overload of histamine and the symptoms that we describe as histamine sensitivity or intolerance. 

You mention that you have histamine intolerance but do not indicate what the sources of the excess may be. If it is the result of an innate deficiency in the level of the catabolic enzymes, especially diamine oxidase (DAO), which will be indicated by early onset of symptoms (often at puberty) and a family history of the condition, you will need to avoid any situation that will increase your body’s histamine. The most important source of the excess is usually allergy. In your case I would suspect a mould allergy.  Have you ever been tested for environmental and air-borne allergens? If not, it would be a good idea to find out if you do indeed have such an allergy.  The symptoms you describe and the damp environment in which you are working would suggest that this is a strong possibility.

The allergic response involves an increase in the level of histamine, but in addition there will be further inflammatory mediators released, including the eicosanoids, such as prostaglandins and leukotrienes, and various other bioactive compounds. These will be responsible for some of your symptoms, so antihistamines alone will not be sufficient to provide complete relief.

As in all allergies, the most important treatment is avoidance. When you have determined your specific allergens, with the help of a qualified allergist, you will need to address the source of the allergens and remove yourself from the environment. It is unlikely that a combination of a low histamine diet, antihistamines and even supplemental DAO will be totally effective because of the effects of the other mediators involved. 

If you are unable to change your work environment it may be worthwhile to speak to an allergist about desensitisation injections against the predominant allergens. This is likely to be a long process and may or may not be successful in individual cases, but if it is imperative that you remain in that specific work environment there may be no alternative.

For further information on mould allergy, please see my article here.

For more questions and Dr Joneja's answers see the top of the page.

11th February 2015

Question:

Dr. Joneja’s  book Dealing with Food Allergies in Chapter 19 under General Instructions for Avoiding Histamine-Rich Foods lists to avoid Cottage Cheese but under Table 19.1 lists curdled mild products under foods allowed. Can you clarify for me in regards to cottage cheese being allowed or not allowed? Isn’t cottage cheese a curdled milk product?

Dr Joneja says:

Cottage cheese is a fermented milk product, produced in a process very similar to that employed in making yoghourt (yogurt), buttermilk and kefir.  The distinctive taste is a result of the products of microbial fermentation. 

Cottage cheese is made from milk that is first heat-treated, then a starter culture is added that forms the curds and whey. Usually these are then washed several times in cold water to remove the whey, the curds are then drained and, finally, given a very light dressing of cultured cream. 

Some cottage cheeses can be considered as probiotics since they contain live cultures, in the same way as probiotic yoghourts.

Just a few examples from the internet: You can find many more at “Cottage cheeses with the fewest additives” by: Dan Wich, last updated January 8, 2015

Daisy Cottage Cheese: Cultured Skim Milk, Cream, Salt, Vitamin A Palmitate.

Friendship Cottage Cheese:  Cultured Skim Milk, Milk, Nonfat Milk, Salt, Carbon Dioxide Added To Protect Freshness, Vitamin A Palmitate, and Enzyme.

Friendship Lowfat Digestive Health Cottage Cheese: Cultured Pasteurized Grade A Skim Milk, Milk, Cream, Inulin (Natural Prebiotic Dietary Fiber), Salt, Tricalcium Phosphate (A Source of Calcium), BB12 Bifidobacterium (Active Probiotic Culture), Vitamin A Palmitate, Carbon Dioxide.  Manufacturer claims live and active cultures.

Kalona SuperNatural Organic Cottage Cheese: Certified Organic Grade A Milk, Organic Grade A Cream, Celtic Sea Salt®, Organic Skim Milk, Cultures.

Nancy's All Natural Cottage Cheese: Skim Milk, Cream, Nonfat Milk Powder, L. acidophilus, B. bifidum, and 4 strains of lactic cultures, salt. Manufacturer claims live and active cultures.

All manufactured products contain lists of ingredients on the label.  Read the ingredients on a cottage cheese label and you will find that the first ingredient in almost all cases indicates “cultured milk” in some form, or “cultures” will appear within the ingredient list.  A histamine-restricted diet will exclude any food or beverage that is made by microbial fermentation because histamine and other biogenic amines are produced as a result of microbial breakdown of proteins; in the case of histamine, milk proteins containing histidine.

In contrast, microbial cultures are not used in making curdled milk products.  The curdling is achieved by a combination of heat and added acids such as citric acid, vinegar, or lemon juice.  Ricotta cheese is an example of a curdled milk product, but some manufacturers are now adding microbial cultures to improve the taste, so make sure you read all labels carefully if you wish to eat such foods while following the histamine-restricted diet.  Another curdled milk product is panir (paneer), which is familiar to people who eat Indian food.  Panir is made by boiling milk and then adding an acid such as lemon juice. This results in formation of a mixture of curds (casein) and whey (the liquid fraction).  The curds are separated by straining the curdled milk through cloth, and the liquid whey discarded, or used in other dishes.  The curds are pressed into a solid block, which is the panir that is usually made into a curry dish.

Further query:

Thank you for the details. Just one more clarification please. The curdling with vinegar or lemon? That's ok although they are excluded on low histamine?

Dr Joneja says:

And as to vinegar, lemon juice, etc. as a curdling agent: all liquid is removed in the making of the cheese, so any minute residue will not be an issue.

For more questions and Dr Joneja's answers see the top of the page.

31st January 2015

Question:

I have recently been looking into histamine as a cause for a few of my problems and I would like to get your take on it if you don't mind.

I believe I have a histamine intolerance. Below are a few things I have been experiencing for quite some time now:

1. My skin gets really itchy and when I scratch it, it turns bright red within a matter of seconds. My dermatologist said it is Dermographism although I do not get big welts. I read Dermographism is from the body creating too much histamine. My skin also may not be itchy bit just gets red blotches on it for no reason. I have attached a picture here.

2. I suffer from Anxiety and Panic Attacks.

3. My feet get really hot at night and my body temperature rises.

4. I have a hard time getting to sleep and staying asleep.

5. I blow my nose a lot.

6. I wake up never feeling rested.

7. My eyes burn sometimes and I cannot tolerate really bright day light.

8. I have been diagnosed with IBS (although it seems to be getting better).

9. My glucose fasting was 6.1 and suggests pre-diabetes even though I exercise regularly. I am 5' 8" and weigh 128 pounds so I am not overweight.

10. My A.M. cortisol was 743 (so very high).

11. Abdominal pain followed by abnormal discharge (this has been happening on and off for years).

12. PMS

Those are just a few of my symptoms. I know Histamine Intolerance is hard to diagnose so I'm not even sure that I do have it but my doctor seems to think changing my diet cannot hurt and may be a good thing to try. I have switched to a low histamine diet a couple of days ago and have added the below vitamins into my diet (I may be overdoing it on the vitamins so please tell me if I am).

I am taking:

Vitamin D
Inositol
Theanine
Methylsulfonylmethane
Quercetin
Phosphorylated Serine
Holy Basil/Rhodiola
Vitamin C
B6
Marine Algae
Magnesium Byglycinate
Phosphatidyl Choline
Magnesium Citrate

I would really appreciate your thoughts on all of this.

 

Dr Joneja says:

You are correct that your symptoms strongly suggest histamine excess, which can be considered as histamine intolerance or sensitivity.  Excessive amounts of histamine in your body account for the symptoms, but there are many reasons for high histamine levels, so tests for histamine intolerance per se are usually unhelpful.  Some practitioners may test for diamine oxidase (DAO) activity.  DAO is the primary enzyme that breaks down the excess histamine, and in some cases where DAO activity is low it may account for the build-up of histamine to the level that symptoms occur. 

However, there are many other reasons for histamine levels rising beyond the tolerable level, including mast cell disorders, chronic inflammation, infection, allergy both to foods and environmental allergens, autoimmune conditions, hormonal fluctuations, stress, in fact any condition that triggers histamine to be produced and released faster than the body can clear it.  Without a good medical history I cannot suggest what the initial trigger for your histamine excess may have been, nor what is causing your on-going problems.  I hope that your doctor has ruled out the most important conditions that would result in excessive histamine.  Obviously, if the source of the excess histamine is not addressed, symptoms will persist.  Just a thought:  have you been under unusual stress?  This is a not uncommon cause of higher than normal cortisol levels, which you report. It may explain your excess histamine and the symptoms you are experiencing as a result.

In the meantime, it would be a good idea for you to follow a histamine-restricted diet.  This will reduce the external sources of histamine that will be adding to the histamine in your body that is already high. You indicate that you have started the histamine restricted diet, but do not tell me which diet directives you are following. Do make sure that while avoiding the “high histamine” foods you consume all the allowed foods in order to ensure a balanced, nutritionally complete diet.  You will find a list of the foods to avoid and those allowed in several of my books and publications.  Possibly the most accessible is “Dealing with Food Allergies”, published by Bull publishing company, Colorado, Pages 241-244.  The consumer factsheet “Histamine Intolerance” associated with my book, “The Health Professional’s Guide to Food Allergies and Intolerances” published by the Academy of Nutrition and Dietetics in 2013 is a comprehensive resource, but at present is only available as part of a complete package of 45 different topics on allergies and intolerances.

If you consume all of the allowed foods in adequate quantities you will be replacing all the macro and micronutrients from non-histamine associated sources, so there will be no need for you to take supplemental vitamins and minerals.  I firmly discourage all supplements while following a histamine-restricted diet.  Any manufactured supplement or “remedy” has the risk of causing imbalance in the vitamins and minerals in the body.  Absorption, production, and metabolism of the nutrients can be adversely affected and may further contribute to a person’s symptoms.  My strong advice is to discontinue all but essential medications while you are trying to diagnose and manage histamine sensitivity.

Some people do find that supplemental DAO in the form of DAOSin or Histame helps to break down the excess histamine when symptoms remain while following the histamine-restricted diet.  I would suggest that you first follow the diet for a week or two to determine whether the diet alone provides symptomatic relief.  You then might try the DAO supplement to deal with any residual symptoms or occasional lapses from the diet.  The DAO alone will not allow you to eat a “normal diet” containing histamine-rich foods, but may be useful as an adjunct when the diet alone seems inadequate in controlling your symptoms.

For more questions and Dr Joneja's answers see the top of the page.

22nd January 2015

Question:

I am wondering if you could help me get additional information for diagnosing histamine intolerance. I have not had any health professional mention this to me or test me in any way, but I have noticed a number of things:
 
- on and off sensitivity to nuts, especially walnuts for much of my life
- terrible headaches from red wine and beer (especially unfiltered/craft beers)
- occasional headaches from dark chocolate
- on and off joint pain for much of my life
- rosacea (diagnosed) and a high propensity for skin flushing in the face
- occasional headaches from drinking kombucha
- periodic, untraceable itchiness that migrates around my body, sometimes with raised bumps sometimes with no perceptible bumps
- terribly dry and itchy scalp (psoriasis or dermatitis? undiagnosed)
- terribly painful menstrual cramps (this symptom has been increasing in the last few years and gynecologists have told me I have no sign of other disorder - tend to prescribe NSAIDs, which I hate taking)
- tendency toward anxiety and occasional panic attacks
- periods of irregular heartbeat
- periods of light-headedness/dizziness/apparent low blood pressure (I have fainted from sitting too long in hot tubs, for instance)
- acid reflux of varying severity, sometimes resulting in bouts of nausea
- inability to reliably trace symptoms to any one food source and inconsistency of all above symptoms (sometimes occurring together but often not)
 
I started looking into histamine and tyramine intolerance a year ago or so, after a bout of migraine-like headaches but never really pursued it with a health professional or instituted any real changes in diet.
 
I started looking into it again this week after a particularly severe headache that started one evening and persisted more than 24 hours through the next day. This was about 1.5 weeks into a sugar detox diet (no sugar, grains, processed foods or dairy and limited fruits and starchy carbohydrates). I had also just begun a probiotic supplement that includes Lactobacillus casei and Lactobacillus bulgaricus (which I understand can increase histamine production?). The terrible headache also coincided with the start of my period and very severe menstrual cramps. My current diet includes many histamine-rich foods and I had been eating in the days and hours previous (and during, without realizing I might be making the headache worse): nuts (primarily almonds), tomatoes, eggs, cured meats, kombucha, kimchi, canned fish, bone broth, leftovers, avocados, olives, spinach, pickles, green tea, cinnamon, nutmeg, chili powder, vinegar, etc.
 
I have read that it is not great to go on an elimination diet without a diagnosis but I'm not sure I trust most doctors/nutritionists/dietitians to recognize and effectively diagnose food sensitivities or histamine intolerance... do you have advice on how to:
a. find a good dietitian who I could trust and/or
b. perform a test on myself to determine if these symptoms may be related to low-histamine tolerance?
 

From Dr Joneja:

The symptoms you describe and their pattern of onset do indeed suggest that excessive levels of histamine are a probable cause. However, histamine sensitivity, or intolerance, is not itself a diagnosis and tests are not available to diagnose it. The reason for this is because histamine excess can result from many different conditions and diseases. Allergy, mast cell disorders, chronic inflammatory conditions in any organ, hormonal fluctuations, and deficiency of the enzyme systems (especially diamine oxidase (DAO)) that maintain histamine at a normal level are just a few examples of conditions that can result in excess histamine. Some laboratories do try to measure a person’s DAO, but that, even if accurate, does not really lend itself to either a useful diagnosis or therapy because it may be only part of the problem.

The first step in finding a solution to your problems is to consult your doctors to rule out what may be the underlying cause of the histamine excess. Unless that is determined and treated, histamine sensitivity will continue. However, if no medical condition is detected, a measure of relief, either complete resolution of symptoms, or at least a reduction in their severity, can be achieved by avoiding all the sources of histamine coming from outside the body (termed extrinsic histamine) that we can control. The most important of these are in a person’s diet and environment such as allergy to airborne and contact allergens and chemicals. A further source of extrinsic histamine is the activity of micro-organisms in the intestines, especially the large bowel. You are correct that certain microorganisms do produce histamine from dietary proteins that have moved into the bowel. At this time we have no means of selectively removing these. Also, there is no probiotic that would be advisable in cases of histamine intolerance. We do know that some micro-organisms can produce DAO and thereby reduce histamine in the digestive tract, but research has not yet been carried out to determine which of these strains are safe in humans. Until we know more, I would strongly advise anyone dealing with histamine intolerance to avoid all probiotics.

You have clearly investigated the possibility that histamine in your diet is contributing to the probably already high level of histamine in your body, from wherever the latter is arising. It would be definitely beneficial for you to try a histamine restricted diet. You are correct in saying that it is usually unwise to attempt an elimination diet without a diagnosis and without supervision by a suitably qualified professional. However, sadly, there are very few of the latter who understand the dynamics of histamine intolerance at the present time. Hopefully research will lead to a greater understanding of the condition and it will enter into mainstream medical practice. In the meantime it will be quite safe for you to follow my histamine restricted diet as long as you keep in mind the most important aspect of any diet: when any foods are eliminated you must ensure that alternative sources of the excluded nutrients are substituted and that you consume a balanced, nutritionally complete diet.  A registered dietitian will be equipped to help you with that.

If, in spite of careful avoidance of all sources of histamine you find that symptoms, especially your migraine headaches, persist, we need to consider tyramine sensitivity, which you have already suspected. You have provided several pieces of information that would suggest a sensitivity to tyramine:

  • You indicate that walnuts seem to have an “on and off” effect.  This would suggest that tyramine is indeed part of your problem as walnuts contain a significant level of tyramine, but not histamine. Furthermore, the intermittent nature of your reaction to them would tend to rule out an allergic reaction to walnut.
  • Headaches after consuming red wine and dark chocolate would also implicate tyramine and other similar biogenic amines that are broken down by the enzyme system that keeps tyramine at tolerable levels, called monoamine oxidase (MOA).

A trial on a combined histamine and tyramine restricted diet would certainly be of benefit.

Details of the histamine-restricted diet with foods to avoid and those allowed can be found in several of my books, including, “Dealing with Food Allergies”, published by Bull Publishing Company, Colorado, in 2003. The histamine restricted diet is on pages 241-244. The combined histamine and tyramine restricted diet is on pages 251-254. Do ensure that you consume adequate amounts of the “Foods Allowed” while eliminating those high in histamine and tyramine. The scientific explanation of both histamine and tyramine sensitivity can be found in my more recent book, “The Health Professional’s Guide to Food Allergies and Intolerances”, and detailed dietary guidelines for both sensitivities in the accompanying consumer handouts, published by the Academy of Nutrition and Dietetics, Chicago, Illinois, in 2013.

Ed. You will also find guidance as to what foods to avoid in Dr Joneja's article on histamine intolerance on this site.

For more questions and Dr Joneja's answers see the top of the page.

19th January 2015

Question:

Over the past couple of years I've been reacting at meal times. It’s mostly evening meals and it usually involves my face turning bright red in the cheeks and across the bridge of my nose, a blotchy rash on my chest and sometimes my upper arms.

My face becomes tight and stingy / itchy, like I've brushed it mildly with a nettle. The rash is flat but slightly raised on my upper cheeks. My GP is not very helpful. It doesn't happen all of the time but fairly regularly. I've tried keeping a food diary but there's nothing that seems to tally. I thought for a time it was wheat, but if I have a sandwich at lunchtime I don't react. At teatime if I have something like a casserole then my face blows up. It’s almost like there's something building up during the day and it strikes at teatime! When I go to bed my face has started to calm, but still feels tight. Then by morning it is as if nothing has happened, and then the whole thing starts again.

Does this sound like a contender for histamine intolerance? It’s driving me around the bend.

From Dr Joneja:

The symptoms you describe and the pattern of their onset does seem to suggest that histamine is playing a significant role in your problem. Reddening, blotchy rash, and itching are all symptoms associated with histamine release. The fact that you react mostly during or after your evening meal also suggests a build-up of histamine during the day. Histamine sensitivity or intolerance, in contrast to allergy, is dose-dependent. Plasma histamine is maintained at a normal (non-symptomatic) level by the action of two enzymes systems, histamine N-methyl-transferase (HMT or HNMT) and diamine oxidase (DAO). The latter is the most important in keeping histamine at a tolerable level. When the amount of histamine in your body increases faster than the enzymes’ ability to break down the excess, symptoms such as those you describe result. The symptoms remain until the enzymes break down (catabalise) the excess and a normal histamine level is achieved. Unlike an allergy, histamine symptoms do not immediately follow ingestion of a particular food, which explains why your food diary has not been helpful in determining any specific food trigger for your reaction.

It is not possible to diagnose histamine intolerance from your question alone. To reach a diagnosis it is important to obtain a full medical history and a carefully recorded 7-day food and symptom record. The former might suggest other causes for your symptoms. The latter would be used to determine your consumption of histamine associated foods over a 24 hour to 48 hour period and its correlation with symptom development when the total intake reaches a critical level. A diagnosis of histamine intolerance is often one of exclusion: if there is no other cause for the symptoms (for example, in this case perhaps allergy or various dermatological conditions), a trial on a histamine-restricted diet would be worthwhile. If symptoms resolve on this diet, a diagnosis of histamine intolerance can be determined.

It is important that while removing histamine-containing foods and histamine-releasing foods and additives from your diet, the nutrients eliminated be obtained from alternative sources. Details of the foods to avoid and those allowed can be found in several of my books, including, “Dealing with Food Allergies”, published by Bull Publishing Company, Colorado in 2003, pages 241-244. You will see that wheat and other plain grains are not associated with histamine release, so unless you are allergic to wheat you would not expect to develop symptoms when consuming wheat, as in fact you have already observed.

For more questions and Dr Joneja's answers see the top of the page.

29th December 2014

Question:

I was wondering if you would be able to tell me if you are aware of how histamine intolerance might affect Alzheimer's. 

I am trying to help my mother and am convinced I am histamine intolerant (following some very strong antibiotics I took).  My mother also took very strong antibiotics and we saw a massive dip in her condition.  If it helps, she took antihistamines for decades.

Dr Joneja says:

You pose a very interesting question, the answer to which involves exploring the role of histamine as a neurotransmitter (a chemical that conveys signals between nerve cells).  Histamine has long been known for its function in contraction of smooth muscles, inflammation, digestive tract function, development of immunity and of course, allergy.  More recently the role of histamine in the brain has been investigated and the findings are sometimes surprising. 

Histamine and its receptors (the molecules on the surface of cells to which histamine attaches in order to “turn on” the cell’s function) in the brain are now known to be involved in learning, memory, motor control, regulation of body temperature, and regulation of food intake.  You can see that the histamine system (called the “histaminergic system” in scientific parlance) is extremely important in the normal functioning of the body.  It is when the histaminergic system is disrupted that things can go very wrong.  This disruption may involve both too much histamine, and what is less well known, too little histamine. Research is indicating that in Alzheimer’s disease, it is the latter that is the problem:  there appears to be reduced histamine in various sites within the brain (for those readers who like more information, specifically the hypothalamus, hippocampus and temporal cortex).

This might suggest that if a person with Alzheimer’s disease increased their intake of histamine, we might see improvement in their symptoms.  Unfortunately, the body is not that straightforward.  Even if we increase, or decrease, plasma histamine by a change in diet for example, this does not directly affect the level of histamine in the brain.  The brain is a very sensitive and essential organ and as such is protected from possible adverse effects of physiological processes within the body and the potentially dangerous by-products they produce by a very efficient system called the blood-brain barrier.  So in order for histamine to enter the brain it must cross that threshold, which itself may be impaired in Alzheimer’s disease.  Furthermore, histamine in the brain does not usually come from mast cells and other cells of the immune system, which are the sites where histamine for functions not involving the brain is made and stored.  Instead it is produced within the brain itself and thus does not need to cross the blood-brain barrier. Scientists are now looking at drugs that can cross the blood-brain barrier and stimulate a higher production of histamine within the brain as a possible treatment for Alzheimer’s disease.

So – a long answer to a short question; and the bottom line is:  it is unlikely that a histamine-restricted diet will help in Alzheimer’s disease, based on our present understanding of the relationship between histamine and the disease process.

For more questions and Dr Joneja's answers see the top of the page.

Question:

I was wondering if you wouldn't mind checking with Dr Joneja if the antihistamines could have caused the reduction in her brain in the first instance. My mother and her mother both had Alzheimer's and I am now curious to find out if my mother's condition could possibly have been induced rather than inherited.

From Dr Joneja:

It is completely understandable that anyone with a family history would want to find out if there is anything that they can do to avoid the development of the disease in themselves. Unfortunately, with regard to Alzheimer's disease, we know very little about the causative factors and how to avoid them. Histamine imbalance is only one of several factors that may be contributing to the condition. Disruption of the blood-brain barrier is another avenue that is being explored, as well as various physiological and biochemical imbalances within the brain. Until we know more, there is not a lot that one can do for prevention.

So sorry to be unable to be more optimistic, but I feel sure that research will eventually uncover the primary triggers for development of the disease, and then we shall be in a position to prevent it.

For more questions and Dr Joneja's answers see the top of the page.

 

Dr Janice Joneja Ph.D., RD

Dr. Janice Joneja is a researcher, educator, author, and clinical counsellor with over thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerances. Dr. Joneja holds a Ph.D. in medical microbiology and immunology and is a registered dietitian (RD). 

She has been a member of the faculty at several Canadian universities, starting her career as an Assistant Professor in the Department of Microbiology, Faculty of Science, and in the Faculty of Dentistry, at the University of British Columbia, Vancouver. Since 2001 Dr. Joneja has been a faculty member in the School of Biomedical and Molecular Sciences, at the University of Surrey, in England, teaching in the M.Sc. course in Nutritional Medicine.  For 12 years she was head of the Allergy Nutrition Program at the Vancouver Hospital and Health Sciences Centre.

Dr. Joneja is the author of six books and a dietetic practice manual on food allergy, a textbook on Irritable Bowel Syndrome, and several distance education courses. Her most recent books include “The Health Professional’s Guide to Food Allergies and Intolerances”, “Dealing with Food Allergies”, and “Dealing with Food Allergies in Babies and Children”.  Dr. Joneja’s work has been published in peer-reviewed scientific and medical journals, as well as in popular magazines.  She is a respected lecturer at universities, colleges and hospitals internationally, and regularly appears on television and radio call-in shows as an expert in her field.

Dr. Joneja is President of Vickerstaff Health Services, Inc., a practice that provides counselling for people suffering from all aspects of adverse reactions to food, and resources for the professionals and care-givers who support them.

 

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