Histamine and Skin, digestive and autoimmune conditions - there a link?

Every so often a new health buzz word emerges. The new “thing” that, once resolved, will, theoretically, solve everything.  
 
From the questions I get within my community forums or from clients, histamine seems to be the current molecule of interest, particularly in relation to skin, gut and autoimmune issues, but does it deserve this notoriety?  
 
There is a lot to unpick regarding histamine, so I have divided the topic into 5 separate articles. The first is published below and the next four will follow over the next month, so keep watching this space or sign-up for my emails to receive the articles direct to your inbox: 

1. What is the histamine and eczema/dermatitis link?
2. What is the histamine and gut health link? 
3. What is the histamine and auto-immune conditions link? 
4. Histamine and oestrogen – why histamine may trigger skin and gut issues at the menopause.
5. Histamine Intolerance is it really a thing? 

 
What is the histamine and eczema/dermatitis link? 
Today’s article covers: 

• What is histamine? 
• Histamine and the immune system, how does it work? 
• Histamine and eczema, what’s the link? 
• Which eczema types are most linked to histamine.
• My top tips for managing histamine as an eczema/dermatitis trigger.

 
What is histamine? 
 
Histamine is a neurotransmitter, produced by mast cells, found throughout the body, but specifically in the skin, respiratory system, and the gastrointestinal tract, but also by basophils, a type of white blood cell which is involved in an immune reaction. 
 
Histamine is mostly known for its involvement in the immune response cascade (one reaction, causing the next and so on).  This neurotransmitter is directly responsible for itching, redness and swelling (inflammation) but is also involved in numerous other processes including stomach acid, contraction of smooth muscle (muscles involved with respiration and digestion amongst others), and the dilation of blood vessels. 
 
Whilst histamine, the neurotransmitter, is the main driver, there are four different types of histamine receptors (H Receptors) which determine the type or location of a histamine response. (2,3)

• H1 receptors are linked to anaphylactic shock and shortness of breath, the most dangerous of all allergic reactions. However, on the flipside, H1 receptors also involve histamine in sleep-wake cycles, body temperature regulation, emotions, especially anger (think of that momentary hot flush), memory, and learning.  Most histamine related skin reactions are linked to this first category of H receptors.

• H2 receptors are mainly found in the digestive tract and heart and can be linked to stomach acid, low blood pressure, rapid heart rate and headaches.
• H3 receptors manage histamine release from mast cells and neurons within the brain and can be linked to mood via dopamine, serotonin, noradrenaline, and acetylcholine. 
• H4 receptors are found in bone marrow and are linked to the production of red blood cells, but also inflammatory disorders and autoimmune conditions. 

 
Histamine and the immune system, how does it work? 
 
When the body encounters an allergen, be it environmental (pollen or dust mites, for example) or food (e.g., gluten, dairy etc.) the immune system responds by producing immunoglobulin E (IgE) antibodies which bind to mast cells and basophils which then trigger the release of histamine. 
 
Histamine release makes blood vessels dilate resulting in blood rushing to the area and leading to the common signs of inflammation: redness, itching and swelling. 
 
Histamine is also involved in the inflammatory response when tissue (or skin) is damaged or infected, causing the blood vessels dilate, drawing blood flow and delivering white blood cells to the damaged area which then help to fight off possible infection.
 
Histamine and eczema/dermatitis – what is the link? 
 
Atopic Eczema alone affects an estimated 20% of children and 10% of adults in the Western world (1), which is an absolutely massive number of people.  If you suffer from any type of eczema/dermatitis you already know that it is a chronic inflammatory skin condition that can be dry, itchy, and inflamed, all symptoms linked to a histamine response. 
 
Most researchers agree that there is a link between histamine and eczema/dermatitis. Histamine triggers inflammation, causing itchiness, redness, swelling and testing has identified that individuals suffering from an eczema/dermatitis flare, have high levels of histamine. What is less clear is what the specific connection is. In other words, just as no two eczema/dermatitis sufferers appear to have the same triggers, the histamine connection may be different for everyone.  
 
In terms of current and recent research, the following three links have been specifically examined: 

1. Whether it triggers eczema/dermatitis in the first place.

1. Whether it only plays a role in exacerbating and maintaining a flare which has already been triggered.
2. Both.

 
Research suggests that histamine’s role in eczema/dermatitis may go beyond its inflammatory role.  Evidence has been found that it may contribute to the breakdown of the skin barrier, resulting in ‘Leaky Skin’, making skin less able to retain moisture and act as a protection against irritants.  This means that potential allergens and irritants cross into the body more easily, triggering an immune response. 
 
Exploring the eczema types most linked to histamine.
 
As we already know, not all eczema/dermatitis is alike, which means that not all types will necessarily have a histamine link, but those that are include:  

• Atopic eczema/dermatitis. This, the most common type of eczema, is associated to allergies and asthma and so it makessense that histamine is linked to this type. However, whilst histamine plays a role in exacerbating symptoms, it isn’t the only driver, other possible causes are low vitamin D status, a SNP on the Filaggrin gene, a poor gut microbiome, amongst others. To learn more about Atopic Eczema/Dermatitis specifically, you can read the linked article.

• Contact dermatitis. Contact dermatitis occurs when the skin comes into direct contact with an allergen or irritant, which can cause an inflammatory response involving histamine. Some of the main triggers for this type of eczema include metals eg. nickel, fragrances, cosmetics, latex, and some plants. 
• Urticaria (hives). Urticaria or hives are raised, itchy welts that appear on the skin and histamine is the main causes of this type of skin reaction. Hives can resolve quickly (which is generally considered less than six weeks) or can persist chronically, for a significant period.
• Prurigo Nodularis. This is a chronic (long-lasting) skin condition which comes up as extremely itchy lumps. Whilst the cause of Prurigo Nodularis is still unknown, histamine has been identified as being linked to the extreme itching individuals suffer.   

 
In summary, here are my 7 top tips for managing histamine as a trigger for eczema/dermatitis: 

1. Identify and avoid triggers. Use a food/environment and symptom diary to log reactions and help identify your own patterns and triggers. You can either use a form or your own diary/journal. Keeping track is essential. 
2. Adopt a low-histamine diet by avoiding some foods that are particularly high in histamine. Some of these foods include aged cheeses, fermented foods, processed meats, alcohol, tomatoes, spinach, and some types of fish.  Complete the histamine quiz here to see if you can identify whether high histamine foods may be an issue for you.
3. Avoid histamine-releasing foods. Whilst some foods aren’t high in histamine, they can trigger a histamine release from the body. These include citrus fruits, strawberries, chocolate, and nuts. Be wary about eliminating too much from your diet as you can make things worse, consider consulting with a nutrition professional. 
4. Support gut health. Histamine is metabolised and broken down in the gut, so the healthier your gut the less likely you are to be affected by histamine.  Consider adding probiotics and prebiotics to your diet. However, careful! Many foods considered good for the gut e.g., kefir and sauerkraut, can trigger histamine flares, so start small and increase rather than going all in immediately.
5. Enzyme supplements. DAO (diamine oxidase) is the enzyme responsible for breaking down histamine in the gut. Taking this supplement before a histamine rich meal may help people with naturally low levels of this enzyme, digest histamine foods better. As before, it is always better to consult with a nutrition practitioner before starting any supplementation.
6. Stress management. Did you know that stress and anxiety can trigger histamine? Include daily stress management techniques to keep yourself calm such as meditation, low impact exercise or hobbies that make your heart sing. 
7. Find out how your genetics may impact your relationship with histamine. The Lifecode Gx Histamine Intolerance test analyses the genes and nutrients needed to breakdown and remove histamine, showing where disruptions occur and how to support optimal function.  

Speak to your medical practitioner, Registered Nutritional Therapist or pharmacist adviser for further guidance. If on medication, please speak to your GP/consultant before making any changes to your diet. 


Histamine Masterclass - 1pm, Thursday 14th September. 

I will be holding an online Masterclass on histamine on Thursday 14th September 2023 at 1pm - claim your early bird ticket at £10.  Don't worry if you can't attend live, you can send your questions in advance and the Masterclass will be emailed to all attendees post the event.
 
Read more: 

• Motivated to change but struggling to stay on track? Tips for long term transformation.

• Symptoms but no idea what’s triggering them? Here are some tips to unravel the mystery.  
• Top Tips for Eating for the Planet without Compromising Your Nutrition 
• I want to eat more plant-based but pulses give me terrible digestive issues
• What is the atopic march?
• Why is eczema/atopic dermatitis itchier at night?
• You’ve been diagnosed with an atopic condition, but what does that mean? 
• Atopic dermatitis/eczema – a chronic condition that effects all ages 
• The skin microbiome, the key to good skin health  
• Autumnal Allergies – Yes, it is a thing
• If one-size-fits all diets worked, don’t you think we would have the magic formula by now? 
  
  

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1.           Nutten S. Atopic dermatitis: Global epidemiology and risk factors. Ann Nutr Metab. 2015;66:8–16. 
2.           Buddenkotte J, Maurer M, Steinhoff M. Histamine and antihistamines in atopic dermatitis. Adv Exp Med Biol. 2010;709:73–80. 
3.           Patel RH; Mohiuddin SS. Biochemistry , Histamine. 2023;32491722.