Histamine Intolerance is it really a thing?

Histamine intolerance is a recently identified but increasingly considered condition that, whilst not life-threatening, can trigger a range of uncomfortable and often debilitating symptoms. The disparity and variety of symptoms that can be attributed to this condition are so widespread that it took time for the scientific community to observe the common denominator, and it is often misdiagnosed in general practice. 
 
This, the fifth and last article in my ‘histamine’ series, will delve into this condition that is grabbing the attention of the healthcare community, providing you with information that may help you unravel whether histamine intolerance may be a factor in your health. The article covers: 

• What is histamine intolerance?
• Which symptoms hint at a possible histamine intolerance? 
• What are the possible contributory causes? 
• The genetics of histamine intolerance 
• My top tips for lowering your ‘histamine load’.

 
What is histamine intolerance? 
 
Histamine intolerance, also known as histaminosis or histamine sensitivity, is an increasingly recognised condition that affects a significant number of people worldwide. (1,2) is usually defined as the inability to adequately breakdown histamine. 
 
Histamine is a neurotransmitter, found throughout the body, but specifically in the skin, respiratory tract, and the digestive system. It is involved in numerous processes including stomach acid production, and vasodilation (the widening of the blood vessels), but is more commonly known for its pivotal involvement in the immune response. 
 
It is believed that individuals who suffer from histamine intolerance have a deficiency or dysfunction of the DAO (diamine oxidase) or HNMT (histamine-N-methyltransferase, enzymes, which are responsible for breaking down histamine in the body. This slowing of histamine degradation leads to a possible accumulation of histamine, leading to a variety of symptoms, depending on the individual. 
 
It is thought that histamine intolerance prevalence is higher in children than in adults (3), but further studies are needed. My clinical experience, working with many infants and young children with digestive and skin symptoms, is that when true IgE allergies have been ruled out, histamine intolerance is often a route to be explored. Lowering an overall histamine load, rather than assuming that multiple food intolerances are at play, can allow children to retain the all-important macro and micronutrient variety, rather than putting them at risk of strict and restrictive elimination diets which oftentimes worsens the situation and puts their health at risk.
 
Histamine intolerance has, in the past, often been misdiagnosed as whole host of other diseases including food allergy and intolerances, urticaria, eosinophilic gastroenteritis amongst others.  When clients come to see me with negative allergy/intolerance testing, but who swear blind that such and such a food triggers a reaction, histamine intolerance is something that immediately springs to mind. 
 
Which symptoms hint at a possible histamine intolerance? 
As I’ve already explored in previous articles (see links at the end of this feature), histamine intolerance can manifest in a variety of different symptoms, hence the diagnosis difficulty. Common symptoms include: 

• Digestive issues including abdominal cramps and pain, diarrhoea, nausea, and vomiting, bloating and flatulence and acid reflux.
• Skin problems including itchy skin, urticaria and eczema.
• Respiratory symptoms including sneezing, runny or blocked nose, coughing, shortness of breath and wheezing.
• Headaches and migraines

 
What are the possible contributory causes? 
There are several possible contributory causes to histamine intolerance, but the main theory involves the concept of an overall histamine ‘load’ or the cumulative effect of several factors, including: 

• DAO and HNMT enzyme deficiencies, as mentioned above, can contribute to histamine being inadequately broken down and, therefore, more histamine circulating within the body.
• Histamine containing foods. Some foods are known to be high histamine such as spinach, avocados, and dried fruits. An accumulation of too many of these foods in the diet, can add to the histamine load.
• Histamine liberating foods. Whilst these foods don’t contain high histamine levels themselves, they are known to either provoke the liberation of histamine or slow down the action of either DAO or HNMT. These include alcohol, fermented foods and citrus fruits. 
• Gut health. Conditions such as intestinal hyperpermeability (leaky gut), small intestinal bacterial overgrowth (SIBO), or irritable bowel syndrome (IBS) can contribute to histamine load and histamine load also has a worsening effect on the symptoms of these conditions.
• Medications – some medication such as non-steroid anti-inflammatory medications which can bought over the counter and some anti-depressants can also slow histamine metabolism or trigger histamine release. 
• Stress. When your cortisol levels rise in response to stress, it may trigger mast cells to release histamine. 

 
Please note that not every individual will be affected by all the above, and this overview should only support the notion of how your overall histamine load could add up. 
 
The genetics of histamine intolerance 
 
For some experiencing histamine issues, the question of low or slow DAO or HNMT activity may stem from their genetics. DAO inactivates histamine in the gut and HNMT within the nervous system and lungs. Genetic variants on these enzymes or their pathways can lead to histamine intolerance. 
 
Nutrigenomics testing, which I offer through Lifecode Gx, can provide information on our own genes which then informs us on the nutrition and lifestyle changes we can make to align with any variants to optimise health and wellbeing. Lifecode Gx offers a specific Histamine Intolerance test. You can find out more, by clicking the link.   Nutrigenomic testing is the only form of testing that is available from the youngest age. Whilst how you eat and live your life will have an effect on whether a gene variation may have an impact, your genes themselves never change. 
 
My top tips for lowering your histamine load. 

1. Consider your histamine ‘genetics’, do you have variants that slow the metabolism of histamine? 
2. Review your daily histamine load – are you stressed? Have you eaten lots of histamine containing or histamine liberating foods? Are you taking a NSAID or other histamine releasing medication. Now consider, what out of the list you’ve drawn up can you reduce or remove so that your overall load is lessened? 
3. Be aware of food sources of histamine and histamine liberating foods. Try to not have too many in one day or all at one time. Eliminating more and more foods is not the answer and could be very dangerous for your health. Consulting with a nutrition professional is recommended. Follow this link for a list of common high-histamine foods.
4. For some, but not all, DAO supplementation before higher histamine meals can be helpful. 
5. Increase antioxidant and anti-inflammatory foods such as green leafy vegetables (except for spinach, which is high histamine), oily fish and ginger. 
6. Introduce daily activities that help balance your stress. What activity can you do without leaving your home, for 10-15 minutes that brings you joy and lowers your heart rate? Consider drafting a list and committing to doing at least one of those activities daily. 

 
If on medication, please speak to your GP/consultant before making any changes to your diet. 
 
If you are interested in histamine and its impact on symptoms, this article is the second in a series I am currently publishing covering.  The series in total will include:

1. What is the histamine and eczema/dermatitis link? (Already published, view using the link)
2. What’s the histamine and gut health connection? (Already published, view using the link)
3. What is the histamine and auto-immune conditions link (Already published, view using the link)
4. Histamine and oestrogen – why histamine may trigger skin and gut issues at the menopause. ((Already published, view using the link)
5. Histamine Intolerance is it really a thing? (Today's article)

 
Sign up for my news to receive the published articles straight to your inbox. 
 
Read more by clicking below to see my previously published articles: 

• 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? 
  
  

Who Am I? 
​
I’m Jessica Fonteneau, the Eczema and Digestive Health Nutrition Expert. I’ve worked with hundreds of clients to help them change their diets, better manage their flares, and find relief.
 
My vocation is to help those with eczema and digestive issues, because I have suffered with these interlinked conditions since I was 6 months old, and I truly know what it is like to experience these debilitating conditions. 
 
Every client I have ever worked with has their own triggers and ideal nutrition. There is no such thing as ‘one-size-fits-all’. Whether you work with me one-to-one or use my guided tools, my objective is to help you uncover what works best for you, so that you take back control and experience relief. 
 
My guided programmes are only suitable for adults as children have very specific nutrition requirements. I do, however, work with many child clients as part of my clinic. 
 
I also offer two free communities for adults caring for children with eczema and digestive symptoms, feel free to come and join us and get some well-deserved support. 

• Free community for adults with skin and/or digestive issues
• Free community for carers of children with skin and/or digestive issues

 
To easily keep up with my articles, masterclasses, ebooks and online programmes and receive exclusive access to early bird offers, sign-up to my newsletter.  
 
Interested in what I do and who I am? Go to my website: www.jessicafonteneaunutrition.com
 
References: 

1. Schnedl WJ, Enko D. Histamine Intolerance Originates in the Gut. Vol. 13, Nutrients. 2021. 
2. Zhao Y, Zhang X, Jin H, Chen L, Ji J, Zhang Z. Histamine Intolerance—A Kind of Pseudoallergic Reaction. Biomolecules. 2022;12(3):40–8.
3. Martin H, Radoslav D, Huorka M, Wawruch M. Histamine Intolerance — The More We Know the Less We Know. Nutrients. 2021;13:1–21. 

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