Zyp Czyk's List: Histamine

• Forty-six patients with atopic dermatitis ranging from mild to severe were evaluated for food hypersensitivity with double-blind placebo-controlled food challenges. Twenty-eight (61%) patients had a positive prick skin reaction to one of the foods tested. Sixty-five food challenges were performed; 27 (42%) were interpreted as positive in 15 (33%) patients. Egg, milk, and peanut accounted for 78% of the positive reactions. As in previous studies, patients developed skin (96%), respiratory (52%), or gastrointestinal (30%) symptoms during the challenge. These studies indicate that children who have atopic dermatitis unresponsive to routine therapy or who continue to need dally treatment after several months would benefit from evaluation for food hypersensitivity.

• Histamine intolerance is generally caused by a defect in the body’s histamine breakdown process, in one of two enzyme systems: histamine N-methyl transferase (HMT) and diamine oxidase (DAO). (1)
• Deficiency in the DAO enzyme system, found in the intestinal mucosa, has been suggested as the most probable cause of histamine intolerance. (2)
• There are likely genetic variations in individual enzyme function, but when activity of either of these enzymes is insufficient, the resulting excess of histamine may cause numerous symptoms resembling an allergic reaction. Common symptoms of histamine intolerance include: (3)
• • Pruritus (itching especially of the skin, eyes, ears, and nose)
   
  • Urticaria (hives) (sometimes diagnosed as “idiopathic urticaria”)
   
  • Tissue swelling (angioedema) especially of facial and oral tissues and sometimes the throat, the latter causing the feeling of “throat tightening”
   
  • Hypotension (drop in blood pressure)
   
  • Tachycardia (increased pulse rate, “heart racing”)
   
  • Symptoms resembling an anxiety or panic attack
   
  • Chest pain
   
  • Nasal congestion and runny nose
   
  • Conjunctivitis (irritated, watery, reddened eyes)
   
  • Some types of headaches that differ from those of migraine
   
  • Fatigue, confusion, irritability
   
  • Very occasionally loss of consciousness usually lasting for only one or two seconds
   
  • Digestive tract upset, especially heartburn, “indigestion”, and reflux
• Histamine intolerance is unlike other food allergies or sensitivities in that the response is cumulative, not immediate.
• Many integrative practitioners, including myself, believe that a primary cause of histamine intolerance is an overgrowth of certain types of bacteria that make histamine from undigested food, leading to a buildup of histamine in the gut and overwhelming the body’s ability to catabolize the excess histamine.
• What to do if you have histamine intolerance
• Fermented foods are some of the biggest culprits, since even beneficial bacteria produce histamine during fermentation. In fact, reacting to fermented foods is a classic sign of histamine intolerance, especially if probiotic supplements are well-tolerated.
•  Other foods that are high in histamine include:
• • Seafood: shellfish or fin fish, fresh, frozen, smoked or canned
   
  • Eggs
   
  • Processed, cured, smoked and fermented meats such as lunch meat, bacon, sausage, salami, pepperoni
   
  • Leftover meat (After meat is cooked, the histamine levels increase due to microbial action as the meat sits)
   
  • All fermented milk products, including most cheeses
   
  • Yogurt, buttermilk, kefir
   
  • Citrus fruits – eg. oranges, grapefruit, lemons, lime
   
  • Most berries
   
  • Dried fruit
   
  • Fermented foods: Sauerkraut, Kombucha, Pickles, Relishes, Fermented soy products, etc.
   
  • Spinach
   
  • Tomatoes- including ketchup, tomato sauces
   
  • Artificial food colors and Preservatives
   
  • Spices: Cinnamon, Chili powder, Cloves, Anise, Nutmeg, Curry powder, Cayenne
   
  • Beverages: Tea (herbal or regular), Alcohol
   
  • Chocolate, cocoa, and cola drinks
   
  • Vinegar and foods containing vinegar such as pickles, relishes, ketchup, and prepared mustard
• strict adherence to a low-histamine diet is necessary for a period of time. After that, smaller amounts of histamine may be tolerated depending on the person. Individual sensitivity varies tremendously

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• The chronic rhinosinusitis is defined as chronic inflammation of the nose and nasal sinuses, with or without nasal polyps. Patients suffering from chronic rhinosinusitis report about nasal obstruction and secretion, olfactory impairment, head and facial pain.
• First choice of therapy should be topical glucocorticoids.
• Hypertonic salt solutions improve nasal symptoms.
• An additional therapy with antihistamines is possible in patients with an allergy

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• Histamine is a tiny messaging molecule that some cells use to communicate with each other.  It is naturally found in all kinds of plants and animals.  Histamine is best known for its role in the body’s allergic response.
•  Under normal circumstances, tiny amounts of histamine are quietly conducting the daily business of the body.  It is not typically cruising recklessly through your bloodstream in large quantities, the way it is during an allergic emergency (anaphylactic shock).
• Histamine is versatile–it helps to regulate body functions as diverse as digestion, sleep, sexual function, blood pressure, and brain function
• The secret to histamine’s multi-faceted nature lies in which type of cell and which type of receptor it binds to
• In the brain, histamine acts as a neurotransmitter, carrying chemical messages between nerve cells.
• As soon as it delivers its special chemical message to its target cell it is then instantly destroyed to keep it under control.
• We all get old…but we do not rot. As long as oxygen and blood are flowing, we stay fresh as a daisy.  Meat used to be alive, but it’s not anymore.  As soon as it stops being alive, bacteria start eating it–decomposing it—fermenting it–breaking its proteins down into ever-smaller, stranger, and often smellier compounds.
• Many of these by-products are biogenic amines. Histamine is just one example of a biogenic amine
• Unlike in living tissues, the histamine that is produced during meat fermentation is not instantly destroyed—so it accumulates.  The longer meat is left out, the higher the biogenic amine content.  Histamine itself has no flavor and is odorless, so you can’t use the smell test to detect its presence.
• What are Biogenic Amines?
• A biogenic amine is a potent signaling molecule made from an amino acid. 
• Histamine, for example, is made from the common amino acid histidine (amino acids are what proteins are made of).  Meat and fish are rich in protein, so they are chock full of amino acids.
• To turn a garden variety amino acid into a powerful biogenic amine, you need to remove its carboxyl group. To accomplish this you need a special enzyme called a decarboxylase
• Many species of bacteria and yeast contain the enzyme histidine decarboxylase (HDC), which turns histidine into histamine. So, when meat (or fish) is not immediately consumed or frozen, bacteria get straight to work breaking down the amino acids within it, and one of the by-products is histamine.
• Foods High in Histamine
•  Levels exceeding 2 mg/L in beverages and 100 mg/kg in foods are considered risky

• Alcoholic Beverages

   

  Red wine         up to 24 mg/Lite

• Plant Foods

   

  Most (fresh) vegetables are very low in histamine, with levels ranging from 0 to 16 mg/kg.  The notable exceptions are tomatoes, eggplant, and spinach:

• Meat

   

  Most fresh meats are very low in histamine, with the exception of ground/chopped beef products

• Fish

   

  Like other animal foods, fresh fish is very low in histamine, whereas levels in canned tuna range from zero to as high as 40.5 mg/kg
• We could not find any study on histamine-releasing effects of most of the foods suggested of having histamine-releasing capacities…there are no DBPCFC (double-blind placebo-controlled food challenge) studies in human beings supporting the widely held belief that foods should have histamine-releasing capacity.
• ” [Vlieg-Boerstra 2005]
• What is Histamine Intolerance?
• “The term “histamine intolerance” was introduced as common denominator for symptoms such as abdominal pain, flatulence, diarrhoea, headache, pruritus (itching), blepharedemas (puffy eyes), urticaria (hives), rhinorrhea (runny nose), dysmenorrhea (menstrual cycle problems), respiratory obstruction (difficulty breathing), tachycardia (racing heart), extrasystoles (palpitations) and hypotension (low blood pressure) occurring after the consumption of histamine-rich foods.” [Komericki 2010]
• estrogen and histamine reinforce each other—histamine can increase estrogen levels and vice versa, which may explain why histamine intolerance is associated with pre-menstrual cramps and menstrual migraine. 
• Histamine intolerance may be caused by abnormally low levels of DAO.  DAO is found, among other places, in the membranes of cells lining the small intestine and the upper portion of the colon, therefore people with damaged gastrointestinal systems seem to be at higher risk for histamine intolerance.
• Is Histamine Intolerance Real?
• “Of the studies performed on the adverse effects of biogenic amines, only a few are methodologically acceptable. Although this limits the conclusions that may be reached, the current scientific literature does not show a relation between the oral ingestion of biogenic amines and food intolerance reactions. There is therefore no scientific basis for dietary recommendations concerning biogenic amines in such patients.” [Jansen 2003]
• “The concept of histamine intolerance as a metabolic disease is in need of more experimental and clinical evidence and affected patients will benefit from a clear, evidence-based, diagnostic and therapeutic regime.” [Schwelberger 2010].
• The way I tend to think about these things is this:  if you notice that foods high in histamine and other biogenic amines bother you, you do not need a scientist or a doctor to prove you right or wrong.
• If you suspect you have HI, here are some options which may help you to feel better:
• HDC, the enzyme that turns histidine into histamine, can remain in foods even after the bacteria (or yeast) that produced that enzyme have died
• However, HDC can be inactivated by freezing for 1-2 weeks, and is destroyed by cooking.
• Histamine itself is NOT destroyed by cooking, freezing, hot smoking, or canning. Therefore, once it has been produced, you are stuck with it

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• Background. Histamine intolerance results from an imbalance between histamine intake and degradation. In healthy persons, dietary histamine can be sufficiently metabolized by amine oxidases, whereas persons with low amine oxidase activity are at risk of histamine toxicity. Diamine oxidase (DAO) is the key enzyme in degradation.
• Histamine elicits a wide range of effects. Histamine intolerance displays symptoms, such as rhinitis, headache, gastrointestinal symptoms, palpitations, urticaria and pruritus.
• Histamine is metabolized in the skin [15]
• A link between histamine and altered mental state has been published. In Kounis-syndrome, among others, depression is said to activate not only a cascade of inflammatory mediators like TNF-alfa, but also triggers mast cells to release histamine: ultimately this leads to symptoms of a coronary syndrome without morphological abnormalities in affected patients [17, 18].
• The mast cells are the major effector cell in immediate hypersensitivity Also the growing importance role of histamine in the amine system in the brain and augmented peripheral histamine effects caused by stress has been elucidated [19].
• Almost all of these clinically relevant effects are mediated through H1 receptors, whereas H2 receptors can be mainly found in gastric, cardiac and some gland tissue. Therefore, most acute histamine effects can adequately be treated with H1 antihistamines.
• We showed, that patients with histamine intolerance and a control group do not remarkably differ in the size of their histamine wheals (Figure 3), but remarkably in their time course of the histamine wheals ≥3mm read at different time points (P < .0001). This difference in skin prick test allows discriminating for histamine intolerance with sufficient sensitivity and specificity.

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