Histamine intolerance: symptoms and treatment

Histamine intolerance: symptoms and treatment

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With a histamine intolerance or histamine intolerance is not an allergy, but an intolerance. It occurs primarily in women between the ages of 35 and 40. We show how symptoms express themselves and which treatment can be considered.


Histamine belongs to the group of biogenic amines, which have a wide variety of functions in the human body. This substance is released during allergic reactions and inflammation, it controls gastric juice production, leads to the enlargement of some large vessels and is also present in the central nervous system.

Histamine is broken down in two different ways. The enzyme DAO (diamine oxidase), which is mainly formed in the intestinal mucosa, breaks down extracellular histamine. With this, the hormone can be eliminated in the food porridge. HNMT (histamine-N-methyltransferase), on the other hand, occurs intracellularly and is primarily involved in the liver in dealing with histamine.

A rapid reaction in the form of symptoms such as diarrhea, rash, stomach cramps is typical of histamine intolerance. With the help of diarrhea, the body wants to try to get rid of histamine as quickly as possible. Long-term symptoms such as exhaustion or mood swings are also possible.

How histamine works in the body

Histamine is a completely natural substance that is formed in the body and performs very important functions. So this is mainly involved in inflammatory and allergic reactions. Histamine causes swelling, the blood vessels to expand and the walls of the vessel to become more permeable. In this way, the location of the event is better supplied with blood and the defense cells can find the way easier and faster.

With an allergy, a lot of histamine is released, which leads to the well-known allergy symptoms. With histamine intolerance, however, this is different. Here the body cannot break down the histamine. The mechanisms required for this no longer work properly. In particular, food that is high in histamine leads to an excess of histamine, whereupon a wide variety of symptoms can develop.

Cause: reduced DAO activity

Various causes are responsible for the development of histamine intolerance. The enzyme DAO, which is mainly active in the intestine, is normally able to break down the histamine that is no longer needed. However, if this is reduced, histamine intolerance can result. Too much histamine gets into the bloodstream, which can cause various physical symptoms.

There are also DAO-blocking drugs or active ingredients that can inhibit the activity of the important enzyme. This includes, for example, metoclopromide, which is contained in medicines that affect motility. Likewise, alcohol and nicotine can inhibit DAO activity. Vitamin C and copper are important for the synthesis of this enzyme. If these micronutrients are reduced, this can ultimately also lead to histamine intolerance.

As mentioned, DAO is mainly found in the intestinal mucosa. If this is disturbed in its function, this can lead to a histamine intolerance. For example, after antibiotic therapy, the intestinal flora is often in an imbalance. Bowel diseases such as ulcerative colitis, Crohn's disease, sprue or celiac disease or leaky gut syndrome are also held responsible and can be the reason for HIT. An intestinal dysbiosis, caused by fungal infestation or an imbalance in the physiological intestinal bacteria, is also one of the possible causes of a disturbed intestinal mucosa.

Another reason for histamine-induced complaints is the existence of a so-called estrogen dominance. This often occurs in the premenopausal phase but also in connection with other hormone changes in a woman's life. Conversely, the existing histamine stimulates the production of estrogen. In this context, it was also found that in women who suffer from histamine allergy, their symptoms decrease during pregnancy because during this time the female body produces a lot of progesterone, which is the antagonist of estrogen.

Histamine intolerance due to impaired activity of the DAO enzyme can also be congenital in rare cases.

Cause: decreased HNMT activity

HNMT is responsible for the intracellular breakdown of histamine and is found primarily in the liver, but also in the skin, in the respiratory tract and in the central nervous system.

Vitamins B 9 and B 12 are cofactors for the synthesis of HNMT. These substances may be missing due to malnutrition or malnutrition, pancreatic insufficiency or diseases of the gastrointestinal tract. Likewise, liver weakness or liver diseases may be "to blame" for the presence of histamine intolerance. In addition, the reduced activity of the HNMT can be innate.

Complaints with increased histamine levels

A large number of complaints can arise from added histamine, especially contained in foods. For example, diseases in the head area, such as migraines or headaches, are possible. Furthermore, the respiratory system, the digestive tract or the cardiovascular system can react to increased histamine levels. Edema formation, exhaustion, joint problems, skin diseases or a weak immune system are also possible.

Histamine intolerance symptoms

The symptoms of histamine intolerance differ due to the underlying cause. Is there insufficient DAO or is the enzyme HMNT missing or are both possibly affected? If only DAO is reduced, this is called acute form. If there is not enough HNMT, the experts speak of the chronic form. In the acute form, the symptoms appear relatively suddenly or in batches; in the chronic form, they start very slowly and gradually increase. The complaints are very individual. Typical key symptoms are swollen nasal mucosa with a runny nose, sneezing, coughing and difficulty breathing. In addition, there are problems in the digestive tract, such as sudden or relapsing diarrhea, flatulence, bloated stomach, abdominal pain, nausea and vomiting. The skin often reacts with redness and itching, on the face through so-called flush (flushing), sweating, rapid heartbeat and irregular heartbeat. A drop in blood pressure, headache, migraines, fatigue, menstrual disorders and edema formation are also possible. The patient can be affected by several symptoms at the same time, but only one symptom is possible. The expression is very individual.

If the food is heavily loaded with histamine, abdominal cramps and acute diarrhea sometimes occur within fifteen minutes after eating. Other possible complaints in connection with histamine intolerance are blemishes, grater skin, mouth ulcers, chronic coughing, urticaria, eczema, difficulty concentrating, sleep disorders, restlessness, melancholy, muscle twitching, flu-like symptoms, tonsillitis, a lump in the throat and much more.

Often alcohol is not tolerated at all or only in small quantities. Above all, red wine should be mentioned as a cause of complaints, since it is rich in histamine.

Food histamine intake

Histamine intolerance is a fairly complicated and as yet unresolved issue. The tables on histamine-containing foods that are published in connection with the disease also differ. Foods that have been subjected to fermentation, maturation or fermentation processes with the help of bacteria, yeast or alcohol usually contain a large amount of histamine. Finished products, canned goods and foods that have been stored for a long time are also included. Other foods that can cause symptoms of histamine intolerance are cured, smoked, dried, but also very minced or even pureed meat, as is included in some spreads. Offal and egg yolk are also possible triggers for the symptoms. There are different opinions about the egg white.

Fresh fish is considered to be low in histamine in fish. In contrast, older fish, smoked, marinated or salted, has a significantly higher histamine content. Marine animals such as mussels, crabs, shrimp and crabs are also among the "contaminated" foods.

The rule for cheeses is that the ripe the cheese, the more histamine is present. Pastries and wheat containing yeast are also histamine-containing. Vegetables such as sauerkraut, tomatoes, aubergines, spinach and avocados as well as legumes such as beans, lentils and soy should also be avoided if there is a histamine intolerance. In addition, citrus fruits, bananas, pineapples, kiwi, strawberries and papaya and nuts are among the "dangerous" foods. Cocoa, alcohol, black tea, chocolate and hot spices must not be left out here.

Substances that inhibit diamine oxidase

As already mentioned, the substances which inhibit the diamine oxidase include some medicament active ingredients, such as, for example, pancuronium, thiopental, dobutamine, aminophylline. Alcohol and certain biogenic amines - contained in pineapple, pear grapefruit, raspberries, legumes, wheat germ, papaya, oranges and bananas - are also included.

Substances that increase intestinal permeability

If the intestinal permeability is increased, macromolecules can enter the body via the digestive tract. It is believed that hot spices make the intestine more permeable and thus histamine is better absorbed.

Acidification - connection with histamine

Histamine is formed in the gastric mucosa. The more acids that have to be processed, the more of this substance is produced. In this way, acidification is also associated with histamine intolerance. The too much histamine also leads to an increased allergy and an increased tendency to inflammation.

Additives that contain histamine

Additives identified by E numbers can also contain histamine. Examples of this are certain preservatives, nitrates or dyes.


A detailed medical history is important for the diagnosis of histamine intolerance. Complaints, possibly in connection with the intake of certain foods, should be described in detail. Diseases such as irritable bowel syndrome, lactose intolerance, fructose intolerance and celiac disease are differentiated by differential diagnosis. Blood and urine tests are done. An elimination diet, in which all histamine-containing foods are avoided for a few weeks, is important in order to be able to make a reliable diagnosis. The lack of one of the vitamins B9, B12, C or the trace element copper could indicate histamine intolerance. Existing liver disease or bowel disease may be related to the occurrence of HIT.

Histamine intolerance treatment

Avoiding certain foods is enough in many cases. Otherwise, after an elimination diet that lasts a few weeks, one or the other food is gradually put back on the menu. This is where the doctor and dietitian help. Rice and potatoes are recommended during the diet, as this reduces the amount of histamine in the blood. Medicines such as antihistamines and / or enzymes may need to be administered. Substitution with vitamins B 9, B 12, C or the trace element copper is also possible.

Existing diseases and disorders that may be the cause of histamine intolerance are treated as far as possible. For example, after a long period of taking antibiotics, a colon cleansing may be advised, if the patient is overacidified, the diet is reconsidered and a diet plan with low-alkaline diet is drawn up. In addition, agents such as daosin can also be taken. These also break down histamine. However, Dao should be taken at least 10 minutes before a meal so that a corresponding effect can be achieved. (sw)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Susanne Waschke, Barbara Schindewolf-Lensch


  • German Allergy and Asthma Association: histamine intolerance (access: August 16, 2019), daab.de
  • Bavarian State Ministry for the Environment and Consumer Protection: Histamine intolerance (accessed: August 16, 2019), vis.bayern.de
  • German Society for Allergology and Clinical Immunology (DGAKI): S1 guideline on how to deal with suspected intolerance to oral histamine, as of September 2016, detailed view of guidelines
  • Helmholtz Zentrum M√ľnchen: Histamine Intolerance Syndrome (accessed: August 16, 2019), allergieinformationsdienst.de
  • Aha! Swiss Allergy Center: Histamine intolerance (accessed: 16.08.2019), aha.ch

ICD codes for this disease: T78ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: HISTAMINE INTOLERANCE Symptoms and Solutions! (October 2022).