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Low-histamine diet - implementation rules and affected individuals
Table of Contents
1. What is histamine?
Histamine is classified as one of the biologically active amines and is produced by the transformation of the amino acid histidine, which is a fundamental component of proteins. Consequently, its abundant source is high-protein diet, especially processed through fermentation (the bacteria responsible for this process have the ability to convert histidine into histamine). Histamine performs multiple functions in the body and influences numerous organs and systems, including affecting the inflammatory response, expansion of blood vessels, production of bile, contraction of the pancreas, and secretion of mucus in the respiratory tract. It also acts as a neurotransmitter in the nervous system, affecting the processes of thermoregulation, hunger regulation, vigilance, and cognitive abilities and behavior.2. Histamine intolerance – Causes and manifestations
In contrast to food allergies, which involve an immune response to a specific food protein, histamine intolerance is a condition that occurs when the body is unable to effectively breakdown histamine, a compound that is found in certain foods and produced by the body. This results in a range of symptoms that can be similar to those of an allergic reaction. Histamine intolerance is not an allergic reaction, but rather the result of a deficiency in the enzyme diamine oxidase (DAO), which is responsible for breaking down histamine. There are several factors that can contribute to a decrease in DAO activity, including genetics, certain medications, and gastrointestinal disorders. Symptoms of histamine intolerance can vary widely, but commonly include headaches, flushing, hives, and gastrointestinal distress.3. Histamine intolerance – diagnostic process
At present, there are no definitive criteria for diagnosing histamine intolerance. Diagnostic methods are available for determining the concentration of histamine and DAO in the blood of a patient and for identifying plasma DAO activity. Mastocytosis is a rare disease in which there is an excessive accumulation of mast cells, i.e. the fat cells responsible for fighting infection. If other food intolerances, gastrointestinal disorders, and mastocytosis are excluded, these tests can be helpful in establishing the diagnosis. Other tests include the histamine provocation test, the skin test for histamine reactions, the measurement of histamine in urine or stool, intestinal biopsy, and genetic testing to identify single nucleotide polymorphisms (SNP) that contribute to the development of histamine intolerance. Suspicion of histamine intolerance is an indication to start a low-histamine diet. The diagnosis is confirmed when at least two characteristic symptoms are observed and a reduction or disappearance of symptoms is observed following the introduction of an elimination diet.4. Nutritional Procedure in Histamine Intolerance
The implementation of a low-histamine diet is one of the primary methods for treating histamine intolerance (M. Bartuzi, N. Ukleja-Sokołowska; I. San Mauro Martin et al. 2016). One of the key elements of this diet is the freshness of the products, and patients adhering to this diet should purchase the necessary products regularly and avoid long-term storage. It is also beneficial to select less ripe fruits and vegetables. This is associated with the fact that long-term storage increases the exposure of food to microorganisms, including bacteria that degrade histidine into histamine.5. The low-histamine diet - a matter of debate
When searching for information on the low-histamine diet, one may come across various, often conflicting lists of prohibited and permitted foods. A 2021 article highlighted this problem by analyzing ten studies and finding that only a few products were unanimously included in the exclusion list, such as fermented foods, alcohol (wine, beer), and long-ripened cheeses. Most studies also mentioned fish, spinach, and tomatoes, while olives, soy, grapes, cherries, apricots, and milk were less commonly listed. After analyzing the histamine content in these products, it was found that only 32% of them contained significant amounts of histamine. The presence of the other products on the list could, however, be related to their content of biogenic amines (putrescine, cadaverine, or tyramine) or properties that enhance histamine release. However, there is a lack of clear scientific evidence to support such measures. The authors emphasize the need for further research to confirm the influence of individual products on histamine release and the occurrence of histamine intolerance symptoms (S. Sánchez-Pérez et al. 2021). For patients, this is information that the rules of the low-histamine diet and the exclusion list may vary depending on individual reactions, hence it is important to keep a diary of self-observation.6. Additional factors triggering the reaction
Not only histamine-containing foods can trigger the symptoms of intolerance. Other factors such as stress, infections, physical exertion, and hormonal changes in the body can also trigger similar reactions. Components of some medications such as acetylcysteine, amitriptyline, and verapamil can also trigger intolerance reactions. Similarly, consumption of other biogenic amines such as tyramine, tryptamine, phenylethylamine, and cadaverine can also trigger symptoms of intolerance. Tyramine is the strongest trigger for reactions and is found in larger quantities in aged cheeses, fermented foods, and fish sauce. If symptoms persist or recur despite a suitable diet, it may be beneficial to pay attention to other factors that may be triggering the reaction. During the treatment of other conditions, it is also important to inform the treating physician of the intolerance to ensure that prescribed medications do not exacerbate symptoms.7. Additional therapeutic methods for histamine intolerance
The low-histamine diet forms the foundation for the treatment of histamine intolerance, however, there are also supportive measures for therapy - primarily supplements containing the DAO enzyme derived from pig kidney tissue. These products have been introduced to the market relatively recently, thus the available data on their effectiveness is limited (studies conducted using various methods, in small groups). Nevertheless, the initial reports are promising and indicate a positive impact on the frequency and intensity of intolerance symptoms. Other means are antihistamines, which directly affect histamine by lowering its concentration in the blood. Additionally, supplementation with vitamins B6 and C, which increase the activity of the DAO enzyme, may also complement the treatment.
