Histamine Intolerance

Why do some people react?

Some people have a reduced ability to break down vasoactive amines, particularly histamine, in the digestive system. This is thought to be linked to low activity of an enzyme called diamine oxidase (DAO), which helps to break down histamine in the gut. When DAO levels are too low, histamine can build up in the body and cause symptoms that resemble those of an allergy.

Symptoms of a histamine intolerance

Symptoms can vary widely from person to person, and how much someone can tolerate may also change day to day depending on factors like stress, illness, hormone levels, or medication use.

Common symptoms may include:

• Headaches or migraines
• Skin rashes, hives, or itching
• Flushing (sudden warmth or redness in the skin)
• Swelling of the face, lips, or eyes
• A blocked or runny nose
• Wheezing or shortness of breath
• Irregular or fast heartbeat
• Nausea, vomiting, abdominal pain, or diarrhoea.

These symptoms usually appear 30 minutes to a few hours after eating, though the delay can vary. It’s important to note that this condition is not a true allergy, but the symptoms can feel very similar.

Diagnosis and Next Steps

If you think certain foods are causing symptoms, speak to your GP or another health professional. There are currently no reliable tests to diagnose sensitivity to vasoactive amines.

The best way to find out if these are a problem is to try cutting out foods that are high in them for 2-4 weeks, then reintroduce them one at a time to see what is tolerated and in what amount.

It’s helpful to keep a food and symptom diary during this process whilst being aware that non-dietary factors such as stress, hormones, medications, or whether you’re unwell might affect tolerance.

It’s best to do this kind of trial with the support of a dietitian, especially if you’re avoiding other foods too. A dietitian can help work out possible triggers while making sure your diet stays balanced and healthy and doesn’t become too restricted.

Foods and drinks high in Vasoactive Amines

People who are sensitive may benefit from reducing or avoiding foods high in vasoactive amines. These commonly include:

Drinks:

• Champagne, wine (especially red) beer, cider
• Coffee, cocoa, and chocolate.

Fermented and aged foods:

• Sauerkraut
• Fermented soy products (e.g. miso, tempeh)
• Aged cheeses: blue cheese, parmesan, camembert, emmental, old gouda, cheddar, and hard sheep or goat cheeses
• Cured meats: sausages, salami, pepperoni, ham, bacon, and other processed pork products.

Fish and seafood:

• Fresh or canned tuna, sardines, mackerel, herring, salmon
• Smoked, dried, pickled, or processed fish (e.g. fish pastes)

Fruit, vegetables, and nuts:

• Tomatoes, aubergines (eggplant), spinach, broad beans
• Pickled vegetables such as cabbage (sauerkraut)
• Oranges, tangerines, bananas, grapes, pineapple, strawberries
• Peanuts and tree nuts

Symptom relief and ongoing management

For those prone to reactions, carrying an antihistamine can help manage symptoms when accidental exposure occurs. It’s also important to ensure that any coexisting conditions like asthma are well controlled, as unmanaged respiratory conditions can make symptoms worse.

Although living with a sensitivity to vasoactive amines can be challenging, many people are able to manage their symptoms successfully by identifying and avoiding their personal triggers.

Keeping informed and working with a healthcare professional can make a significant difference.