Could your allergies really be histamine intolerance?

Identifying the source of an allergic reaction is a process of elimination that can feel like solving a mystery. In the past few years, Dr. Nathan Lebak, an allergy & immunology physician at Aurora Health Care, has added one more piece to the puzzle: histamine intolerance.

“Histamine intolerance is not widespread, affecting only about 1–3% of the population, but it’s often mistaken for a food allergy or gastrointestinal disorder,” says Dr. Lebak. “It should be ruled out as a potential cause for the symptoms the patient is experiencing.”

Histamine release occurs as part of an allergic reaction. Histamine is stored in allergy cells, ready to be released quickly when those cells are activated.

“When histamines are released, the body responds in different ways,” Dr. Lebak explains. “Blood vessels enlarge, nerves in the skin are stimulated causing itching, and contractions may occur in the gut, causing vomiting, diarrhea, constipation, and discomfort. Cardiovascular symptoms, which can be common with allergy, are less frequent in histamine intolerance.”

Besides allergic reactions, other factors contribute to elevated histamine levels. For one thing, the body may not be regulating histamine levels properly. Some studies show that histamine levels fluctuate with menstrual cycles and may change after menopause. Also, people may be ingesting certain foods containing histamine that trigger the intolerance.

Histamine intolerance is considered a sensitivity, not an allergy – comparable to lactose intolerance. In the last 10 years, more doctors have become aware of histamine intolerance and researchers are investigating the disorder, especially as it relates to food safety.

Dr. Lebak says to assess histamine intolerance, an elimination diet may be prescribed in which foods containing histamine are taken out for several weeks to determine if there is an improvement without the ingested compound.

“The most common food types to avoid are certain dairy products such as cheese – especially aged parmesan, yogurt, sour cream, buttermilk and kefir. Milk itself is lower on the list of concerning foods,” he says.

In addition to fermented dairy products, the list of high-histamine foods to avoid include:

• Fermented vegetables, such as sauerkraut and kimchi
• Alcoholic beverages, including beer and wine
• Fermented products, including soy sauce, miso and kombucha
• Some breads, including sourdough
• Some vegetables and fruits, including eggplant, tomato, spinach, strawberries and citrus
• Dry fermented meat products, such as sausages and prosciutto
• Canned meats, especially fish
• Fatty fish like tuna, salmon and mackerel

In general, fresh meats are considered safer as part of a low histamine diet. Similarly, fruits and vegetables lower in histamine are recommended to be eaten as fresh as possible. These include carrot, garlic, onion, asparagus, apple, pear, cherry and peach.

Dr. Lebak says, “It is important to differentiate between true allergic reactions and histamine intolerance. That process begins with talking to your primary care doctor and a consultation with an allergist including testing, if warranted. Allergic reactions can be life-threatening and require both strict avoidance and monitoring.”

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