Histamine intolerance: The Traditional Chinese medicine perspective

What’s covered?

• Histamine intolerance is a chronic condition leading to many symptoms such as bloating, constipation, palpitations, eczema, rashes, dizziness, headaches, sinus congestion, and insomnia.
• It has many causes: Gut dysbiosis, SIBO, Crohn’s, inflammatory bowel disease, leaky gut, coeliac disease, or gluten sensitivity, and certain medications.
• Acupuncture and Chinese herbs can be effective tools in the treatment of histamine intolerance
• Dietary considerations are explored to reduce histamine symptoms

Histamine intolerance refers to a sensitivity to dietary histamine and impaired ability to metabolise histamines due to several underlying mechanisms. Whilst modern medicine conducts more research into histamine intolerance and its cause, diagnosis and treatment, this article will explore histamine intolerance from both a western and Chinese medicine perspective. This will include common symptoms, causes, dietary factors which affect individual symptoms, and offer a holistic approach to better address and manage this condition.

What is histamine

Histamine intolerance (HIT) and its effects on the body were first identified in 1910 by researchers Dale and Laidlaw, pioneers in the study of histamine’s role within the body. Today, we know that histamine acts as both a neurotransmitter and a compound involved in various immune and physiological functions. It plays a critical role in stimulating the inflammatory response, increasing stomach acid production, promoting vasodilation (the widening of blood vessels), inducing muscle contractions, and boosting cytokine production, which is crucial for immune and inflammatory responses [1].

What is histamine intolerance

In essence, histamine intolerance (HIT) refers to the body’s inability to effectively break down excess histamines, leading to a buildup over time. This accumulation results in a variety of non-specific, non-allergic gastrointestinal (GI) and systemic symptoms, which will be discussed in detail below. One suspected cause of HIT is a deficiency in the GI enzyme diamine oxidase (DAO), which is responsible for breaking down histamine in the gut. Several factors may contribute to DAO deficiency, including genetics, certain medications, chronic alcohol consumption, underlying gut disorders such as SIBO, IBD, Crohn’s disease, leaky gut syndrome, gluten sensitivity, or celiac disease, as well as H. pylori infections [2]. Additionally, the intake of high-histamine foods or those that suppress DAO activity can exacerbate the condition. As we can see, HIT is a complex issue, potentially involving multiple causes and mechanisms. So, what are some of the most common symptoms?

Symptoms

Given histamine’s diverse role in the body, symptoms of histamine intolerance can be wide-ranging and non-specific. For clarity in this article, we will categorize these symptoms into distinct groups.

Gastrointestinal:

A trial in 2019 conducted by the journal Intestinal Research, found that the most common symptom observed amongst HIT sufferers was bloating [3]. The study indicated that other very common symptoms included:

• Uncomfortable upper abdominal fullness
• Abdominal pains
• Diarrhea or constipation
• Acute belching, nausea or vomiting

Skin:

• Skin itch
• Flushed facial complexion
• Eczema and rashes
• Swollen or red eyelids

Cardiovascular:

• Dizziness
• Headaches
• Heart palpitations
• Feeling listless

Respiratory:

• Sinusitis & nasal congestion
• Sneezing
• Shortness of breath

Other:

• Anxiety
• Insomnia
• Restlessness & agitations

Chinese medicine & HIT

In Traditional Chinese Medicine (TCM), there are numerous causes of histamine intolerance (HIT), which can be classified into various internal patterns of imbalance. The specific pattern responsible for HIT is determined through a thorough assessment of the individual’s symptoms, as well as pulse and tongue diagnosis. However, in clinical practice, many patients with HIT tend to exhibit common patterns and underlying causes. Here are a few examples:

Damp-heat:

The damp-heat pattern is one of the most common presentations I observe when treating patients with histamine intolerance. This pattern develops due to a combination of factors over time, often including yo-yo dieting, irregular sleep habits, prolonged use of medications or antibiotics, excessive consumption of cold, raw, or fatty-fried foods, habitual alcohol use, and chronic stress.

Often they will complain of predominately gut related issues. Symptoms include, abdominal bloating and fullness which is worse after eating, constipation and diarrhoea or alternating between the two, inconsistencies with their stool, reflux and nausea. They may also feel hot, restless or jittery, and have difficulties falling sleep.

Water metabolism issues/internal dampness:

Another prevalent pattern seen in the clinic is internal dampness combined with water metabolism issues. This pattern is especially common due to chronic stress, excessive water intake, consumption of cold and raw foods, or prolonged antibiotic use. As a result, the internal environment of the body becomes cold and damp, impairing the Spleen and Stomach’s ability to transform pathological fluids, which stagnate and lead to a variety of signs and symptoms.

Specific symptoms include, a lack of thirst, frequent urination after consuming fluids, postural light-headedness or palpitations, anxiety, eye or muscular twitches, brain fog, watery eyes, clear nasal mucus, bloating, and loose or sticky stools.

Cold of the small intestine:

The last Chinese medicine pattern worth noting is cold of the small intestine. This is normally considered the underlying mechanism of HIT according to Classical Chinese Medicine (CCM) and is where we eventually need to focus when addressing the root cause of the condition. Some practitioners of Traditional Chinese Medicine refer to this pattern as Spleen Yang and/or Kidney Yang deficiency. Normally by this stage of treatment, the predominate HIT symptoms are less severe and the digestion, sleep and energy levels have greatly improved. Chinese herbal formulas containing internal warming herbs such as Gan Jiang (aged ginger) are used to warm the small intestine and prevent future recurrences of HIT. Of course, it is vital that the patient maintains a healthy diet and lifestyle, otherwise it is like trying to drown out a fire which is being doused in petrol!

The three patterns described above are certainly not an exhaustive assessment of the Chinese medicine diagnostic patterns for HIT, but rather a glimpse into some of the most commonly seen in the clinic. It’s also important to note that multiple patterns can occur simultaneously. Now that we’ve explored common symptoms and Chinese medicine considerations, what are some of the dietary and lifestyle factors that can be implemented to manage this condition?

Acupuncture:

Acupuncture provides another potential treatment option for HIT and its associated symptoms such as skin itching and rhinitis [4], [5]. Depending on the Chinese medicine pattern diagnosis, many acupuncture points can be chosen to address the individual symptoms. Common points used in clinic include Spleen 4, Stomach 43, Large Intestine 20, Yintang Extra point, Master Tung’s Mu (Liver anger) point, and many more! Empirical evidence in clinic has demonstrated Dr. Tan’s 8 Magical Acupuncture balance treatment or Yangming-Taiyin balance to be quite effective in reducing HIT symptoms, especially when dietary/gastrointestinal related.

Dietary & lifestyle

It is widely taught that people who suffer from HIT should avoid high histamine foods and liberators or foods which prevent DAO activity. The following dietary changes can be helpful in the initial stages of treatment to reduce the histamine burden on the body, whilst the underlying cause is addressed. It is important to note, that these dietary considerations should only be considered under the guidance of a trusted medical or allied health professional and are not to used as a permanent solution to HIT. Each individual circumstance needs to be considered, which is especially true for pregnant women, children or individuals with underlying medical conditions.

Foods to minimise or avoid according to some studies [6], [7]:

1. Aged cheese and bone broths
2. Fermented foods, including sauerkraut, kimchi, yogurt, kombucha and even some probiotics (these are beneficial once the underlying cause of HIT is addressed)
3. Processed meats such as sausages.
4. Preserved or canned fish
5. Alcoholic beverages, especially beer and wine
6. Vinegars and dressings
7. Certain fruits such as papaya, pineapples, strawberries, bananas, citrus fruits and dried fruits
8. Some vegetables such as tomatoes, spinach and avocado
9. Peanuts, tree nuts and chocolate

Generally considered “safe” foods for most cases [6]:

1. Fresh meat and fish (avoid pork and sausages)
2. Most vegetables which include things like beans, sprouts, cucumbers, radishes, lettuce, parsley, pumpkin, potatoes, onions, carrots and cabbage.
3. White rice and millet
4. Eggs and dairy
5. Cooking oils

To find our more information regarding HIT and foods to avoid or include, you can follow this link to self-code.com which lists many of the aformentoned foods and also provides links to numerous clinical research trials.

Closing thoughts:

Histamine intolerance is a complex disorder with many potential underlying causes that can disrupt daily life and cause discomfort. But with potential Chinese medicine treatment options and dietary adjustments, many individuals can find relief. Understanding the common symptoms, causes, and dietary strategies outlined in this article can be a valuable step toward living comfortably and reducing histamine intolerance.

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[1] Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Histamine Intolerance: The Current State of the Art. Biomolecules. 2020 Aug 14;10 (8):1181

[2] Schnedl, W. J., & Enko, D. (2021). Histamine Intolerance Originates in the Gut. Nutrients, 13 (4), 1262. https://doi.org/10.3390/nu13041262

[3] Schnedl, W. J., Lackner, S., Enko, D., Schenk, M., Holasek, S. J., & Mangge, H. (2019). Evaluation of symptoms and symptom combinations in histamine intolerance. Intestinal research, 17 (3), 427–433.

[4] McDonald, J. L., Cripps, A. W., Smith, P. K., Smith, C. A., Xue, C. C., & Golianu, B. (2013). The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-based complementary and alternative medicine.

[5] Min, S., Kim, K. W., Jung, W. M., Lee, M. J., Kim, Y. K., Chae, Y., Lee, H., & Park, H. J. (2019). Acupuncture for Histamine-Induced Itch: Association With Increased Parasympathetic Tone and Connectivity of Putamen-Midcingulate Cortex. Frontiers in neuroscience, 13, 215.

[6] Son, J. H., Chung, B. Y., Kim, H. O., & Park, C. W. (2018). A Histamine-Free Diet Is Helpful for Treatment of Adult Patients with Chronic Spontaneous Urticaria. Annals of dermatology, 30 (2), 164–172.

[7] Chung, B. Y., Cho, S. I., Ahn, I. S., Lee, H. B., Kim, H. O., Park, C. W., & Lee, C. H. (2011). Treatment of Atopic Dermatitis with a Low-histamine Diet. Annals of dermatology, 23 Suppl 1 (Suppl 1), S91–S95.