Man sneezing. Histamine intolerance

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 was first described in 1910 by Dale and Laidlaw, who were two esteemed researchers that studied the functions of histamine in a physiological research laboratory. Current research has revealed that histamine is both a neurotransmitter and compound with several immune and bodily related functions. Histamine has been shown to stimulate an inflammatory response, increase stomach acid production, stimulate vasodilation (widening of the blood vessels) and muscle contractions, and increase cytokine production, which are involved in immune and inflammatory related responses [1]. So its pretty clear that histamine has a significant role in the body and serves many different useful functions.

What is histamine intolerance

So now that we’ve covered histamine, what exactly is HIT. In short, this condition describes an inability for an individual to break down a build up of histamines in the body. Overtime this leads to numerous non-specfic and non-allergic gastrointestinal (GI) and bodily symptoms, which will be covered further below. It is thought one of the causes of HIT is due to a deficiency of the GI enzyme Diamine Oxidase (DAO) which is responsible for the breakdown of histamine in the gut. This may be due to several factors which include genetics, certain medications, chronic alcohol use, underlying gut related disorders such as SIBO, IBD and Crohn’s, leaky gut syndrome, gluten sensitivity or coeliac disease, H. Pylori infections, and concurrent intake of high histamine foods, or foods which suppress DAO activity in the gut [2]. Already we can see that HIT is quite a complex condition and can potentially involve many different causes and mechanisms. So what are some of the most common symptoms?

Symptoms

Due to the role of histamine in the body, the symptoms can be very non-specific and broad in nature. For the purpose of this article, symptoms will be broken down into categories.

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

There are numerous causes of HIT according to Chinese medicine, which can be further broken down into many internal patterns of disease. The specific pattern causing HIT is determined after careful assessment of the individuals symptoms, pulse and tongue diagnosis. However, in clinic most patients presenting with HIT share similar patterns and underlying causes. Here are just a few examples:

Damp-heat:

The damp-heat pattern is very common when I first see a patient. The cause of this pattern is complex and can involve a multitude of factors over time, which often include yo-yo dieting, irregular sleep patterns, medications, antibiotics, excessive intake of cold and raw foods or fatty-fried foods, habitual alcohol consumption 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 extremely common pattern in the clinic is internal dampness with water metabolism issues. This is especially prevalent due to high levels of chronic stress, excessive intake of water or cold and raw foods or excessive antibiotic use. The internal environment of the body becomes too cold and damp, and the Spleen and Stomach are no longer able to transform the pathological fluids which become stagnant arising in numerous signs and symptoms.

Specific symptoms include, a predominate 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 after certainly not an exhaustive assessment of the Chinese medicine patterns of diagnosis for HIT, but merely a glimpse at some of the most common seen in the clinic. It is also important to note that more than one pattern of diagnosis can occur at the same time. Now that common symptoms and Chinese medicine considerations have been explored, what are some of the dietary and lifestyle factors which can be implemented in 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.


[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. Nutrients13 (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 research17 (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 neuroscience13, 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 dermatology30 (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 dermatology23 Suppl 1 (Suppl 1), S91–S95.

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