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Suspects in case of food intolerance- histamine and others

biogenic amines



Prepared by Sandra Tamm







Food intolerancedoes not differ in its disease picturefrom food allergy, however, in the case of food intolerance, the symptoms do not occur as a result of an immune reaction, i.e. the effect of antibodies or immune cells. In the case of food intolerance  , allergy tests turn out to be negative, although the person confirms that by observing his body and keeping a food diary, he notices a clear connection between the ailments and the consumption of certain foods. At the same time, the amount of food consumed can also play a role in the occurrence of ailments. If one food causes an allergy in some people, the same food may trigger an intolerance in another (2).


More common symptoms of food intolerance:


• Nettle disease or urticaria (itchy bumps)

• Digestive disorders (abdominal pain, intermittent diarrhea, vomiting)

• Eczema flare 



Biogenic amines - one of the possible suspects



Food intolerance can be caused by biogenic amines in food. They are substances with a strong bioactive effect that mediate various processes in the body (intercellular communication, nerve impulses, inflammation, digestion). Their excessive amount can cause food intolerance and exacerbate allergies (2). 


Examples of biogenic amines are histamine, serotonin, tryptamine, tyramine, cadaverine (1,5,9). Biogenic amines are found in almost all foods in small amounts, but in larger quantities they are formed during food storage (e.g. meat, fish), bacterial processing (e.g. fermentation, acidification, fermentation) and thermal processing (e.g. roasting nuts), as well as during food spoilage and spoilage (e.g. for raw fish). Disease symptoms depend on both the concentration of amines and the amount of food (2,8).


Sometimes, instead, the balance in the intestinal microflora or digestive activity and the movement of food in the intestine is disturbed, which is why some intestinal bacteria synthesize an excessive amount of biogenic amines from the amino acids produced by the breakdown of proteins. There are special enzymes in the body to break down amines, if they are lacking or low activity, amines from food are more effective (2). 




Histamine - the most common cause of food intolerance and allergy


Histamine is an extremely important bioactive organic nitrogen compound, a biogenic (formed by living organisms) vasoactive (affecting blood vessels) amine (3,7).


Histamine has several important functions in our body. Histamine is a neurotransmitter, an intercellular messenger in the nervous system, which plays a central role in allergic reactions and inflammatory processes. Histamine triggers an inflammatory reaction and plays a key role in allergies, it is when histamine is released that allergy symptoms such as dilation of blood vessels, reddening of the skin, formation of blisters and sometimes breathing difficulties occur (3,5,7,8).


Histamine also regulates gastrointestinal function and  sleep-wake cycle and has an alerting effect (3). Bacteria are capable of producing histamine from all proteins, and its starting material is the amino acid histidine (2,9).


Histamine is also produced by our body itself, but we can also get it from food. Histamine occurs naturally in certain foods, but some foods or their components are capable of releasing histamine from mast cells or blood basophils (2). 


Depending on the origin, a distinction is made (3):


  • Endogenous or internal histamine (the body produces it itself in nerve cells, mast cells, basophilic leukocytes).

  • Exogenous or extracorporeal histamine, which the body receives from outside the body - from food



Histamine intolerance is associated with many causes, including deficiencies of the enzymes diamine oxidase (DAO- an enzyme produced by intestinal mucosal cells) and histamine-N-methyltransferase (HNMT- produced in body cells such as the brain), so the body cannot break down histamine break down correctly and it accumulates, to which the body in turn reacts (1,3).  However, people with histamine intolerance can either suffer from said enzyme deficiency or instead have an overgrowth of bacteria and fungi that have created a "histamine factory" in the gut (1). 


Histamine intolerance affects at least 1% of the population, with more women than men. This may be related to the hormone estrogen, as histamine can increase estrogen levels and vice versa, which explains why histamine intolerance can be associated with menstrual cycle ailments such as headaches, migraines, stomach aches. During pregnancy, histamine intolerance can show signs of regression, as the placenta produces very large amounts of the enzyme diamine oxidase (DAO), which breaks down histamine (1).


Other possible causes of histamine intolerance (1,10):


• Inflammatory bowel disease (IBD) or another factor that causes damage to the cells of the intestinal lining

Celiac disease 

• Small intestinal bacterial overgrowth (SIBO)

• Infections (parasites, bacteria)

• Permeable salt 

• Alcohol or other DAO enzyme blockers

• Excessive amount of biogenic amines in food

Allergies(IgE reactions)

• Medicines that increase the level of histamine in the body



In the case of histamine overabundance (when the histamine level exceeds the body's tolerance limit, for example, too much of a particular food was consumed or several such foods were consumed at the same time that affect the body's histamine level), possible symptoms (1,2,3,4):


• Urticaria (bumpy, itchy rash)

• Angioedema, or swelling of the skin, mucous membranes and their underlying tissue

• Cold 

• Reddened face and/or neck

• Itching

• abdominal pain, diarrhea, nausea, bloating, heartburn

• Mild or severe headaches or migraine attacks

• Asthma, breathing problems

• Low blood pressure, dizziness, fatigue

• Difficulty in orientation, palpitations

• Anxiety, panic attacks, blurred vision

• Sweating 




Histamine intolerance and conscious nutrition



As described above, several food processing processes also increase the level of amines in food, especially histamine.


It has been found that certain foods such as strawberries, citrus fruits, tomatoes, kiwi and pineapple are the most conducive to the release of histamine from the body's own cells. Alcoholic beverages, especially red wine, have been found to contain histamine or DAO enzyme blockers. Foods that contain less histamine but are rich in other biogenic amines are chocolate, cocoa, dried and smoked meat products (4).


Fruit - and vegetables are generally well tolerated, only acidified or pickled products can cause problems. However, depending on the individual, fruits and vegetables rich in other biogenic amines (eg, spinach, banana, pineapple, papaya, raspberries, pears, wheat germ, legumes, and certain nuts) are intolerable to some (4). As mentioned above, depending on the individual, symptoms of histamine intolerance may also depend on the amount of food eaten. 


In addition to knowing which foods may contain or release histamine, it is important to remember that food storage also plays a role in the development of symptoms associated with histamine intolerance. So, for example, freshly caught fish is very low in histamine levels, but if you put it in the refrigerator, the histamine level rises very, very high within a few hours.  So if you can't eat the fish fresh, store it in the freezer. For example, the histamine level also increases in milk when it is acidified or fermented, in meat when it is processed (dried, smoked) and in grapes when they are made into wine (1,4).
















Foods rich in histamine and other amines (including acidified foods) (1,6,8,11):


• Champagne, wine, beer, cider and other fermented drinks

• Anchovies

• Avocados 

• Cheeses, especially long-aged and hard cheeses 

• Dried fruits such as apricots, dates, plums, figs, raisins (you may be able to tolerate these foods if you soak and rinse them beforehand), seeds, nuts

• Eggplant

• Acidified foods (sauerkraut, acidified soy products, etc.)

• Soy sauce, tofu

• Mackerel

• Mushrooms 

• Prepared meat products 

• Sardines 

• Smoked fish and meat

• Sour milk, sour cream, yogurt 

• Sourdough bread and foods that contain a lot of yeast

• Spinach, tomatoes 

• Black and green tea

• Yeast extract, yeast

• Chocolate, cocoa, cola

• Vinegar and vinegar-containing foods such as mayonnaise, salad dressings, ketchup, 

• Certain spices such as cinnamon, chili powder, cloves, anise, nutmeg, curry powder, cayenne pepper



Histamine releasing foods:


• Alcohol 

• Bananas 

• Chocolate

• Eggs 

• Fish

• Milk 

• Papaya

• Pineapple

• Boxes

• Strawberries

• Tomatoes

• Citrus fruits

• Nuts

• Peanuts

• Pumpkin

• Kiwifruit

• Grapefruit

• Raspberries

• Mango

• Spinach

• Avocado

• egg white






Allergy tests (for example, a blood test that measures IgE levels or determines specific IgE antibodies in the blood and skin prick tests) are negative for histamine intolerance because reactions to histamine are not related to an immune response, as is the case with allergies.


For diagnosis, a modified menu is usually used, where the main suspects - foods that potentially increase the level of histamine the most or contribute to its increase in the body - are excluded for a few weeks. During this period, it is monitored whether the symptoms subside. 

Blood tests that measure the level of histamine in the body or the level of a specific enzyme that breaks down histamine in the body are not considered reliable (11).




Dietary and lifestyle changes for histamine intolerance


The first step in the treatment of histamine intolerance is to avoid histamine-rich foods and food additives (such as the azo dye tartrazine and other synthetic food colors and benzoates, sulfites, BHA and BHT etc.), in addition to medicines and food supplements, which may contain the above-mentioned additives.


At this point, individuality must be taken into account, which means that the amount of histamine-rich food that can be tolerated varies from individual to individual. Also, not all foods on the list may automatically mean problematic foods for all people with histamine intolerance. Unlike allergies, where even a small amount of food can cause problems, the symptoms of histamine intolerance depend on the amount of food(s) eaten (8).


Referring also to the above-mentioned possible causes of intolerance other than enzyme deficiency, in addition to avoiding foods that cause ailments, the normal microflora of the intestine should be restored, rid of possible infections and the intestine should be healed by following a conscious diet and lifestyle. Also avoid possible allergens (food, pollen, house dust, animal hair, etc.) so as not to promote an increase in histamine levels in the body.


After some time, the foods that were removed from the menu for a while can be selectively added to the menu, as various studies have confirmed that apart from the food exclusion diet, there are a number of foods that a person with histamine intolerance can eat again without developing symptoms related to histamine intolerance. For example, it was found that if a person could not tolerate avocados and pears before the food exclusion diet, after the diet he could eat them in moderation (1,4).


Although various antihistamines are available both by prescription and over the counter (drugs that are often used in the treatment of various allergic conditions to lower histamine levels), certain nutrients have shown a positive effect on histamine intolerance, such as ascorbic acid or vitamin C, copper, vitamin B6 and quercetin, the latter of which is especially abundant in onions (1). In summary, it can be said that with a conscious change in menu and lifestyle, it is possible to successfully support your body in case of histamine intolerance.




Used sources:


1. Carnahan, J. “Is Histamine Intolerance the Cause of Your Problems?”, 2013 -your-problems/

2. Jürisson, M. Estonian Allergy Association brochure "Food and allergy"

3. Singer, K. Journal "Nutrition Therapy" No. 8, September 2013, article "Headache and sleep disorders from histamine"

4. Zechmann, M., Masterman, G. “Food Intolerances. Fructose Malabsorption, Lactose and Histamine Intolerance", 2013

5. Zilmer, M., Karelson, E., Vihalemm, T., Rehema, A., Zilmer, K. "Biomolecules of the human body and their most important medical functions", 2010, p. 326



8. Joneja JMV and Carmona Silva C. Outcome of a histamine-restricted diet based on chart audit. Journal of Nutritional and Environmental Medicine. 2001 11(4):249-262










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