Do High Histamine Foods Trigger Allergies? - Ask a Nutritionist

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Alyssa: Welcome to Dishing Up Nutrition's midweek “Ask a Nutritionist” program. If you are enjoying this show, let us know by leaving a rating and reviewing it on your favorite podcast platform. Your feedback is appreciated and helps others find the podcast. Now onto today's show of answering a question from a fellow Dishing Up Nutrition listener.

Today's listener's question is “Would avoiding high histamine foods help lessen my allergies?” As a person living with allergies, today's question hits close to home. Hello, I am Alyssa, a Registered Dietitian here at Nutritional Weight & Wellness. I see clients in person and virtually from our St. Paul and Eagan, Minnesota offices.

I believe the listener who asked today's question is referring to managing symptoms of allergic rhinitis and not food allergies. Allergic rhinitis, or what some people call hay fever, is a condition that affects millions of people worldwide and occurs when a person's immune system overreacts to something in the environment. There are two main types of allergic rhinitis.

Seasonal allergic rhinitis often occurs in the spring, summer, and fall months due to outdoor pollen from trees, grasses, weeds, and possibly from outdoor molds. Perennial or year round allergic rhinitis is often caused by indoor allergens, such as dust mites, indoor molds , and dander from animals like dogs or cats.

Symptoms of allergic rhinitis, while a minor inconvenience for some people can have a significant impact on a person's quality of life. Symptoms range in severity and in can include things like an itchy nose, mouth, or eyes, nasal congestion, sneezing, mouth breathing from said nasal congestion, snoring, dark circles under the eyes, known as allergic shiners and headaches.

These symptoms can really hinder a person's ability to enjoy daily activities such as having fun outside when the weather is nice, working productively, learning, and sleeping. It's understandable that a person with environmental allergies may wonder if making changes to the foods they eat could make a noticeable difference in the severity of their allergy symptoms.

Okay, so would avoiding high histamine foods help lessen allergies? Well, allergies are an immune response. When an allergen enters your body through whether it be breathing, eating, or touching, your immune system is treating the allergen something that should be harmless as harmful. The immune system sees it, thinks this is a problem, and it sends out a chemical called histamine to help fight off the allergen it's perceiving as a threat.

What is histamine?

Histamine causes all the different symptoms we see in allergies. It's a signaling molecule that sends messages between cells. Histamine plays a role in various functions of the body, not just the immune system. For instance, histamine is released from cells in the stomach lining that bind to H2 receptors and prompt the release of stomach acid that's needed for digestion.

Histamine also plays a role in gut motility influencing how quickly food passes through the GI tract. And histamine acts as a wake promoting neurotransmitter. It plays a role in our body's sleep/wake cycle. As part of the body's immune response, histamine helps to protect our body from foreign invaders.

When the immune system finds an invader, the immune cells then send out the histamine and other inflammatory chemicals. Blood vessels become leakier, so white blood cells can sneak through and fight off the invader. This system is fantastic to help protect the body from harmful things like parasites.

Unfortunately, when someone is allergic to something, their body's immune system remembers the allergen protein as something it does not like. Subsequent encounters with the allergen then result in histamine being released, potentially a lot of histamine. Everyone has a level of histamine they tolerate without having allergy symptoms.

The analogy of a bucket being filled up is often used when thinking about histamine levels in the body filling up and overflowing to the point of symptoms occurring. The most severe allergic reactions lead to something called anaphylaxis, a potential fatal, severe reaction that involves multiple body systems all at once, such as the skin, gut, lungs, and heart.

Each time a person has an allergen exposure, the reaction in terms of the severity can be a bit different. The amount of allergen exposed along with other factors, like if a person is sick with a cold, under a lot of stress or maybe sleep deprived, all can affect the severity of the reaction and the amount of histamine released.

For severe allergic reactions, epinephrine, otherwise known as the EpiPen is the one available medication used to quickly stop anaphylaxis. Antihistamine medications, including common ones like Zyrtec or Claritin, work by blocking cells from seeing the histamine, it's like, hey, I can't see you, so it's not going to talk to those cells.

They can help in the treatment of managing allergy symptoms. They help stop that uncomfortable runny nose, itchy skin, things that occur with seasonal allergies. Some antihistamines medications used for allergies can have unwanted side effects like making a person feel sleepier. So not everyone with seasonal allergies chooses to use them.

Other antihistamine medications known as H2 blockers like Pepcid, can be used to help treat acid reflux. It's important to remember that for those people with severe allergies at risk for anaphylaxis, antihistamine medications are not strong enough and won't work quickly enough to stop an anaphylaxis reaction. In the case of anaphylaxis, we use epinephrine first and we use it quickly.

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Foods that contain histamine naturally

In addition to the histamine our body produces, histamine is as this listener's question suggests for today, naturally present in many foods. These foods include things such as aged meats, fish, dairy, and fermented foods, including kombucha and alcohol, like red wine and beer. Many foods with histamine are healthy nutrient dense foods.

What is histamine intolerance?

Some people can experience something known as histamine intolerance. The enzyme known as diamine oxidase or DAO, under normal conditions quickly breaks down histamine from foods typically within minutes. Histamine intolerance, while considered rare, is when people experience an increased sensitivity to dietary histamine.

After eating foods high in histamine, they can experience symptoms like those of traditional allergies such as itchy skin, flushing, hives, diarrhea, nausea, reflux, headache, and a runny nose. So, DAO deficiency is suspected to be the reason for this dietary histamine intolerance.

A person may have reduced DAO activity due to other underlying conditions affecting the health of their gut, like inflammatory bowel disease or imbalances in the gut microbiome such as small intestinal bacterial overgrowth. The histamine from the foods that is not effectively broken down ends up being enough to overfill the person's histamine bucket and they experience symptoms.

A person with dietary histamine intolerance usually has something else, not just the dietary histamine triggering their immune system, activating mast cells and releasing histamine to a level close to and or above their tolerance level, resulting in symptoms when they eat the high histamine foods, maybe during the meal or shortly afterwards, then those symptoms start to occur.

Other factors besides the dietary histamine contribute to the filling of their histamine bucket. When DAO does not break down the dietary histamine effectively, that bucket can overfill often because of those foods. It's not necessarily though a food allergy. As dietitians, we can and do support people with dietary histamine intolerance, with nutritional support for overall gut health, digestion, and symptom management.

There's currently no approved and validated tests to see if a person has low DAO. A person with allergies could also have digestive struggles, including a deficiency in DAO. They could experience dietary histamine intolerance, which results in a worsening of their allergy symptoms after eating high histamine foods up to, and even including anaphylactic reactions.

Personally, in my own experience with allergies before working with a board certified allergist, my environmental allergies were not well managed. On top of my allergies, I also have IBS, so my digestive system tends to be a little more sensitive. I did experience worsening in my symptoms several times after, or in the middle of eating high histamine meals.

Initially, my allergist screened me for several food allergies that are possible since all my reactions happened after eating or while I was eating a, a meal. It turns out my environmental allergies were just really severe. I did not have any food allergies.

Additional factors like being stressed and sleep deprived at the time I had an infant and toddler at home, played a role in how I had this perfect storm come up and that histamine bucket overflowed to the point that I experienced some severe reactions. One time it was really just hives and flushing of the skin. Other times I experienced more severe reactions and ended up going to the emergency room. For several years after those experiences, I did end up limiting dietary histamine, especially during the spring, summer, and fall months. I am still in the habit of freezing all my protein rich foods after I've cooked them, instead of just putting leftovers in the refrigerator to help slow the production of histamine.

I also don't drink alcohol. The dietary histamine restriction did not treat my allergies. However, too much dietary histamine at the time had the potential to make my symptoms worse, so I found it was an extra step that I took. Not becoming over restrictive, but taking some extra steps to see maybe these changes might lessen a severity of a reaction that I'm experiencing.

After working with my allergist for several years, I've gone through and am still in the middle of allergy immunotherapy, otherwise known as allergy shots, to teach my immune system not to overreact as much, and doing work nutritionally to support my digestive system, managing my IBS. Knock on wood, I've not experienced any severe reactions after eating high histamine foods for almost five years now.

I do still carry EpiPens though now it's mostly for one of my children who lives with food allergies. So if you have allergies, you are exposed to those allergens. Whether those allergens are from indoor things or outdoors, your immune system is already overreacting and that histamine is being released.

Your histamine bucket of tolerance is being filled up, potentially a lot of histamines being released and factors like stress or lack of sleep can result in more histamine being released. Avoiding or limiting foods high in dietary histamine will not necessarily lessen your allergy symptoms. The immune system exposed to allergens is sending out histamine because it recognizes the allergens in your body as a threat.

A small number of people can also deal with that diamine oxidase or DAO deficiency. In these people, dietary histamine is not as quickly broken down, or it's not broken down as well. The addition of the dietary histamine to their system paired with the allergy and exposure may lead to worse allergy symptoms.

When working with patients who may have dietary histamine intolerance, I do recommend they meet and work with a board certified allergist if they don't already, to rule up things like food allergy since many of these symptoms present as allergy symptoms.

Summary

So in summary, if you have environmental allergies, AKA allergic rhinitis, whether they're seasonal outdoor allergies or perennial indoor allergies. And you are having exposure to your allergens, limiting foods high in dietary histamine will not serve as a treatment for your allergies. A low histamine diet will not help your allergies go away or minimize symptoms. At the same time, if you are low in DAO and sensitive to dietary histamine, limiting or avoiding high histamine foods may help prevent you from having even worse symptoms.

If you are curious about low histamine, please do not venture into a low histamine plan on your own. Work with a knowledgeable registered dietitian well versed in food allergies and tolerances and sensitivities. As dietitians, we want to make sure that you are well-nourished and not unnecessarily avoiding restricting food.

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Some clients I find do benefit from a trial of a low histamine plan or a lower histamine plan. Most of my clients who have needed lower histamine plans do not need them forever. If it's a gut related issue, after the gut has time to heal, I've usually found that clients can start to tolerate more high histamine foods again, and it's not as much an issue.

Nutritionally, the first step I recommend to clients without over restricting food is to focus on enjoined fresh, minimally processed foods over ultra processed foods, rich in preservatives and additives. I also recommend clients avoid alcohol since alcohol being fermented, like wine and beer are high in histamine, and the alcohol inhibits the enzyme DAO from working as well.

Remember that DAO enzyme is responsible for the breakdown of the dietary histamine. If you like to meal prep, I know I do, remembering to freeze leftover cooked protein rich foods like grilled chicken instead of just putting it in your refrigerator for the week, will slow that histamine production.

Thank you to the listener who asked today's question. Remember, a low or restricted histamine diet will not lessen your allergy symptoms. Also true, if you are a person who has dietary histamine intolerance and you have allergies, eating high histamine foods could make your allergy symptoms worse.

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