Micronutrient therapy
| Definition |
| Histamine intolerance (HIT) is a congenital or acquired reduction in the activity of the enzyme diaminooxidase (DAO), which results in a slower breakdown of the body's own messenger substance histamine and also other biogenic amines. Histamine is formed a.o. in mast cells, controls numerous functions in the organism and is released as part of the immune system when required. If the DAO activity is too low, the affected person can no longer maintain the histamine in the body at the desired level, which leads to the defective regulation of numerous body functions. This can happen, among other things, through the increased intake of histamine through food, the excessive release of the body's own histamine, or through the inhibition of enzymatic degradation. In a healthy person, the histamine produced can be rapidly broken down so that no symptoms usually occur. However, if there is an imbalance between an elevated histamine level or an increased histamine effect in the metabolism of histamine, a wide range of symptoms similar to an allergy, a cold or food poisoning will occur. The main focus of the therapy of a HIT is the permanent avoidance of incompatible food as well as other histamine-releasing factors (stress, environmental influences, medication), accompanied by micronutrients and, if necessary, drug support. |
| Symptoms |
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A great variety of predominantly unspecific symptoms can be observed, whereby the type of symptoms that occur varies from one individual to another and is dose-dependent. Typical symptoms include runny nose, respiratory problems, palpitations, abdominal pain, diarrhoea, heartburn, nausea, vomiting, skin rashes, itching, headaches and migraines, dizziness, menstrual cramps, as well as fatigue and sleep disturbances. The first symptoms, such as nasal congestion, flushing or stomach problems, can occur as early as 10 to 15 minutes after food intake and change into circulatory problems, diarrhoea and other symptoms after about 30 minutes. While mildly affected people only experience symptoms in extreme situations, HIT can lead to a severe reduction in quality of life in severe cases. |
| Causes |
| The causes of a HIT are considered to be the increased intake of histamine from outside, the excessive release of endogenous histamine and histamine degradation disorders by the DAO. The supply of histamine and other biogenic amines depends on the diet, with histamine being found in most foods, although in varying concentrations. While only a few foods can be considered absolutely histamine-free, all others contain histamine, from small traces to very high levels. In this context, so-called histamine releasers should also be mentioned, which do not contain histamine themselves, but can release it in the body, which can also increase the histamine load. In addition, other foods have the characteristic of inhibiting the DAO or promoting the absorption of histamine via the intestine. Incompatible foods can be found in all food categories, whereby the degree of freshness is often decisive for tolerance. In addition, histamine is also produced during desired fermentation, fermentation and ripening processes, which serve to refine a product or extend its shelf life, but also during spoilage processes. The foodstuffs concerned include sausages, dried meat, canned fish and fish, long-ripened cheeses, wine, sparkling wine, beer, vinegar, sauerkraut, spinach, tomatoes, aubergines, avocado, pulses (lentils, beans, soya), mushrooms, strawberries, raspberries, citrus fruits, banana, pineapple, kiwi, pears, papaya, guava, nuts, cocoa, vinegar, as well as many sauces and spices, alcoholic beverages and certain food additives (1). In addition, an incorrect colonisation of the intestine (dysbiosis) with the accompanying increase in bacterial species, which produce particularly large amounts of histamine and/or other biogenic amines, as well as an increased permeability of the intestinal mucosa (leaky gut syndrome) can contribute to increased histamine levels in the body. The histamine-related symptoms can also have their origin in psychosomatics, since the peripheral nervous system releases histamine from neighbouring mast cells when it is strongly excited (e.g. by stress, anxiety, nervousness etc.). The causes of DAO degradation disorders can be diverse and sometimes congenital, acquired, of short or long duration. A lack of cofactors of DAO (copper, vitamin C and vitamin B6) can also contribute to histamine-related symptoms. |
| Diagnostics |
| Due to the non-specific symptoms and the multifactorial causes, the diagnosis of HIT is more difficult compared to other food intolerances and is therefore considered to be an exclusion or suspected diagnosis. If HIT is suspected, the main focus is on an anamnesis interview with the treating physician followed by a differential diagnosis to exclude the presence of other diseases. Subsequently, an elimination diet lasting several weeks with an accompanying change in diet can be carried out, which is currently regarded as the only reliable method of diagnosis (see chapter on therapy). Since many affected persons may have other, unrecognised allergies or intolerances in addition to their HIT, and thus the elimination diet may be unsuccessful, an allergologist should be consulted before starting the diet. In an elimination diet, all foods with histamine potential are consistently avoided and the individual tolerance threshold for the reintroduction of the avoided foods is then determined on the basis of an eating and complaints protocol. In addition to foods rich in histamine, those containing other biogenic amines should also be avoided, as well as so-called histamine liberators, which release histamine in the body, and also those foods containing inhibitors of the enzymes that break down histamine and other biogenic amines in the body. In addition, various laboratory analytical test methods are offered for the diagnosis of a HIT, including determination of the DAO amount or the concentration of histamine blood and its degradation products such as methyl histamine in stool and urine. |
| Therapy |
| The main focus of the therapy of a HIT is a low histamine diet (see causes), which can be supported by micronutrients and, if necessary, drug therapy (antihistamines, mast cell stabilizers). Due to the heat and cold stability of histamine, it cannot be eliminated by cooking or freezing. Patients therefore benefit from a fresh processing of raw materials that are as unprocessed as possible and a quick consumption or immediate freezing. Furthermore, allergy sufferers in particular should pay attention to avoid allergens and potential cross-allergies, since very high amounts of histamine are released in the case of allergies. In addition, other factors such as stress, physical exertion, chemicals, heat and cold can exacerbate the symptoms in certain sufferers. Since in many cases a disease of the digestive tract is the cause of HIT, a restoration of the intestinal mucosa is another important point of the therapy, so that it can produce DAO again in sufficient quantities. Taking a supplement with DAO can also help the body break down histamine in the gut before it is absorbed into the body. It is also important to avoid certain drugs and alcohol, which inhibit the activity of the DAO and thus block the breakdown of histamine. |
| Relevant micronutrients |
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In case of a proven histamine intolerance, the consistent avoidance of food containing histamine is an essential therapeutic factor. An accompanying and flanking measure is the strengthening of the activity of the histamine degrading enzyme DAO (diaminooxidase) as well as the supply of the required micronutrients. These include in particular vitamin B6, but also copper, zinc and vitamin C. Since in many patients a histamine intolerance can also be attributed to the lack of DAO formation due to a subclinically inflamed intestinal mucosa, an accompanying treatment of the intestinal mucosa is advisable. L-glutamine is an amino acid that serves as an energy source for the cells of the intestinal mucosa and the immune system and thus regenerates and strengthens cells of the intestinal mucosa attacked by intolerance. Black cumin oil (Nigella sativa) has long been used for prevention and alleviation of symptoms of allergic reactions due to its immunomodulating, anti-inflammatory, antioxidant and cytoprotective properties. Clinical studies in patients with allergic rhinitis, asthma or atopic eczema underpin the efficacy of its use in this indication. By suppressing inflammatory mediators such as prostaglandins and leukotrienes and by increasing T-cell and killer cell activity, black seed oil also appears to be a suitable therapeutic agent in autoimmune diseases (10). |