Letzte Aktualisierung am 9. March 2025 von Dr. Michael Zechmann-Khreis
Histamine intolerance, also known as histamine intolerance, is caused by an imbalance between orally ingested biogenic amines such as biogenic amines like histamine or tyramine and their breakdown. Histamine and the other biogenic amines fulfill important functions in the body. However, if too few of the enzymes that break down these biogenic amines, diamine oxidase (DAO) or histamine N-methyltransferase (HNMT), are present, symptoms can occur.
Causes of histamine intolerance
We do not yet know exactly what causes histamine intolerance, but there are a number of factors that are likely to play a role. The main causes of histamine intolerance that have been discussed are
- Lack of nutrients: Copper and vitamin B6 are essential for DAO function, while vitamin C supports the breakdown of histamine.
- Reduced DAO activity: A lack of DAO, often caused by intestinal damage, can lead to histamine not being broken down sufficiently.
- Increased histamine intake: Histamine-rich foods such as mature cheese, wine or fermented products can increase symptoms.
- Intestinal bacteria: Certain bacteria in the gut can produce histamine themselves and thus contribute to the symptoms.
- HNMT inhibition: HNMT regulates histamine within the cells. If there is a disruption here, this can lead to a gradual accumulation of histamine.
Frequency of histamine intolerance
Histamine intolerance occurs in approx. 1-3% of the population. According to a study by the nmi portal, however, the number of unreported cases is very high, i.e. there are probably more people affected. According to a study by Jarisch, around 80% of those affected are women, most of them over the age of 40. This trend could not be verified in the nmi portal survey.
DAO and pregnancy
Women repeatedly report that their histamine intolerance disappears during pregnancy and reappears after the birth. This is due to the fact that DAO is produced by pregnant women in very large quantities. The DAO is increasingly released into the bloodstream in order to protect the child from possible histamine surpluses.
Differentiation from other diseases
Histamine intolerance is often confused with other diseases, including:
- Vagus nerve disorders: As the vagus nerve regulates numerous bodily functions, its symptoms can be very similar to those of histamine intolerance.
- Food poisoning: Excessive intake of biogenic amines can cause acute symptoms of poisoning.
- Mast cell activation syndrome (MCAS): Here, an excessive release of histamine by mast cells leads to similar symptoms.
- Food allergies: These are mediated by the immune system and must be excluded diagnostically.
Treatment and therapy
- Dietary adjustment: low-histamine diet, preferably according to the 3-phase model
- Enzyme therapy: Taking DAO preparations can help to break down histamine. H1 antihistamines can also be used as support.
- Optimize nutrient supply: Supplementation of vitamin C, B6 and copper can support enzyme activity.
- Stress management: Chronic stress can disrupt the balance of the autonomic nervous system and exacerbate symptoms. Breathing exercises, meditation and moderate exercise can help.
Histamine intolerance is a complex intolerance that is triggered by various mechanisms. An individual dietary strategy, targeted nutrient intake and avoiding trigger factors can help to alleviate the symptoms. Professional diagnosis and care by doctors or nutritionists is recommended in order to rule out other illnesses and initiate the right treatment.
Sources (among others)
Komericki, P., Klein, G., Reider, N., Hawranek, T., Strimitzer, T., Lang, R., Kranzelbinder, B., & Aberer, W. (2011). Histamine intolerance: Lack of reproducibility of single symptoms by oral provocation with histamine: A randomized, double-blind, placebo-controlled cross-over study. Wiener klinische Wochenschrift, 123(1-2), 15-20. https://doi.org/10.1007/s00508-010-1506-y
Reese, I., Ballmer-Weber, B., Beyer, K., Dölle-Bierke, S., Kleine-Tebbe, J., Klimek, L., Lämmel, S., Lepp, U., Saloga, J., Schäfer, C., Szépfalusi, Z., Treudler, R., Werfel, T., Zuberbier, T., & Worm, M. (2021). Guideline on the procedure for suspected intolerance to orally ingested histamine. Allergology, 44(10), 761-772. https://doi.org/10.5414/ALX02269
Sattler, J; Hafner, D; Klotter, HJ; et.al;“Food-induced histaminosis under diamine oxidase (DAO) blockade in pigs: Further evidence of the key role of elevated plasma histamine levels as demonstrated by successful prophylaxis with antihistamines“; Agents and Actions; Volume 27, Numbers 1-2 / April 1989
P. Velicky, K. Windsperger, K. Petroczi, S. Pils, B. Reiter, T. Weiss, S. Vondra, R. Ristl, S. Dekan, C. Fiala, D. E. Cantonwine, T. F. McElrath, B. Jilma, M. Knöfler, T. Boehm, J. Pollheimer: Pregnancy-associated diamine oxidase originates from extravillous trophoblasts and is decreased in early-onset preeclampsia. In: Scientific Reports. Vol. 8, No. 1, April 20, 2018, doi:10.1038/s41598-018-24652-0.
