Dr Janice Joneja, a world expert on histamine intolerance, has published two books on histamine intolerance:

A Beginner's Guide to Histamine Intolerance – read more about it here.

Buy the paperback from Amazon here; buy the e-book from Amazon here.

Histamine Intolerance: The Comprehensive Guide for Healthcare Professionals – read more about it here.

Buy the ebook from Amazon here.

You can buy all of Dr Joneja's books here in the UK or here in the US.

To go straight to Dr Joneja's answer click here.

Question:

Last October (2014) my then nine year old had a serious respiratory illness that triggered ongoing histamine issues.  The issues (urticaria, angioedema, headache, etc.) have largely resolved, but still crop up from time to time (most notably in the form of exercise-induced angioedema).

He does not appear to have any GI issues (no gas, bloating, cramping, etc.).  His stools are regular.  He is currently on a high-nutrition, anti-inflammatory and mostly lower histamine diet (he does tolerate quite well even higher histamine foods at this point, but we try to keep them at a moderate level).  He does not tolerate probiotics or fermented foods.  We try to keep our home as allergen-free as possible (we do have two cats).  He gets plenty of fresh air and outdoor time.  What I don't know how to do, though, is go about correcting any bacterial issues that might be affecting his microbiome since he doesn't seem to be able to take in any probiotics without breaking out in a rash.

Is there one of your books you can direct me to that might tackle the question of what to do when, following a respiratory illness, your child may have developed an overgrowth of bad bacteria which is leading to histamine intolerance, allergy symptoms, occasional hives, angioedema, etc.  He doesn't handle probiotics or fermented foods very well (he gets a rash), and I'm a little at a loss as to what to do.

This has been going on for a little over a year, and has resolved to a large extent on a low to moderate histamine diet.  The exercise-induced angioedema, though, has increased recently and is a scary development.  I've brought him to an allergist, but, short of ruling out asthma, she hasn't been a great deal of help.

Dr Joneja says:

Your question allows me to discuss and clarify a number of topics that are currently of increasing interest, especially on internet sites, but are becoming rather misunderstood and consequently of mounting concern to many people.

Dysbiosis:

First of all, let us consider the name, “dysbiosis”.  It is not actually a medical term; it was originally coined to describe a change in the types and numbers of micro-organisms that live and thrive in and on the body (sometimes called the normal microbial flora, or microbiome), especially in the large bowel.  It is used to describe an imbalance between the “good” and “bad” microorganisms, specifically, an increase in the strains considered to be harmful and a decrease in the numbers of the so-called beneficial organisms, principally bacteria. (1)

The condition has been studied mainly in diseases of the digestive tract such as Crohn’s disease, inflammatory bowel disease, colitis and cancer.  Microbial imbalance has also been questioned in cases of obesity, bacterial overgrowth in bacterial vaginitis (bacterial infection of the vagina causing inflammation), and other inflammatory conditions in various sites throughout the body. 

At this stage of our knowledge, however, it is safe to say that we cannot with any certainly ascribe any imbalance to a specific cause or triggering event.  In an inflammatory condition such as Crohn’s disease, for example, the change in the microflora may precede the inflammation and thus be a cause of the condition, or equally possible, the change in the microbiome composition may be a result of the inflammation (which may be an auto-immune process), and thus be an effect.  Researchers are currently trying to resolve this question in a number of disease processes.

The Resident Microflora

The types of microorganisms that live and thrive in the human body begin to become established as soon as we enter the world at birth. The permanent resident flora of the digestive tract is typically in place after the infant in weaned and is consuming a fairly wide range of foods.  It is interesting that the microbial flora of people living in the same household and eating the same diet can greatly differ between individuals.  The types and numbers of microorganisms depend not only on the environment and diet, but also on the unique immunology and physiology of each person.  In most cases the permanent microbiome remains relatively stable and unchanged throughout life. 

After some cataclysmic event such as taking oral antibiotics the composition of the microflora will change.   Specific microbial types will be killed off, thus allowing an increase in others not affected by the antibiotic employed. However, in most cases, the original types and numbers of the microbial population within the bowel becomes re-established over time.  With this in mind I would suspect that your son’s normal microbiome will have re-established itself by now since it has been more than a year since his respiratory illness, which I am assuming, was treated with antibiotics.

Histamine and the Gut Microflora

You mention that your son has no signs of a disturbed digestive tract microflora, which would be indicated by symptoms such as abdominal pain, excessive gas, bloating, diarrhea or constipation.  In reading your question it would appear that the only remaining symptom is the angioedema, the severity of which is increased by exercise, and an occasional rash.  It is quite possible that the microbial strains now re-established within his digestive tract have nothing to do with either the angioedema nor are the result of oral antibiotic use.

Angioedema, as you have correctly surmised, definitely involves excessive amounts of histamine.  However, the origin of the histamine is not apparent from the history you have provided.  It may be a result of a large number of histidine decarboxylase-producing bacteria in his bowel.  However, there is not a great deal we can do to correct that condition.  I have written at length about the microbial flora of the bowel, its relationship to histamine production, and the value of probiotics, in a number of my answers to similar queries:
• The development of the microbiome with especial reference to histamine
• Could a fecal transplant help to re-establish DAO?
• Can taking probiotics help a histamine intolerance?

From these articles you will understand that there are no probiotics that will lead to a decrease in the microorganisms that produce histidine decarboxylase and therefore increase histamine in the digestive tract, nor are there any that produce diamine oxidase (the enzyme that breaks down excess histamine).  Therefore, there is no value in trying to manipulate the microbial flora of the gut in an effort to change your son’s microbiome.  At the present state of our knowledge, probiotics are definitely contraindicated in the management of histamine intolerance.

Managing Angioedema

You have managed your son’s situation extremely well.  You can do very little about the possible microbial species in his digestive tract that may be contributing to his histamine load. Angioedema does involve histamine excess. Exercise will of course increase your son’s response to any trigger for histamine release that may be involved in his symptoms.  I would recommend reducing every source of additional histamine that is under your control.  My histamine-restricted diet (please see the bottom of this article) together with a diamine oxidase supplement is the best approach that we can recommend at this stage of our knowledge.  Your son’s doctor may recommend an antihistamine to treat the angioedema when it is acute, especially after exercise.

As a footnote, I would like to reassure you that, although angioedema is very distressing, it is not a sign that the condition is in any way life-threatening or harmful in the long-term.

You can buy DAO supplements here in the UK or here in the US.
You can buy all of Dr Joneja's books here in the UK or here in the US.

February 2016

If you found this article interesting you can find a number of other articles on histamine intolerance both by Dr Joneja and others here, reports on histamine research here and a Q & A section on histamine with Dr Joneja here.

For many, many other articles on every type of food allergy and intolerance click here; for coeliac disease and other food related conditions, go here.

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Dr Janice Joneja, Ph.D., RDDr. Janice Joneja is a researcher, educator, author, and clinical counsellor with over thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerances. Dr. Joneja holds a Ph.D. in medical microbiology and immunology and is a registered dietitian (RD). 

She has been a member of the faculty at several Canadian universities, starting her career as an Assistant Professor in the Department of Microbiology, Faculty of Science, and in the Faculty of Dentistry, at the University of British Columbia, Vancouver. Since 2001 Dr. Joneja has been a faculty member in the School of Biomedical and Molecular Sciences, at the University of Surrey, in England, teaching in the M.Sc. course in Nutritional Medicine.  For 12 years she was head of the Allergy Nutrition Program at the Vancouver Hospital and Health Sciences Centre.

Dr. Joneja is the author of six books and a dietetic practice manual on food allergy, a textbook on Irritable Bowel Syndrome, and several distance education courses. Her most recent books include “The Health Professional’s Guide to Food Allergies and Intolerances”, “Dealing with Food Allergies”, and “Dealing with Food Allergies in Babies and Children”.  Dr. Joneja’s work has been published in peer-reviewed scientific and medical journals, as well as in popular magazines.  She is a respected lecturer at universities, colleges and hospitals internationally, and regularly appears on television and radio call-in shows as an expert in her field.

Dr. Joneja is President of Vickerstaff Health Services, Inc., a practice that provides counselling for people suffering from all aspects of adverse reactions to food, and resources for the professionals and care-givers who support them.

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