Dr Joneja's Guides to Histamine Intolerance

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.

Food poisoning, hives the menopause and puberty. Is there a histamine connection?
As part of our on going histamine Q&A with Dr Janice Joneja we had two questions which related to food poisoning, travel and, coincidentally, the menopause and puberty.

Question 1 – food poisoning which morphed into swelling around the eyes, hives and itchy bumps. Could seasonal allergies be relevant, or the menopause?

Question 2 – a 14-year old girl with food allergies develops hives and headaches while travelling. Could this be puberty or histamine realted?

Question 1:

I'm 45 year old woman who got food poisoning last October and three weeks later started getting angioedema of eyes in the morning. These then morphed into hives, reddening of cheeks and itchy bumps on cheeks – mostly after I eat.

I've been clinically cleared of all diseases and came across your article. I'm convinced that as a result of the food poisoning my body can't breakdown histamines any more. How should I proceed in terms of getting tests done? How can I help my body go back to poisoning when I ate everything. I don't want to live on antihistamines forever!

Dr Joneja says:

The symptoms you describe are the result of excess histamine, but the source of the excess could be one of several causes.

In answering your questions, I am handicapped by the absence of some key facts:

  • Was the cause of your food poisoning diagnosed?
  • Did you receive any treatment in the form of antibiotics for the food poisoning or did you wait for it to clear up on its own?
  • Do you have any allergies to inhalants such as pollens or other environmental allergens?
  • Do you have any symptoms of menopause or perimenopause?

The details will affect my answers to your questions for the following reasons:

  • If your food poisoning was due to an infective micro-organism you may have received an oral antibiotic to treat the condition.  This may have affected your normal bowel microflora which could have resulted in an increase in bacteria that are able to produce the enzyme histidine decarboxylase.  This enzyme will convert histidine in undigested proteins into histamine in your digestive tract.  Such histamine can increase the level of histamine in your body and result in the symptoms you describe.
  • You state that you have “been clinically cleared of all diseases”, so I am assuming that stool tests have not produced any evidence of an infective micro-organism remaining in your digestive tract.  Thus, we can assume that no new strains have been introduced as a result of the contaminated food.
  • If the food poisoning was due to a toxin in the food you consumed you would not have been given an antibiotic.  The symptoms would have cleared up on their own without treatment as your immune system would have gradually removed the toxin from your body.  In this case your normal microflora would likely remain unchanged.
  • We cannot assume that your excess histamine is a result of the food poisoning because there could be several other reasons for your reactions, including respiratory allergies.  This is the season when there is a significant increase in air-borne allergens and this year the pollen count in many areas is especially high.  You report that your symptoms are noticeable just after eating.  This is a fairly common observation in people who have seasonal inhalant allergies as histamine is released every time a person eats because the histamine is required for the release of gastric acid – an essential part of protein digestion.  Therefore, if a person’s “histamine bucket” is almost full as a result of an allergy (see this article for more detail), the increase in histamine triggered by the process of eating will cause the bucket to over-flow and result in symptoms such as you describe.
  • If you are in, or reaching menopause, the levels of hormones such as oestrogen and progesterone may be fluctuating.  Such changes can affect the level of histamine in your body and result in symptoms due to histamine excess.

To answer your specific questions in light of this information:

  • Your statement that possibly your body “can't breakdown histamines any more” is actually incorrect.  The level of the enzymes that break down histamine, diamine oxidase (DAO) and histamine N-methyltransferase (HNMT) do not change.  You will still be producing the same amount of each of these as you did prior to your food poisoning episode.  The change in your histamine level is due to the amount of histamine in your body now exceeding the capacity of these enzymes to break down the excess fast enough to prevent the development of symptoms.  You need to reduce the level of histamine in order to remain below your body’s “limit of tolerance’ – the level above which symptoms develop.
  • There are no reliable tests to accurately measure either the activity of your histamine-degrading enzymes, or the level of histamine in your body. See here for more details.

The most effective way for you to manage your excess histamine and to reduce your reliance on antihistamines is to closely follow my histamine-restricted diet for a trial period.  If you find that your symptoms resolve, or diminish in intensity, you will be able to control your reactions by dietary management. See the second half of this article for guidance. Supplementary diamine oxide in the form of DAOSin, Histame, or another brand, taken before eating will further help by reducing the amount of histamine in the food. (You can buy DAO supplements here in the UK or here in the US.)

If your histamine excess is indeed due to a change in the microbial flora of your bowel (your microbiome) and no other cause, you may find that over time you will begin to tolerate more histamine-containing and releasing foods as your microbiome returns to its normal composition. 

May 2016

Question 2:

Three weeks ago, while on holiday, my 14 year old daughter who has food allergies to fish, nuts, sesame and shellfish, broke out in hives all over her legs.  At the time I gave her Benadryl.  The hives would come back every 5 hours in different locations on her legs and then arms.  I took her to an allergist who said he thought it was viral and prescribed 20mg of Reactine daily.  She has been on Reactine for 10 days she is extremely fatigued and has had a constant headache at times severe when I lower the dose of Reactine in hopes it might alleviate her headache her face begins flushing. 

My daughter who has suffered from allergies has never experienced hives or headaches in the past.  Just as a note she has started to menstruate and her first 2 cycles have been a few weeks apart. 

Dr Joneja says:

It is not uncommon for a girl entering menarche (onset of puberty) to experience symptoms of histamine excess such as hives, flushing, headaches and fatigue.  Although the precise mechanism of the association is still unclear, research is indicating that histamine levels are influenced by hormones, especially progesterone and oestrogen, which change significantly during the menstrual cycle.  For some reason, the changes in the level of these hormones at menarche and menopause seem to result in unusually high levels of histamine release.  These effects seem to be diminished over time as the body adjusts to the changes.  Because your daughter is atopic – in other words, is already sensitised to a number of allergens, she is at a higher than normal risk for developing symptoms of histamine excess because her basal level of histamine is already unusually high.  Even a slight change, probably triggered by hormone production during her menstrual cycle, will cause her “histamine bucket” to overflow – see this article for more information.

Of course there is the possibility that your daughter contracted a viral infection during her holiday in the USA, which would increase her histamine levels as any infection would, because it is an inflammatory reaction which inevitably results in histamine release.  If this is the case, her symptoms will diminish as the virus is cleared from her body.

In any event, whether your daughter’s symptoms are due to an infection, allergy, or hormonal fluctuations, she is dealing with an excess of histamine.  The effects can be controlled by antihistamines such as Benadryl, which however, is a sedative and therefore will increase her fatigue, or a non-sedating antihistamine such as Reactine. 

For the long-term I would suggest that she follow my histamine-restricted diet (see the end of the same article for the diet), making sure that she consumes all of the “allowed foods” to ensure complete balanced nutrition, which is critical at this stage of her development.  The diet will at least reduce the exogenous (from outside the body) sources, so decreasing the total body level of histamine.  In addition, supplementary diamine oxidase in the form of DAOSin or Histame taken immediately before food, will aid in breaking down any histamine in a meal before it enters the body. (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.)

It is most likely that as your daughter’s body adjusts to the hormonal changes, her histamine levels will return to a more “normal” level and her present symptoms will resolve to a large extent.  I hope that it will be of some reassurance to you both to know that the situation is temporary and should not be a long-term issue.  However, the adjustment period is an individual characteristic, so unfortunately I cannot give you any time frame in which to expect such an improvement.

May 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 was a registered dietitian (RD) – now retired. 

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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