From the Academy

Question of the Month

Is There a Diet for Histamine Intolerance?

L’intolérance à l’histamine ou fausse allergie alimentaire de mécanisme histaminique correspond à l’apparition de symptômes lors de l’ingestion d’aliments contenant de l’histamine à des doses bien tolérées par des sujets sains. Les réactions d’intolérance à l’histamine se manifestent par des pathologies relativement fréquentes que sont l’urticaire chronique et les céphalées. Sa prévalence est estimée à 1 %. Les auteurs exposent les mécanismes physiopathogéniques : anomalies de l’absorption intestinale de l’histamine, déficit des systèmes de dégradation enzymatique (diamine oxydase et histamine-N-méthyl-transférase), hyperréactivité à l’histamine et/ou facilité à l’histaminolibération non spécifique. Les éléments du diagnostic se basent sur la réalisation d’une enquête catégorielle alimentaire, l’exclusion du principal diagnostic différentiel qu’est l’allergie alimentaire et sur un régime d’épreuve pauvre en histamine, équilibré sans excès de consommation catégorielle selon les recommandations du Programme national nutrition santé.

Histamine intolerance or false food allergy with histamine mechanism is defined as symptoms caused by ingestion of food containing histamine at dose well tolerated by healthy subjects. These reactions consist in relatively frequent disease such as chronic urticaria or headache. Prevalence is estimated at 1%. The authors highlight the pathophysiological mechanisms: abnormalities of intestinal absorption of histamine or enzymatic catabolism (diamine oxidase and histamine-N-methyl-transferase), hyper-reactivity to histamine and/or increase of non-specific histamine release. Diagnosis is based on food diary, the exclusion of the main differential diagnosis that is food allergy, and histamine restricted diet. The authors suggest a diet poor in histamine, balanced without excess biogenic amines consumption as recommended by the National health nutrition programme.

Excessive accumulation of histamine in the body leads to miscellaneous symptoms mediated by its bond to corresponding receptors (H₁–H₄). Increased concentration of histamine in blood can occur in healthy individuals after ingestion of foods with high contents of histamine, leading to histamine intoxication. In individuals with histamine intolerance (HIT) ingestion of food with normal contents of histamine causes histamine-mediated symptoms. HIT is a pathological process, in which the enzymatic activity of histamine-degrading enzymes is decreased or inhibited and they are insufficient to inactivate histamine from food and to prevent its passage to blood-stream. Diagnosis of HIT is difficult. Multi-faced, non-specific clinical symptoms provoked by certain kinds of foods, beverages and drugs are often attributed to different diseases, such as allergy and food intolerance, mastocytosis, psychosomatic diseases, anorexia nervosa or adverse drug reactions. Correct diagnosis of HIT followed by therapy based on histamine-free diet and supplementation of diamine oxidase can improve patient's quality of life.