Histamine intolerance: an enigmatic clinical picture

Histamine intolerance: an enigmatic clinical picture

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The riddle of histamine intolerance

Histamine intolerance is not infrequently suspected in people who develop severe symptoms after consuming fish, meat, cheese, wine or some vegetables. The associated ailments can range from reddening of the skin, itching and hives, to nausea, vomiting and stomach cramps, to diarrhea, dizziness and migraine attacks. However, the clinical picture is difficult to prove because there is no suitable diagnosis.

Red spots appear around the nose and cheeks. Sometimes there are swellings on the face. And it can also itch. Sometimes, but not always, the symptoms disappear quickly. If red wine or Roquefort cause symptoms, there is often talk of a “histamine intolerance”. However, there is no evidence of such a diagnosis.

No test - no clinical picture?

Experts think it off: "Histamine intolerance is a clinical picture that actually doesn't exist," explains dermatologist Professor Thomas Fuchs from the University Medical Center Göttingen. The reason: there is no test with which such an incompatibility could be proven.

What are histamines?

First of all, it has to be clarified what histamines are. "These are messenger substances that cells in the body produce from the amino acid histidine," explains Fuchs. These messenger substances fulfill important functions. Not only that they ensure a balanced sleep-wake rhythm and regulate blood pressure. Histamines also stimulate gastric juice production and increase bowel movement.

After work, they are broken down in the small intestine, using the enzyme diamine oxidase (DAO). "This usually happens when there are too many histamines in the body," says Fuchs. Histamine is not only produced by the body itself, but is also supplied via food.

From wine to cheese

"In addition to red wine, sparkling wine and champagne, sauerkraut, long-aged cheeses such as Roquefort, Tilsiter or Parmesan and anchovies in oil or aged ham are considered to be high in histamine," says Sonja Lämmel of the German Allergy and Asthma Association (DAAB).

Chocolate has little histamine, but it can possibly release it in the intestine - that is not certain. "In some cases, bowel problems seem to be the cause of complaints," says Fuchs. There is no evidence that histamine alone triggers these symptoms.

The histamine intolerance puzzle

It has not yet been clarified whether and to what extent the breakdown of histamine in the small intestine can be slowed down - for example, by inflammatory processes in the body or certain hormones. Researchers are also discussing whether excessive alcohol consumption or insufficient intake of vitamins B6 and C may interfere with the function of the DAO enzyme in the small intestine. Another option: certain pain relievers or antibiotics could slow down histamine breakdown.

Record symptoms and seek help

But if there is no such thing as an intolerance - what are the complaints such as facial flushing, itching, nausea, dizziness or voice disorders after eating and drinking? "It is probably not the histamine alone that triggers the symptoms, but the histamine in the context of other substances," explains Lämmel.

Keeping a food diary can help

She advises those affected to keep a food diary first. In it you should write down exactly what you have eaten when and what reactions the body then showed. Those affected can then present this food diary to an allergist or an allergy-savvy nutritionist.

On the basis of the nutritional symptom diary and together with a detailed medical history, the specialist examines whether there is a connection between the food consumed, triggering factors and symptoms. In the next step, the patient can discuss such a suspicion with the allergist, who initiates further examinations.

Temporary change of diet

If the suspicion is confirmed, there are nutritional tips for those affected. "Statutory health insurance funds subsidize such nutritional therapy," says Lämmel. Incidentally, the intolerance to certain foods or beverages is in many cases not a permanent condition. "Sometimes problems only occur in phases," emphasizes Fuchs. Sometimes waiting also helps. One day, red wine, parmesan and Co. may no longer cause problems. (vb; source: Sabine Meuter, dpa)

Also read:

  • Histamine intolerance: symptoms and treatment
  • Histamine allergy - causes, symptoms and therapy

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Graduate editor (FH) Volker Blasek


  • German Allergy and Asthma Association: histamine intolerance (access: April 15, 2020),

Video: HISTAMINE INTOLERANCE Symptoms and Solutions! (June 2022).


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