Histamine Intolerance and Mast Cell Activation Syndrome: An Overview for Practitioners

Histamine intolerance, an often overlooked condition, is estimated to affect about 1 to 3 percent of the population, though this number might be higher due to underdiagnosis. With the blossoming flowers and the renewal of nature comes an increase in allergens, making spring the perfect time to discuss how we, as practitioners, can support our patients through the challenges of histamine intolerance and Mast Cell Activation Syndrome.


What is Histamine Intolerance?
Histamine intolerance isn’t the Allergy we see with bee stings or peanuts. Instead, it’s a mismatch between too much histamine in your body and the speed at which your body can clear it. If your body builds up too much histamine or cannot break it down, you can develop symptoms. This condition is often characterized by itching, hives, sneezing, watery eyes, asthma, headaches, abdominal pain, diarrhea, bloating, tachycardia, hypotension, anxiety, depression, and more. This increased histamine can affect different parts of the body, leading to a wide range of symptoms that are often vague and overlap with other conditions. The impact of histamine tends to vary depending on various factors, including age, sex, genetics, and gut health.


Understanding Mast Cell Activation Syndrome
Another condition associated with histamine intolerance is Mast Cell Activation Syndrome (MCAS). When the body encounters an allergen, whether cat hair, pollen, or peanuts, it sends a signal to mast cells to release histamine. This spurs several reactions to help clear the allergen. In the case of MCAS, mast cells are inappropriately activated and released, leading to too much histamine in the body. Common triggers include certain foods, chemicals, fragrances, exercise, and stress. Symptoms are similar to those associated with histamine intolerance and can range from swelling and hives to nausea and fainting.


Diagnosis and Management for Practitioners
Identifying histamine intolerance and MCAS can be challenging due to the nonspecific nature of their symptoms. A 2020 review noted that histamine intolerance affects one to three percent of the population, but this area of research is still evolving. Currently, there are no standard blood tests to identify intolerance. According to a 2018 study published in Allergy, a histamine elimination diet determines if someone has a histamine intolerance. This involves removing any foods high in histamine and slowly reintroducing them to watch for new reactions. This should be done with the guidance of a qualified health practitioner.


Without standard blood tests for intolerance, an elimination diet remains the primary method for diagnosis. This involves removing foods high in histamine and gradually reintroducing them to observe reactions, a process that should be conducted under the guidance of a practitioner. MCAS diagnosis hinges on symptom assessment, alongside blood and urine tests during symptomatic episodes, and response to medications that block the effects of mast cell mediators.


Importance of a Low-Histamine Diet
Controlling dietary histamine intake can significantly reduce symptoms for those with histamine intolerance or MCAS. Practitioners play a crucial role in guiding patients through the complexities of a low-histamine diet, which involves avoiding high-histamine foods and incorporating foods that are less likely to trigger symptoms.


Key Dietary Recommendations

Foods to Avoid Foods to Include
Citrus fruits, strawberries, etc. All fruits not listed as to avoid
Eggplant, olives, spinach All vegetables not listed as to avoid
Aged cheese, milk, yogurt Non-dairy milks
Canned meats/fish, sausages, etc. Freshly cooked or frozen meat and fish
Bleached wheat flour Corn, rice, oats
Walnuts, cashews, peanuts (No recommended nuts due to histamine levels)
Vinegar, soy sauce, fermented foods Fresh and dried herbs, salt
Coffee, alcohol, black tea Water, herbal tea, non-citrus fruit juices


Mineral-Nutritional Balancing Program
As practitioners, when we support our patients with a Mineral-Nutritional Balancing Program, one of our goals is to strengthen gut health. This often starts with limiting high-histamine foods. Improvements in gut health can expand the variety of foods patients can tolerate, reducing their histamine-related symptoms. This holistic approach underscores the importance of dietary management alongside broader health strategies.