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Therapy

Procedure

There are different factors which may lead to histaminosis. They all have in common that they upset the histamine balance and lead to an overload with histamine and other biogenic amines (please refer to page Histaminosis). There is histamine release and uptake from several sources at the same time. We have the following therapy approaches at our disposal to reset the balance and maintain a condition more or less free of complaints:

1. Identifying and eliminating histamine sources
2. Accelerating histamine degradation
3. Stabilizing histamine release with medication
4. Blocking the effect of histamine with medication
5. Alleviating symptoms and discomfort

Usually, it is sufficient to choose one or a few of the available therapeutic options. Every person affected by HIT has to find his or her ideal combination. Sometimes, the strategy also has to be adapted to the scheduled daily routine and current histamine exposure.

1. Identification and elimination of histamine sources

The main sources are the diet, medication, allergies and stress.

Diet

On the page therapy > dietary change we describe the elimination diet, which helps people find out whether avoiding certain foods may improve symptoms. Such a diet is one of the cornerstones of the treatment of histamine intolerance. In the wake of a positive diagnosis, sufferers need to find out individually how closely they need to follow such a diet.

Medication

A number of active ingredients in medications are able to release histamine produced by the body (histamine liberators) or to block the activity of diamine oxidase (DAO blockers). Some drug ingredients identified as incompatible are listed on the page therapy > medicaments. Such medications should if possible be discontinued or replaced with a well-tolerated alternative after consultation with your doctor in charge.

Allergies

The contact with allergens may release large amounts of histamine in the body. Allergy sufferers therefore have to consistently avoid substances, which they are allergic to. This is not always possible, for example with pollen allergies.

Allergy and atopic sufferers may possibly be more prone to mast cell degranulation than other people, even without any allergen contact.

Allergy sufferers also have to consider potential cross reactions. People who are allergic to pollen, for example, may sometimes also react to certain foods because they contain certain protein sequences (epitopes), which resemble those of pollen so that the antibody against pollen also fits the food epitopes.

Stress

Definition: In everyday language the term "stress" is used as a synonym for flurry of activity, for example a heavy workload. Here we use the term stress in a wider sense, for mental or emotional stress as well as physical stress. In simplified terms; stress comprises the body's reactions to all situations and influences that deviate from the norm.

Mental stress (psychosomatic component)

The peripheral nervous system connects the central nervous system to the limbs and organs and particulary stimulates the digestive and genitourinary systems. This interaction may explain why we have butterflies in our stomach when we are in love, why anger and worries cause an upset stomach and why we wet our pants with fear. Strong excitation may cause mast cells to release histamine. This is how nervousness can lead to diarrhea. You may also know the expression that you are allergic to a certain person because he or she is getting on your nerves. This also illustrates the release of histamine, which is controlled by the brain.
The psychosomatic component is only one of many histamine sources and is relatively insignificant compared to the intake of histamine through ingestion. With people who have a certain predisposition, the psychosomatic component may, however, represent the main source. Still, histamine intolerance is not a mental disorder, but a result of an impaired histamine degradation, which may affect the entire body. The release of histamine due to mental stress is a normal process. People who suffer from histamine intolerance may not be able to break down this histamine fast enough. The degradation as such is, however, a process that is independent from a person's state of the mind. That is why it is hard to understand that many physicians label patients with HIT symptoms as mentally ill, denying them medical support by shunting them off to the psychiatric ward. Doctors often do not consider histamine intolerance in differential diagnostics.

Physical stress

Excessive physical strain or other extraordinary extraneous influences, such as major physical exertions or injuries, may trigger the release of smaller amounts of histamine in the body.

Unspecific stimuli

Chemical sensibility, multiple chemical sensibility (MCS), cold urticaria, fragrance sensitivity, etc.

In people with a certain predisposition unspecific stimuli such as the cold (cold urticaria), heat, wind, smoke, pollutants (exhaust fumes, chemicals released from construction materials or furniture), scents (fragrances in perfumes, cosmetics, detergents, air fresheners etc.), physical urticaria through mechanical stimuli (for example Darier's sign after stroking the skin of a person with mastocytosis, "wool allergy" when woolen clothes are worn directly on the skin) may lead to a release of histamine. Particularly extreme manifestations are multiple chemical sensibility (MCS) or aquagenic urticaria.

2. Accelerating histamine degradation

In cases where a disorder of the digestive tract has led to histamine intolerance, it is advisable to try and restore the intestinal mucosa as much as possible so that it is able to produce sufficient amounts of diamine oxidase.

The intake of oral diamine oxidase allows to replace the missing enzyme from the outside so that the body is able to start breaking down histamine in the intestines before it is even exposed to it.

Many substances, including common drug ingredients as well as alcohol and its metabolite acetaldehyde, inhibit the activity of the diamine oxidase and thus block the degradation of histamine. The intake of these substances should be avoided whenever possible. (Medication should only be discontinued or replaced with a well-tolerated alternative after consultation with a doctor!)

These measures are described on the page therapy > medicaments.

3. Stabilizing histamine release with medication

Another specific drug therapy is the intake of mast cell stabilizers, which have the function of decreasing the amount of histamine released by the mast cells, a mechanism called mast cell degranulation. This medication can be used if the release of histamine by the body cannot be stemmed by other means (avoiding of histamine-rich foods, allergens or stress etc.).

Certain vitamins and minerals also have a positive effect, possibly because they stabilize the mast cells.

These measures are described on the page therapy > medicaments.

4. Blocking the effect of histamine with medication

If the above-mentioned measures are not successful to keep the level of histamine at bay, the histamine receptors may be blocked with antihistamines. While the histamine would remain in the body, it would not be able to trigger most of the symptoms as long as the antihistamine's effect lasts.

This measure is described on page therapy > medicaments.

5. Alleviating symptoms and discomfort

Alleviating symptoms and discomfort, i.e. fighting the symptoms without knowing or tackling the cause, seems to be very popular with many physicians. They prescribe painkiller against headaches, lozenges against sore throats and decongestant spray for a runny nose. Relapsing sinus infections often require antibiotics and antidepressants are readily given to fight depressions. There are suitable treatments for hypotension, reflux, diarrhea and many other ailments. Physicians, pharmacists and the drug industry are the beneficiaries. Patients who focus on alleviating HIT symptoms are not likely to benefit and achieve satisfying results in the long run; they may even feel their condition aggravate, for example if they are prescribed medicaments which are histamine liberators or DAO blockers. Alleviating the symptoms should only be a temporary solution, should all the above-mentioned targeted measures fail.

Guided tour: Go to
therapy > dietary change

References and bibliography