Food allergies and intolerances are on the rise in Australia, with a staggering 10% of infants under 1 and 4-8% of children under the age of 5 experiencing a food allergy. In fact, Australia has one of the highest rates of food allergy in the world! So, just why are food allergies and intolerances on the rise? This an important question and there aren’t yet clear or definitive answers, but some factors that play a role include:

• Genetics – allergies and intolerances often run in families. A family history of food or other allergies increases a child’s risk of having allergies. This includes families who experience eczema, hay fever, and asthma, too.
• Birth History: allergic type conditions are more prevalent in children who were born via caesarean, not breast fed or who were born prematurely due to the impact this has on important gut bacteria colonisation.
• Early or late food introduction – children who are exposed to solids very early (before 4 months of age) or who aren’t exposed to allergenic foods until late (after 1 year of age) have a higher risk of developing food allergies.
• Gut dysfunction – the gut is important for immune regulation and protecting the body from particles in our food that we might react to. Imbalances in gut bacteria and damage to the intestinal wall can both contribute to food intolerances, by allowing undigested proteins and other immune-reactive food particles to be absorbed into the blood.
• Low stomach acid production – stomach acid is needed for breaking down foods that can cause immune and intolerance reactions. Low stomach acid production can sometimes occur due to altered gut microbes.
• Low levels of vitamin D – an important nutrient for regulating the immune system and one which many Australians are deficient in.
• Gut microbiome – Altered gut microbiome thanks to diet and extent of antibiotic use.
• Medication use – including antacids, which affect the breakdown and absorption of nutrients.
• Stress – stress suppresses our immune function and can cause negative changes to gut bacteria, too.
• Limited or restricted diet – consuming the same foods repeatedly, without sufficient variation in the diet, can increase the risk of food intolerances.

Navigating food allergies and intolerances can be complex and overwhelming, but with education and planning, it can be very manageable. In fact, many children are able to improve their health and increase their tolerance to many foods that they previously were unable to eat, simply by modifying their diet in the short term and looking after their overall health in the long term. This blog provides you with the information and tools you need to help your child manage their food allergies and intolerances and regain control of their health.

What is the difference between allergy and intolerance?

Sometimes, the terms “allergy” and “intolerance” are used interchangeably, but there are important differences between the two.

Allergies

A true food allergy is an immunological response. The immune system mistakenly recognises a protein or other component within a certain food as being harmful and initiates a cellular (immune) response to the food when exposed to it. This response typically involves the release of IgE antibodies, which triggers the release of large amounts of histamine – the chemical responsible for symptoms such as itchy, watery eyes, nasal congestion, and hives. Allergic reactions to foods can occur when exposed to even the tiniest amount of the food. If your child has a severe food allergy, even breathing in particles from someone else’s meal may be enough to trigger an immune response. Allergies tend to have more sudden, severe symptoms, including anaphylaxis (the type of allergy that requires an EpiPen). However, not everyone with a food allergy experiences anaphylactic responses. They may instead experience less severe allergic-type symptoms, such as allergic asthma or hay fever, or even skin rashes.

Symptoms of a food allergy may include:

• Anaphylactic response – sudden and severe swelling of the throat, eyes, lips, with swelling causing difficulty breathing – a medical emergency that requires rapid care.
• Respiratory symptoms – sneezing, red itchy nose, sinus pain.
• Gastrointestinal symptoms – bloating, flatulence, abdominal cramps, tingling or itching sensation in the mouth, swelling of the mouth, tongue and throat, difficulty swallowing.
• Skin symptoms – hives, red and itchy rashes, swelling of the face.
• Other – feeling dizzy or light-headed.

Food allergy symptoms are typically very quick to develop after exposure to the allergen, often within a matter of minutes after exposure. Symptoms also tend to get worse with each subsequent exposure. This is why exposure is a serious issue with those with allergies.

Intolerances

A food intolerance is a chemical reaction to a food which results in symptoms. Food intolerances typically cause less severe symptoms than allergic reactions, but they can still be significant. Food intolerance reactions may occur due to a person lacking an enzyme required to properly digest a food or may occur in response to chemicals or additives found in foods. Symptoms of food intolerance can range from mild to severe. They tend to be more chronic and have less obvious symptoms compared to a food allergy. Food intolerance reactions can be much slower to develop compared to allergic responses, with a lag of several hours (and up to several days) after each exposure. This lag in symptom development is why it can be much more difficult to identify trigger foods for intolerance symptoms.

Symptoms of food intolerances in children may include:

• Gastrointestinal symptoms: abdominal pain, bloating, flatulence, diarrhoea, constipation, or erratic bowel movements, heartburn.
• Respiratory symptoms – sinus congestion, asthma, chronic cough, wheezing.
• Skin symptoms – rashes, hives, itchy skin, eczema.
• Neurological symptoms – headaches or migraines, fatigue, low energy, “brain fog”, poor concentration, mood changes, restlessness.

Common Food Allergens

A food allergy can involve any food, but just eight different food-types make up 90% of cases of food allergy. The most common food allergens are:

• Dairy
• Wheat and gluten
• Soy
• Eggs
• Fish
• Shellfish
• Peanuts
• Tree nuts

Some less common food allergies include:

• Tomatoes
• Pineapple
• Corn
• Meat (sometimes occurs due to complications following tick bites)
• Sesame, sunflower, and poppy seeds
• Celery
• Carrot
• Avocado
• Potato
• Pumpkin
• Note: Allergic reactions to fresh fruits and vegetables is sometimes referred to as oral allergy syndrome.

Common Food Intolerances

The range of foods that can cause intolerance reactions is much larger and more varied. Here we have categorised them according to food intolerance type – histamine intolerance, salicylate sensitivity, FODMAPs, food additives and preservatives, nightshades, and other types of intolerance reactions. Your child may experience intolerance reactions to a number of different foods or may only react to one.

Histamine

Histamine is a chemical that causes allergic-type symptoms in the body. We all have a limit to how much histamine in food we can tolerate, but for some, this tolerance level is significantly reduced, leading to symptoms occurring from eating foods that others do not react to. Foods that are high in histamine include:

• Highly processed or smoked meats such as salami, bacon, hot dogs, pepperoni
• Fermented foods, such as kombucha, kefir, kimchi, sauerkraut, vinegar
• Fermented and/or aged dairy products, such as yoghurt, cheddar, parmesan, and Swiss cheese
• Dried fruits
• Processed and pre-packaged foods, including condiments like tomato sauce
• Leftovers, particularly once 24 hours+ old
• Coffee
• Fish and seafood
• Beef
• Strawberries, pineapple, citrus fruits
• Avocado, spinach, eggplant

Foods that trigger histamine release in the body:

While these foods themselves do not contain high amounts of histamine, they ca trigger the release of histamine in the body when we eat them, so are best avoided if histamine is causing health issues.

• Bananas, papaya, citrus fruits
• Tomatoes, beans
• Wheat germ
• Chocolate
• Walnuts
• Cashews, peanuts

Salicylates

Salicylates are a type of phenol that are found in many different plant foods. A salicylate sensitivity in children can present with behavioural and mood changes, including anxiety and depression, and even difficulty sleeping. Foods that are high in salicylates include:

• Vegetables: alfalfa, artichoke, broad beans, broccoli, capsicum, chilli, corn, chicory, cucumber, eggplant, endive, fava beans, gherkin, okra, canned mushrooms, spinach, squash, zucchini, olives, sweet potato, canned tomato, radishes, water cress
• Fruits: Apple (granny smith), avocado, cherries, dried figs, grapes, grapefruit, mandarin, oranges, loganberries, guava, dates, mulberry, peach, tangelo, prunes, raisins, pineapple, canned plums, raspberry, redcurrants, strawberries, sultanas, youngberry, cranberry, rockmelon, boysenberry, apricot, blackberries, blueberries
• Nuts, seeds and grains: pine nuts, macadamias, pistachios, almonds, peanuts, flavoured chips and crackers
• Herbs, spices, seasonings and condiments: all spice, anise seed, cayenne, celery, cinnamon, cumin, curry powder, dill, fenugreek, five spice, garam masala, ginger, honey, jam, vegemite, vinegar, mace, mint, mixed herbs, mustard, oregano, paprika, pepper, rosemary, sage, tarragon, turmeric, thyme, Worcestershire sauce
• Sweets and sugars: liquorice, mints and peppermints, chewing gum, fruit flavourings
• Beverages: tea, peppermint tea, fruit juices, cordials
• Non-food products: mint-flavour toothpaste, sunscreens, after sun lotion, certain soaps and cleansers, shampoo and conditioners

FODMAPs

FODMAPs (AKA fermentable oligo-, di-, monosaccharaides, and polyols) are specific types of sugars that are found in many types of food. These sugars are often associated with bloating, abdominal pain, and flatulence in conditions like IBS, but can also cause intolerance reactions. Examples of FODMAPs include:

• Oligosaccharides (such as fructan, inulin, and GOS): nectarines, watermelon, artichokes, garlic, onions, chickpeas, kidney beans, lentils, pistachios, cashews, wheat, barley, rye
• Disaccharides (such as lactose): dairy products – milk, ice cream, yoghurt, ricotta, cottage cheese, other soft cheeses
• Monosaccharides (such as fructose): honey, apples, boysenberries, figs, mangoes, pears, watermelon, asparagus, artichokes, dried fruits
• Polyols (such as xylitol, sorbitol, mannitol): apples, apricots, blackberries, plums, cauliflower, mushrooms, snow peas, artificial sweeteners and “low sugar” food products

Food Additives and Preservatives

Both artificial and natural food additives and preservatives can cause intolerance reactions and symptoms in children. If intolerance or sensitivity to food additives and preservatives is suspected, it is crucial to always read food labels – it can be surprising which foods contain these chemicals. The following are common intolerance reaction-causing chemicals:

• Glutamates: MSG, flavour enhancers (620-627) – found in many different foods, such as soy and yeast extracts, soy sauce and other condiments, processed meats, chips and other snack foods, fast food, frozen meals, and commercial seasoning blends
• Colours: coal tar/ petroleum food dyes, (102, 104, 110, 122, 123, 124, 127, 129, 132, 133, 142, 143, 151, 155) – these are commonly found in foods such as soft drinks, lollies, syrups, frozen treats, packet-mix gravy, and cereals
• Preservatives: sorbates (200- 203), benzoates (210-213), parabens (216, 218), sulphites (220-228), nitrates (249-252) – found in many commercially prepared, pre-packaged foods
• Preservatives: propionates (280-283), gallates (310-312), BHA (320), BHT (321) – found in many commercially prepared, pre-packaged foods

Nightshades

Nightshades are a family of plants, which contains a number of commonly eaten fruits and vegetables. A nightshades intolerance can lead to symptoms such as bloating and abdominal pain, or even fatigue and joint pain. Nightshades foods include:

• Potato
• Tomato
• Eggplant
• Capsicum
• Chilli
• Goji berries

Other

Other common foods that trigger food intolerance reactions include:

• Wheat and gluten (e.g., non-Coeliac gluten sensitivity, or NCGS)
• Eggs, especially egg whites
• Casein, the protein found in milk, which can also cause allergy

Health Consequences of Food Allergies and Intolerances

Gastrointestinal System and Microbiome Changes

Exposure to foods that cause an immune reaction over time leads to damage to the intestinal walls, as chronic inflammation damages cells and the gut barrier. This chronic inflammation can also cause negative changes to the gut microbiome. These changes not only lead to poor health overall but can even lead to an increased likelihood of reacting to even more types of foods, as the defence barriers in the gut are no longer working.

Immune System

Over time, the immune system becomes overloaded and overburdened. This can lead to poorer defences against other infections and an increased risk of illness.

Neurocognitive Changes and Mental Health

Chronic inflammation, altered microbiome, and ongoing immune reactivity can all wreak havoc on mental health. Depression, anxiety, insomnia, and behaviour issues can all result.

Health Conditions Associated with Food Allergies and Intolerances

Certain health conditions are associated with food allergies and intolerances and will often go hand-in-hand with an underlying, undiagnosed food intolerance or allergy.

Eczema

Eczema is a chronic skin condition that is due to an allergic-type immune reaction in the skin. It is often first diagnosed in childhood but can also develop for the first time in adulthood. For many (but not all) people, eczema occurs alongside other allergic-type conditions, such as asthma and hay fever, but the triggers for each may vary. Food is a common trigger for eczema flares. Common trigger foods include wheat, cow’s milk, soy, eggs, shellfish, nuts, and peanuts. Food additives, amines, and salicylates can also trigger eczema symptoms.

Asthma

Asthma is a chronic respiratory condition that often first develops in childhood. While many children will outgrow asthma, for others it is a lifelong issue. Like eczema, asthma is part of the group of common atopic (allergic) conditions that can affect children, along with hay fever and sinusitis. Asthma in children is very common, particularly in Australia, and can be due to underlying food intolerances or allergies.

Hay fever and Sinusitis

More allergic-type health conditions that can be associated with food allergy or intolerance. Hay fever is an allergic, immune response to specific irritants. Food allergies or intolerances can trigger or worsen hay fever symptoms. Sinusitis, which is due to an infection, can be a consequence of chronic hay fever and can make the condition worse. Hay fever and sinusitis may be misdiagnosed in children with an undiagnosed food allergy or intolerance, as they can present very similarly, with itchy, watery eyes, runny nose, cough, and fatigue.

Chronic Fatigue

Chronic and prolonged exposure to food intolerances or allergies can deplete vitality, leading to chronic fatigue. There may also be underlying gastrointestinal, immunological, and neurological inflammation that is contributing to the fatigue, as a result of the intolerance/ allergy.

Irritable Bowel Syndrome

IBS is becoming more commonly understood as often being associated with food intolerance, particularly an intolerance to FODMAPs.

Coeliac Disease

Whilst not technically a food intolerance or allergy, it’s worthwhile touching on Coeliac disease. Coeliac disease is an autoimmune response to gluten, found in wheat and other grain products. Although not an allergy, a diagnosis of coeliac disease requires life-long strict avoidance of gluten, similarly to food allergies.

Naturopathic Testing for Allergies and Intolerances

In young children, blood testing may not be the ideal approach initially. In older children, it is something commonly recommended and I often test for allergies, food intolerances and look at blood tests to identify nutrient deficiencies and allergic responses. Assessing for food allergies and intolerances requires a two-pronged approach – testing, followed by dietary assessment and intervention.

In addition to these, it may be necessary to assess your child’s level of certain important nutrients, such as vitamin D. Whilst allergies are more easily identified through blood tests, it is much more difficult to accurately identify food intolerances which is why the following is commonly used:

• Food & Symptom diary
• Elimination Diet
• Reintroduction/Challenge Diet
• Rotation Diet

A food and symptom diary is important so that as a naturopath I can review what your child is eating and how it coincides with symptoms.  There are common reactive foods that can be quickly identified.

The goal of an Elimination Diet and gradual reintroduction food challenge is the strategic identification of trigger foods and symptom relief whilst we focus on correcting a number of underlying processes that trigger an immune response including:

• Restoring healthy gut bacteria and digestion.  Repairing the gastrointestinal barrier.
• Supporting normal immune system function
• Symptom relief

Any known allergies from serious food reactions or IgE testing are simply excluded.

Developing a 4-Day rotation diet for children following the investigative process above means that symptoms of allergies, eczema and more are reduced.  As food reactions commonly occur within 3 days of exposure to the food, this gives your child’s body ample time for inflammation and immune response to die down again before the food is introduced again.  If a reaction does occur, there is not the added pressure on the immune system of having this food again the next day and the body is not exposed over and over, causing histamine related symptoms.  It is also much easier to identify any new culprit foods.

There is nothing more frustrating for parents than supporting their child with allergic type conditions.  Watching your child succumb to constant infections, itching with eczema or hay fever or trying to manage troublesome digestive issues can be traumatic for parents and their children.

Food allergies and intolerances are often the forgotten piece when supporting a child with the conditions mentioned in this blog.  As you will sense from reading this education piece, identifying culprit foods so that they may be included in your child’s rotation diet is no simple task.

If you require support in this process so that you have more unique information as to what your child may be reacting to, please reach out for an initial naturopathic consultation or email me on tanya@performanceinhealth.com.au

The post Tackling Food Allergies and Intolerances in Children appeared first on Performance in Health.

What is Allergic Rhinitis?

Allergic rhinitis is essentially an allergic response by the immune system to an allergen or irritant. It falls under the umbrella of atopic conditions that can often occur together, along with asthma and eczema. These conditions often run in families, as there is a genetic component. Typically, allergic rhinitis is associated with the Springtime when the sudden increase in airborne pollens triggers immune activation in those with pollen allergies. However, as we often see in our naturopath clinic in Sydney, allergic rhinitis can be a year-round issue, as it is not only pollen that can trigger the condition. Many different allergens can cause hay fever-type symptoms, including:

• Pollen from trees, grasses, and other plants
• Animal dander
• Mould
• Dust mites
• Food allergies and intolerances can trigger or worsen rhinitis symptoms
• Non-allergic rhinitis can be triggered by irritants such as pollution, smog, smoke, and even strong odours

On a cellular level, symptoms are brought on by the release of the chemical histamine from mast cells, a type of immune cell that responds to the presence of allergens and other foreign particles in the body. It is histamine that causes the classic signs of allergic rhinitis – watery eyes, itchy skin, and a runny nose – because it causes our blood vessels to dilate. Symptoms can range from mild to severe and can impact on daily living and quality of life. Symptoms of rhinitis include:

• Watery eyes
• Runny nose
• Itching of the eyes, nose, and/or roof of mouth
• Sore throat
• Fatigue
• Cough and/or wheeze

Allergic rhinitis can also be associated with post-nasal drip coughs and even sleep apnoea. Nasal congestion can lead to oral dryness, blocked airways and even swelling of the tonsils and adenoids while you sleep. This can lead to symptoms of obstructive sleep apnoea, as the body triggers you to wake up from sleep multiple times through the night as a protective measure.

Is Allergic Rhinitis the Same as Sinusitis?

Allergic rhinitis and sinusitis are two different conditions; however, they can be related, and people can experience both conditions at once. Whilst allergic rhinitis is an immune response to allergen exposure, sinusitis is due to an infection, usually viral or bacterial. The infection causes inflammation of the innings in the sinuses, causing mucous build-up, post-nasal drip and a cough. However, the chronic congestion that can occur with allergic rhinitis can also lead to a sinus infection; chronic congestion means a stagnant build-up of mucous in the nasal cavities and sinuses.

This build-up provides an ideal breeding ground for bacteria and viruses, which can lead to infection developing. In fact, up to 80% of chronic sinusitis patients have an underlying allergy that has lead to their symptoms developing. This is why patients might experience both conditions at once, and why it is worthwhile excluding sinusitis as a cause of your symptoms. A co-occurring sinus infection may also mean that antimicrobial treatments might be needed for you, even if the root cause of your condition is an allergy.

Naturopathic Perspective

In addition to the allergic and non-allergic triggers listed above, naturopathically there are other factors that can play a role in allergic rhinitis.

Stress

Stress is a known immune suppressant and can wreak havoc on our health. Our body’s stress response is primed for acute stressors, such as attack by a wild animal. It prepares the body for fight or flight by suppressing all functions that aren’t necessary for immediate survival – including digestion and immunity. Unfortunately, in our busy, stressful modern lives, our sources of stress are often complicated and ongoing. Our bodies don’t get a chance to heal and be adequately relieved from stress for our immune system to properly do its job. The body is then more susceptible to illness, and issues such as allergic rhinitis can arise.

Histamine Overload

Histamine overload and histamine intolerance can be a hidden cause of allergic rhinitis symptoms. As discussed above, mast cells are one of the main producers of histamine in the body. These cells respond to germs and allergens in the body by releasing histamine, triggering an immune response and inflammation. It is histamine that causes the classic signs of allergic rhinitis – watery eyes, itchy skin, and a runny nose – because it causes our blood vessels to dilate. If we already have high levels of histamine due to a high histamine diet, or else have a low threshold for histamine (e.g. histamine intolerance), then even brief, transient exposure to irritants will trigger symptoms.

Poor Gut Health

The gut is one of the most important parts of the body for regulating the immune system, and good gut health is crucial for overall health. When the gut is impaired, such as due to an imbalance of gut bacteria or poor digestion, the lining of the gut can become damaged and porous, allowing the absorption of potentially harmful food particles and toxins that can trigger an immune response and lead to rhinitis symptoms. In addition, chronic gastrointestinal inflammation and imbalanced gut bacteria (known as dysbiosis) actively suppress immune system function, making it even more difficult for the body to heal.

Immune Dysregulation

Allergic reactions are a sign that your immune system is working overtime. There are a vast range of issues that can impact immune health, from stress to lifestyle issues to underlying chronic disease. Because immune system dysregulation is one of the primary drivers behind allergic rhinitis, supporting the immune system is a key component of naturopathic treatments for the condition.

Lymphatic Congestion

The lymphatic system is the highway on which our immune cells travel throughout the body. It relies on both adequate hydration and sufficient physical activity in order to work properly. If either of these factors are jeopardised, the lymphatic system can become sluggish and congested. This can be an issue particularly with conditions such as allergic rhinitis, as lymphatic congestion can worsen symptoms like mucous build-up, and means pollen and other irritants are stuck in our system for longer.

Structural Issues

Structural issues such as a deviated septum can mimic or worsen allergic rhinitis symptoms. If these are a possible issue for you, referral to an ENT will be required.

Naturopathic Testing

Because there are such a wide range of potential triggers for allergic rhinitis, testing can play an important role in determining the best treatment strategy to help you improve your symptoms. Allergy and food intolerance testing can help to identify the specific triggers that are causing your symptoms so that they can be eliminated from your diet and lifestyle and looking at nutrient deficiencies is also important as certain nutrients are critical for your immune system to be more balanced as opposed to overreacting.

Dietary Treatment Strategies

Naturopathic treatment strategies include a detailed investigation on diet as it is unique to each person.  Identifying trigger foods through testing and elimination can make an enormous difference in addition to reducing foods and substances that may suppress your immune system.

There is also a range of foods that cause excess mucus production and foods that are high in histamine.  When you are battling hay fever, the last thing you need is additional histamine being created by what you eat.

And whilst supporting you around what not to eat, it is equally important to eat healthy food that nourishes your immune system, supports healthy digestion, feeds healthy bacterial species and more.

Diet is complex and one size does not fit all when it comes to allergy and hay fever, however some of the common food triggers for allergy sufferers include:

• Common food allergens, such as wheat, cow’s milk, soy, fish, nuts, wheat, and peanuts
• Certain food additives or food colours
• Foods containing high levels of salicylates, such as citrus, berries, tomatoes, eggplant, chillies, and herbs (except parsley)
• Foods high in amines, including aged cheese, preserved meats, bananas, tinned fish, beer, chocolate, pre-packaged ready meals, fermented foods, and leftovers (especially when more than 24 hours old)
• Foods high in glutamates, including MSG, celery, and tomatoes

Lifestyle Strategies

Again, this requires a thorough investigation and often testing is recommended for accuracy however some common strategies include:

Reduce Exposure to Dust Mites in the Home

Reduce Your Exposure to Pollen and Other Environmental Triggers

Reduce Stress

Exercise Daily

Supplements & Herbal Medicines

Herbal medicines are a great tool for relieving rhinitis symptoms and returning the body back to balance. Some herbs that may be used include:

• Immune-regulating and anti-allergic herbs, such as echinacea
• Anti-inflammatory herbs, such as liquorice or chamomile
• Anti-catarrhal herbs (to reduce mucous overproduction), such as eyebright or elderflower
• Lymphatic herbs, such as stinging nettle and calendula
• Anti-microbial herbs to address any underlying infections, such as garlic, golden seal, or thyme
• Anti-anxiety and calming herbs for the role that stress plays and herbs to support a good night’s sleep such as ashwagandha, lavender, Siberian ginseng.
• Demulcent herbs, such as liquorice or marshmallow, especially if asthma is also an issue for you

 Nutrients that are critical for a healthy immune response, reducing stress, improving sleep and digestive health may include Zinc, Vitamin C, Vitamin D however a review on where you are deficient is critical for a treatment plan that is specific to your needs.

Should you require a detailed and thorough investigation and naturopathic support on managing your hay fever or allergies, please contact me on tanya@performanceinhealth.com.au or book an initial consultation via the contact details on my website. You may want to visit my award winning naturopath clinic in Stanmore in Sydney’s Inner West to see how we can help you.

The post Allergic Rhinitis appeared first on Performance in Health.

This blog provides you with some information on the condition and what may be contributing to your health picture, as well as providing you with dietary and lifestyle strategies to help you manage your symptoms and return to good health.

What is Eczema?

Eczema is a chronic skin condition that is due to an allergic-type immune reaction in the skin. It is often first diagnosed in childhood but can also develop for the first time in adulthood. For many (but not all) people, eczema occurs alongside other allergic-type conditions, such as asthma and hay fever, but the triggers for each may vary, and you may not experience them all at the same time. In adults, eczema typically presents as patches of dry, scaly skin that can also be thick and leathery.

The key aspect to the development of eczema is a tendency towards an allergic reaction (known as a type 1 hypersensitivity reaction) towards certain triggers (see below). This immune reaction causes immune cells to gather under the skin and mount a response to the trigger, releasing chemicals such as histamine and causing inflammation. This reaction leads to skin damage and physical changes in the skin like scaling, flaking, and itchiness. Over time, the skin’s barrier becomes damaged, as the immune cells cause changes to the fats and proteins in the skin. This damage means less protection from common irritants like soaps, rough fabrics, and heat, and a higher risk of infection.

Triggers for eczema can include:

• Foods – common trigger foods include wheat, cow’s milk, soy, eggs, shellfish, nuts, and peanuts. Food additives, amines, and salicylates can also trigger eczema symptoms.
• Environmental allergens, such as mould, dust mites, pollen, pet fur, cockroaches, and cigarette smoke
• Soaps and detergents, including handwash, dishwashing liquid, shampoos, laundry detergents. Excessive hand washing can dry skin out and make it more prone to a reaction
• Cosmetics, perfumes, and products with added fragrance
• Certain materials, such as wool, synthetic fabrics, or latex
• Changes to the climate, such as temperature changes, or when the air becomes very dry
• Stress
• Sweat
• Dry skin can be more prone to reacting to triggers.

Why do some people react to these things while others don’t? It is because underlying causes are at play, such as a poorly functioning immune system, or chronic and ongoing stress. Underlying causes of eczema include:

• Genetics – some families have a higher tendency to suffer with issues such as allergies, eczema, hay fever and asthma
• Diet – certain foods can be the underlying cause (e.g. due to a food allergy or coeliac disease damaging the gut lining), or they can exacerbate existing eczema, like above
• Gut dysfunction – the gut is important for immune regulation and protecting the body from particles in our food that we might react to. Imbalances in gut bacteria and damage to the intestinal wall can both contribute to eczema symptoms, by allowing undigested proteins and other immune-reactive food particles to be absorbed into the blood.
• Low stomach acid production – needed for breaking down proteins in food that can cause immune reactions. Low stomach acid can also lead to issues such as constipation, which can affect gut health, too.
• Stress – suppresses our immune function and can cause negative changes to gut bacteria, too
• Immune system dysfunction – eczema is an immune-mediated condition. If the immune system is not functioning optimally, it can be impossible for the body to get symptoms such as eczema under control
• Poor elimination function – the skin forms part of the body’s Channels of Elimination. If other channels (such as the kidneys, liver, or bowels) are not working well, the skin can become over-burdened.

Other factors that can play a role in eczema:

• Blood sugar imbalances – poor blood sugar regulation can exacerbate issues like stress and high cortisol, as well as suppressing immune function
• Nutrient deficiencies – without adequate nutrients for optimal immune system and skin health, it is impossible for the body to properly heal

As you can see, there are many, many different factors that can play a part when it comes to eczema. Understanding the unique triggers to your health will determine which of these factors are relevant to you and need to be addressed.

Naturopathic Understanding of the Skin

The skin is the largest organ of the body and is integral to keeping us healthy. It provides a physical barrier against infection and illness. It is also a part of the body’s Channels of Elimination, the ways in which our bodies get rid of metabolic wastes, toxins, and other substances that are not beneficial to our system. The skin assists this process through sweat, which contains excess minerals, hormones, and other substances to be excreted – some even call the skin “the third kidney”. Our skin is also home to a thriving bacteria population which assists with immune and barrier function and helps to maintain healthy pH levels. When the skin is no longer working optimally, so many other body systems can be affected. Conversely, the health of other body systems, including our digestion, liver, kidneys, immune system, and even our stress response and cortisol balance, can all impact on skin health. It is this link between the skin and the rest of the body which is why skin conditions can be so incredibly complex, and why they require long-term, gentle treatments. Treating chronic skin conditions aggressively can lead to short term worsening of symptoms, which is not ideal! Naturopaths understand that the skin can be sensitive to changes in other body systems, especially in chronic skin conditions. This is why naturopaths typically use a longer-term and more gentle approach to restoring skin health.

Naturopathic Testing

Because eczema is such a complicated condition that can be affected by such a wide range of potential triggers, testing plays an important role in developing a treatment strategy for you. One of the biggest ways testings can help is by identifying your specific triggers (such as certain foods or environmental allergens) so that they can be eliminated from your lifestyle. Some of the common tests that are used for eczema include:

• Full blood count, including eosinophils (a type of white blood cell which can indicate allergy)
• IgE allergy blood testing for food, chemicals & inhalants, and moulds
• IgG mediated food intolerance testing
• ALCAT testing for non-allergic type hidden food and chemical intolerances
• Pin prick allergy testing
• Food and symptom diary

In addition to these, it may be necessary to assess your levels of certain important nutrients, such as vitamin D, Iron and Zinc.

Treatment Strategies that may be incorporated into your Treatment Plan

Dietary Strategies are unique to everyone but may include the following:

Elimination Diet – Identify and Eliminate Food Intolerances

Because foods are a common trigger for eczema, a food and symptom diary, followed by an elimination diet, is frequently required to identify possible trigger foods and is particularly useful if allergy testing hasn’t been done. It is also useful for identifying non-allergy food triggers, such as salicylates, amines, and glutamates, which aren’t always as readily identified through blood tests.

IgG, IgE and ALCAT testing is often preferred due to the time it can take to properly follow an elimination diet.

The foods you need to eliminate will depend on the results of your IgE allergy testing, ALCAT testing and your food and symptom diary and it is important to remember that in many cases, many of the foods you are eliminating can be eventually reintroduced to your diet. Remember that it is vitally important to completely eliminate suspected food intolerances, at least for a set period of time while we investigate their impact on your health. Be sure to read all food labels carefully while you are on an elimination diet to prevent accidental exposure. Even a small exposure to these foods can trigger inflammation to start back up again, particularly as your body is healing.

Rotation Diet

For those who are prone to food intolerances, eating the same foods every day can be detrimental, because it can allow for an intolerance to develop. This is why people can sometimes find that it is the foods they eat daily that are causing them issues. Using a rotation diet can help.

Other strategies may include:

• Reducing Sugar Intake and Eliminate Added Refined Sugar
• Reducing Alcohol Intake
• Reducing Caffeine Intake
• Eating Plenty of Anti-Inflammatory Fruits and Vegetables
• Eating Anti-Inflammatory Omega 3-Rich Foods

Lifestyle Strategies

Each person is unique when it comes to triggering their eczema; however your naturopathic consultation will support you in strategies that may require:

• Reducing Exposure to Irritating Chemicals
• Reducing Exposure to Dust Mites in the Home
• Daily Sun Exposure
• Minimising prolonged exposure of affected areas to water
• Reducing Stress

Supplements and Herbal Medicines that may be recommended for you

Supplements that may be recommended for you as part of your naturopathic plan, depending on your health picture, diet and deficiencies identified include:

• Magnesium and B Vitamins
• Vitamin D
• Vitamin C
• Iron
• Zinc
• Quercetin
• Omega-3 fatty acids or fish oil
• Iron
• Vitamin A
• Probiotics & prebiotics
• Digestive enzymes

Herbal Medicines

Herbal medicines are a wonderful tool for treating eczema and can be used internally or externally in the form of a cream or salve. Some herbs that may be used include:

• Adaptogens – herbs that help to manage stress response and cortisol levels, such as ashwagandha, siberian ginseng, rhodiola
• Anti-anxiety herbs, such as lavender, skullcap, kava and lemon balm
• Lymphatic herbs to assist the Channels of Elimination, such as burdock, cleavers, or stinging nettle
• Immune-regulating and anti-allergic herbs, such as echinacea, astragalus, licorice, medicinal mushrooms, albizia, baical skullcap
• Anti-inflammatory herbs, such as curcumin, gotu kola, rehmannia and liquorice
• Skin soothing and anti-itch herbs, such as stinging nettle, chickweed, or oats
• Skin healing herbs, such as calendula, chamomile

At Performance in Health wellbeing clinic, supporting clients naturopathically with their quality of life when they have been living with eczema, asthma, and other similar conditions for many years is important.

For a detailed and thorough investigation of your triggers and a comprehensive treatment and testing suggestion plan, please reach out for an initial consultation via the contact tab on our website here or email tanya@performanceinhealth.com.au.

The post Living with Eczema appeared first on Performance in Health.

So, what exactly is histamine?

Histamine is an important molecule in the body that is involved in immune, allergy and inflammation pathways. It is a type of biologically active amine (also known as a “biogenic amine”), a group of many different amino acids that cause physiological changes in the body. There are receptors for histamine spread throughout the body, including in the gastrointestinal tract and even in the brain, as it exerts effects in many different body systems. Its role in the body is complex, and different types of histamine receptors in the body lead to different outcomes, as histamine often plays a regulatory role in different body systems.

One of the main producers of histamine in the body are our mast cells, a type of immune cell that responds to germs and sites of infection by releasing histamine, triggering inflammation and an immune response that helps the body to fight bacteria and other pathogens. Mast cells are also triggered to release histamine in response to allergens (e.g. food, pollen, etc.). It is histamine that causes the classic signs of allergic reaction – watery eyes, itchy skin, and a runny nose – because it causes our blood vessels to dilate. It is also responsible for more serious anaphylactic allergic reactions. In addition to causing the symptoms of allergic reactions, histamine is an important part of our innate immune system, is involved in neurotransmitter release, and may even play a role in ovulation (as well as implantation, uterine contractions, and even lactation). Despite its bad wrap, it is an essential part of our body’s normal functioning. It’s only when histamine accumulates in excessive amounts that issue arise.

As well as being released in response to exposure to allergens, the release of histamine in the body can also be triggered by other factors, including:

Oestrogen

• This is why histamine intolerance symptoms can be worse at certain points in the menstrual cycle when oestrogen levels are higher, such as during ovulation. (For more info on the link between histamine and oestrogen, check out our blog post here.)

Inflammation

• Histamine is one of the molecules released as part of our normal inflammatory response

Gut bacteria

• Certain types of gut bacteria, such as E coli, produce histamine in the gut

Stress

• Histamine acts as a neurotransmitter in the brain. Higher amounts of histamine are released during periods of both acute and chronic stress (which can contribute to feelings of anxiety)

In addition to being made by our cells, histamine is also found in certain types of common foods, particularly fermented foods. The histamine found in foods is due to bacteria breaking down amino acids (from protein) through the process of fermentation. This is why fermented foods and drinks (including beer and wine) can be particularly high in biogenic amines like histamine.  Most people can tolerate eating small amounts of histamine because enzymes in our body are able to break down the histamine in our intestines to be eliminated before it causes harm. One of the main enzymes responsible for breaking down histamine is called diamine oxidase (DAO). DAO is continuously produced and secreted by intestinal cells during digestion to breakdown histamine that is ingested with foods, preventing excess histamine absorption. Whilst we all possess enzymes to break down histamine, there is a limit to how much histamine these enzymes can process, a limit known as “histamine tolerance”. If our bodies exceed this limit, we end up in “histamine intolerance”, leading to excess histamine circulating throughout the body and causing symptoms. Those with low levels of DAO, as well as people with chronic gut issues, are more susceptible to the effects of histamine in food, as their body can’t break down sufficient amounts of histamine before it enters the blood stream. Deficiencies in the micronutrients required for producing DAO (particularly B vitamins such as B6 and vitamin C), as well as gastrointestinal conditions such as Crohn’s disease and even dysbiosis/SIBO, can negatively impact on our DAO levels and leave us at greater risk of histamine overload. Recurring hives and chronic allergic-type symptoms are a sign that your histamine levels are too high (histamine overload) or are exceeding the amount your body can cope with (histamine intolerance).

The Role of Histamine in the Body – Allergies, Hay Fever and More

Whilst too much histamine is certainly an issue for our health, histamine is also a vital part of our body’s normal functioning, and is involved in myriad processes, including normal immune and inflammatory pathways that protect the body from bacteria and viruses. Histamine also plays a role in regulating the function of various immune cells, including monocytes, T cells, and other white blood cells and, as discussed above, is the cause of allergic-type symptoms. However, it’s not all inflammation and runny noses when it comes to histamine’s effects on the body. Histamine is also involved in regulating gastric acid secretion, blood vessel dilation, and can even act on the brain as a neurotransmitter. Histamine can also impact on your menstrual cycle and worsen symptoms of PMS.

Because of the wide-reaching impact of histamine in the body, there are a huge number of conditions that are associated with histamine overload in one way or another, including:

• Chronic allergic-type conditions, such as chronic recurrent urticaria (hives) and chronic hay fever
• Skin conditions including eczema, rosacea and acne
• Asthma
• Gastrointestinal conditions, particularly functional conditions such as IBS, non-coeliac gluten sensitivity and functional dyspepsia
• Menstrual conditions including PMS, Perimenopause, painful periods and endometriosis
• Interstitial cystitis (“Painful bladder syndrome”)
• Neuropathic pain, migraine, headaches
• Certain neurological conditions such as narcolepsy, epilepsy, Parkinson’s disease, Alzheimer’s disease, and schizophrenia

Below we look at the role of histamine in some of these conditions more closely.

Histamine and Eczema

Eczema (or atopic dermatitis) is a really common skin condition that affects children and adults alike. Substance P, a neurochemical associated with pain, is one of the key chemicals which induce symptoms of itching in eczema. Substance P sends a chemical message to mast cells in the skin, triggering the release of histamine and increasing inflammation. The link between eczema flares and exposure to food intolerances or allergies has been well established. Emerging evidence suggests that for some patients, who experience food-related eczema flares but in whom food allergy testing comes back negative, it may be histamine intolerance which is worsening their symptoms. In fact, trials of low-histamine diets in patients with eczema have demonstrated marked improvement of eczema symptoms in as little as one week of dietary change.

Histamine and Rosacea

Histamine acts as a vasodilator, opening up blood vessels and leading to flushing of the skin – one of the primary mechanisms leading to symptoms in rosacea. In those with rosacea, excess histamine-rich foods can trigger rosacea flares and skin redness.

Histamine and Acne

Acne is an extremely common issue particularly in adolescents, caused by an overproduction of sebum (oil) within sebaceous glands in the skin and leading to inflammation and infections within the pores. Whilst there is often an underlying hormonal issue triggering acne, recent research suggests histamine may also play a role, as histamine receptors have been identified in sebaceous glands.

Histamine and Hives

Allergic reactions are one of the most well-known effects of histamine in the body, one of the symptoms of which is hives. Whilst hives can be a reaction to known allergens (such as exposure to poison ivy, for example), chronic spontaneous urticaria is a common skin complaint whereby hives occur without a known trigger. A recent study found that a low-histamine diet was able to reduce symptoms of chronic spontaneous urticaria in 75% of people studied, suggesting dietary histamine may be a factor in many cases.

Histamine and Asthma

In asthma, the role of histamine is even more complex. A study from 2016 showed that people with asthma have an altered gut microbiome, with increased levels of histamine-secreting bacteria in their guts. The study found asthma patients to have higher levels of certain bacteria such as E coli and M morganii, both of which are associated with biogenic amine food poisoning.

Histamine and the Brain

Aside from its role in allergic responses and immune system function, histamine also plays an important role in brain functioning. Both neurons (brain cells) and mast cells produce and release histamine in the brain. Within the brain, histamine acts as a type of neurotransmitter, sending signals to control a range of different bodily functions, including regulating our sleep-wake cycles (higher histamine leads to increased wakefulness), hunger and even regulates the release of certain hormones. Histamine acts to suppress appetite and increase the breakdown of fat within the body – this is part of the reason why some older anti-depressants can cause increased hunger and weight gain, as they block the activity of some histamine receptors in the brain. Histamine also acts to regulate certain hormones, including thyroid hormones, as well as oxytocin and prolactin hormones in breastfeeding mothers. Brain histamine levels have been shown to play a role in a number of neurological conditions, including narcolepsy, Alzheimer’s disease, Parkinson’s disease, epilepsy, and even schizophrenia. Histamine has also been found to play a role in neuropathic pain, headaches and migraines. Although the mechanisms for this role is not fully understood, it is believed that the histamine system within the brain may sometimes be a trigger to the onset of migraines.

Histamine and the Gastrointestinal Tract

As well as influencing hunger, appetite and weight gain, histamine is involved in the digestion of food in the stomach. Histamine is one of the main molecules responsible for stimulating the release of gastric acid by parietal cells in the stomach. Neurons that are sensitive to histamine are found throughout the gastrointestinal system, and elevated histamine receptors within the gut have been found in those with food allergy and even irritable bowel syndrome, demonstrating a link between histamine and these conditions. It has also been speculated that histamine may play a role in a number of other gastrointestinal disorders such as non-coeliac gluten sensitivity.

Diagnosis of Histamine Intolerance

Diagnosis of histamine intolerance is difficult due to a lack of standardised tests to assess for histamine load. Instead, assessing for histamine intolerance or overload through a naturopath is likely to be done via a diet diary and food elimination trial. If you suspect you may be experiencing histamine-related issues, it is important to speak with a naturopath before experimenting with food elimination, to make sure you are well supported nutritionally and are able to effectively assess your histamine tolerance, so long term treatment strategies can be prepared for you.

What are the symptoms of histamine intolerance/ histamine overload?

The symptoms of histamine intolerance are highly varied, but can include:

• Hay-fever type symptoms such as a congested, runny nose
• Allergy-type symptoms (hives and itchy, red skin)
• Bloating after meals, abdominal pain
• Headache, dizziness
• Diarrhoea or constipation
• Asthma
• Painful periods
• Flushing of the skin

You may experience only one of these symptoms, or you may experience many of them. You may also experience these symptoms in conjunction with one of the other conditions discussed above. Because symptoms are so highly varied, histamine intolerance/ histamine overload can often appear to be something else entirely, and studies suggest that some instances of functional gastrointestinal conditions such as IBS and non-coeliac gluten sensitivity may in fact be an intolerance to dietary histamine.

Will taking Anti-Histamines Solve the Problem?

Whilst anti-histamines can help with many issues caused by histamine overload, they have significant limitations, and of course aren’t addressing the root cause of the issue. As well, anti-histamines work by blocking histamine receptors on cells so that the histamine isn’t able to bind to the cell. However, there are multiple different types of histamine receptors on cells, and anti-histamines aren’t able to bind to all the different types of receptors. Anti-histamines also don’t help to reduce the levels of histamine circulating in the body, so they aren’t an ideal solution, although can be helpful in the short term.

To effectively manage histamine overload/ histamine intolerance symptoms in the long term, it’s vital to address the root causes of the issue, including reducing your intake of high histamine foods and addressing chronic stress and gut issues which are leading you to being more susceptible to elevated histamine levels.

Reducing the Impact of Histamine on Your Health

The good news is there are many strategies for reducing the impact of histamine on your health. Some of the key ways to help reduce your histamine load include:

• Reduce your intake of high histamine foods
• Reduce your intake of foods that increase production of histamine in the body
• Reduce excess oestrogen in the body

Foods that are high in histamine:

• Alcoholic drinks, including wine (particularly red wine), beer and whiskey
• Highly processed or smoked meats such as salami, bacon, hot dogs, and pepperoni
• Fermented foods, such as kombucha, kefir, kim chi, sauerkraut and even vinegar
• Fermented and/or aged dairy products, including yoghurt and aged cheeses like cheddar, parmesan and swiss cheese
• Dried fruits
• Processed and pre-packaged foods, including condiments such as tomato sauce
• Leftovers, particularly once 24 hours or more old
• Coffee
• Fish and seafood
• Beef
• Strawberries, pineapple, citrus fruits
• Avocado, spinach, eggplant

Foods that trigger histamine release:

While these foods themselves do not contain high amounts of histamine, they can trigger the release of histamine in the body when we eat them, so are best avoided if histamine is triggering your menstrual health issues.

• Bananas, papaya, citrus fruits
• Tomatoes, beans
• Wheat germ
• Chocolate
• Walnuts, cashews, peanuts

Foods that block DAO production:

Remember the enzyme that helps to clear histamine? These foods can stop our body from producing sufficient amounts of DAO and should be avoided.

• Tea, including black, green and mate
• Alcohol
• Energy drinks

Foods that Help to Reduce Histamine

• Vegetables: broccoli, rocket, asparagus, Brussels sprouts, cabbage, carrots, cauliflower, fennel, garlic, kale, onions
• Fruits: apples, blueberries, blackberries, cherries, mangoes
• Dairy-free substitutes such as coconut milk and almond milk
• Gluten-free grains such as rice and quinoa
• Eggs

Supplements to Reduce Histamine

• Quercetin: Quercetin is an important micronutrient when it comes to immune health and can reduce histamine by preventing mast cells from releasing stored histamine. Quercetin can be found in a wide range of low-histamine foods, including apples, berries (except strawberries), onions and green leafy vegetables.
• Vitamin C: Vitamin C is also a powerhouse micronutrient for preventing mast cells from releasing too much histamine. Vitamin C is also an important nutrient for the production of DAO, thus helping to boost the body’s ability to break down histamine. Boost your intake of vitamin C with low-histamine foods such as berries (except strawberries), broccoli, capsicum, and rockmelon.
• Vitamin B6: Vitamin B6 is another nutrient important for DAO production. Increase your intake of vitamin B6 by including freshly cooked meats such as kangaroo, salmon and chicken in your diet.
• Various herbal liquid medicines

Other Tips for Reducing Histamine Load

• Purchase your fruits, vegetables and meats as fresh as possible
• Eat foods immediately after cooking
• If you do need to store leftovers, freeze them rather than refrigerating, as this will slow down the production of histamine
• Eat plenty of fibre, which helps to bind and expel excess oestrogen to help naturally balance oestrogen levels
• Avoid inflammatory foods such as gluten, fried foods, and highly processed sugary foods – histamine is released as part of the inflammatory response
• Increase your intake of Brassica vegetables such as broccoli, kale, cauliflower, and Brussels sprouts, which support liver detoxification of excess oestrogen

References

Alstadhaug, K. B. (2014). Histamine in migraine and brain. Headache, 54(2), 246–259.

Barcik, W., Pugin, B., Westermann, P., Akdis, C. A., Frei, R., O’Mahony, L., Smolinska, S., Jutel, M., Hessel, E. M., & Michaolovich, D. (2016). Histamine-secreting microbes are increased in the gut of asthma patients. The Journal of Allergy and Clinical Immunology, 138(5), 1491–1494.

Chung, B. Y., Cho, S. I., Ahn, I. S., Lee, H. B., Kim, H. O., Park, C. W., & Lee, C. H. (2011). Treatment of atopic dermatitis with a low-histamine diet. Annals of Dermatology, 23.

Haas, H. L., Sergeeva, O. A., & Selbach, O. (2008). Histamine in the nervous system. Physiological Reviews, 88(3).

Ito, C. (2000). The role of brain histamine in acute and chronic stresses. Biomedicine & Pharmacotherapy, 54(5), 263–267.

Maintz, L., Benfadal, S., Allam, J.-P., Hagemann, T., Fimmers, R., & Novak, N. (2006). Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema. Journal of Allergy and Clinical Immunology, 117(5), 1106–1112.

Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American Journal of Clinical Nutrition, 85(5).

Nuutinen, S., & Panula, P. (2010). Histamine in neurotransmission and brain diseases. In Histamine in inflammation. Landes Bioscience and Springer Science + Business Media.

Pelle, E., McCarthy, J., Seltmann, H., Huang, X., Mammone, T., Zouboulis, C. C., & Maes, D. (2008). Identification of histamine receptors and reduction of squalene levels by an antihistamine in sebocytes. Journal of Investigative Dermatology, 1289(5).

Schnedl, W. J., & Enko, D. (2020). Considering histamine in functional gastrointestinal disorders. Critical Reviews in Food Science and Nutrition.

Schnedl, W. J., Lackner, S., Enko, D., Schenk, M., Holasek, S. J., & Mangge, H. (2019). Evaluation of symptoms and symptom combinations in histamine intolerance. Intestinal Research, 17(3), 427–433.

Thakkar, M. M. (2011). Histamine in the regulation of wakefulness. Sleep Medicine Reviews, 15(1), 65–74.

Thangam, E. B., Jemima, E. A., Singh, H., Baig, M. S., Khan, M., Mathias, C. B., Church, M. K., & Saluja, R. (2018). The role of histamine and histamine receptors in mast cell-mediated allergy and inflammation: The hung for new therapeutic targets. Frontiers in Immunology, 13.

Wagner, N., Dirk, D., Peveling-Oberhag, A., Reese, I., Rady-Pizarro, U., Mitzel, H., & Staubach, P. (2017). A popular myth—A low-histamine diet improves chronic spontaneous urticaria—Fact or fiction? Journal of the European Academy of Dermatology and Venerology, 31(4), 650–655.

Worm, M., Fiedler, E.-M., Dolle, S., Schink, T., Hemmer, W., Jarisch, R., & Zubrerbier, T. (2009). Exogenous histamine aggravates eczema in a subgroup of patients with atopic dermatitis. Acta Dermato-Venereologica, 89(1), 52–56.

The post Histamine Intolerance and Reducing Histamine appeared first on Performance in Health.

What is Histamine?

Histamine is an important molecule in the body that is involved in immune, allergy and inflammation pathways. Histamine is a type of biologically active amine (also known as a “biogenic amine”), a group of many different amino acids that cause changes in the body. Histamine is stored and produced in many different cells within the body, however one of the main cells associated with histamine and its production are mast cells, an immune system cell that makes up part of our innate immune system. Mast cells produce and store histamine inside their cell walls, and then release it in response to certain stimuli, such as exposure to allergenic substances (e.g. foods, pollens, etc.).

You may be familiar with the term “anti-histamines” and assume that histamine is therefore something we need to eliminate completely, however histamine is an essential part of our body’s functioning and is responsible for many diverse effects in the body. One of the most recognisable effects of histamine is in response to allergens – it is histamine that is responsible for the tell-tale runny nose, watering eyes and itchy skin we associate with allergies. It is an important part of our innate immune system, is involved in neurotransmitter release, and may even play a role in ovulation (as well as implantation, uterine contractions, and even lactation).

Too much histamine, however, can cause health issues. Recurring hives and chronic allergic-type symptoms are a sign that your histamine levels are too high (histamine overload) or are exceeding the amount your body is able to cope with (histamine intolerance). Excess histamine is also associated with conditions such as interstitial cystitis (“painful bladder syndrome”), pre-eclampsia and preterm delivery, and menstrual conditions such as PMS and endometriosis.

Our bodies are able to process and neutralise histamine via enzymes, particularly diamine oxidase (DAO). Whilst we all possess enzymes to break down histamine, there is a limit to how much histamine these enzymes can process, a limit known as “histamine tolerance”. If our bodies exceed this limit, we end up in “histamine intolerance”, leading to excess histamine circulating throughout the body and causing symptoms. Deficiencies in the micronutrients required for producing DAO (particularly B vitamins such as B6 and vitamin C), as well as gastrointestinal conditions such as Crohn’s disease and even dysbiosis/SIBO, can negatively impact on our DAO levels and leave us at greater risk of histamine overload.

Signs that you might be experiencing histamine issues (e.g. histamine overload or histamine intolerance): 

• Headaches or migraines
• Hives, itching skin
• Irregular periods, PMS symptoms (breast pain, cramps)
• Fatigue and brain fog
• Nausea and vomiting
• Nasal congestion, sinus issues
• Anxiety
• Mood changes
• Asthma

How Can Histamine Affect Oestrogen?

So what exactly does histamine have to do with hormones? It turns out, a lot. Histamine and oestrogen are linked – the number of mast cells, and the amount of histamine they produce, fluctuates throughout the menstrual cycle, rising as oestrogen levels rise and falling as oestrogen levels fall. Oestrogen increases histamine levels by triggering mast cells to release their stored histamine and also down-regulates DAO, the enzyme responsible for clearing excess histamine from the body. Progesterone, on the other hand, reduces the release of histamine and increases DAO activity, providing balance. This effect of hormones on mast cells and histamine levels has been demonstrated with skin prick allergy tests – changes to hormone levels throughout the menstrual cycle can affect your test results! A 1995 study found that skin prick testing revealed higher histamine levels in women during days 12-16 of their cycle, during ovulation and when oestrogen is at its highest. Because of this link between oestrogen and histamine, women tend to have higher levels of histamine than men and are therefore predisposed to histamine intolerance. This link between histamine and female hormones also helps to explain why symptoms for some women are worse at certain points during the menstrual cycle, such as during ovulation.

When oestrogen levels become too high compared to progesterone, (e.g. oestrogen dominance), a feedback loop occurs between oestrogen and histamine; oestrogen stimulates mast cells to release more histamine, and histamine stimulates the ovaries to produce more oestrogen, further worsening the oestrogen dominance. It is this feedback loop that leads to histamine’s impact on female hormonal issues, and why focusing on reducing excess oestrogen as well as reducing histamine can help to quell symptoms.

Elevated histamine levels have been shown in women with endometriosis and even correspond with higher levels of pain experienced by these women. Histamine may also contribute to certain symptoms of PMS, such as headaches, breast pain, and anxiety, due to the increase of histamine when oestrogen levels rise just before menstruation. Histamine can also wreak havoc on your health during perimenopause. Whilst most of us understand that our oestrogen levels drop after menopause, during the perimenopausal period (the 1-10 years leading up to menopause), our oestrogen levels are far more variable. In fact, oestrogen levels can actually be up to 3 times higher than normal during this time! Combined with changes to thyroid hormone production that often occur at this time (and can also impact histamine levels), it’s no wonder many women will develop symptoms of histamine intolerance during this period of their lives.

Reducing the Impact of Histamine on Your Menstrual Health

The good news is there are many strategies for reducing the impact of histamine on your menstrual health. Some of the key ways to help reduce your histamine load include:

• Reduce your intake of high histamine foods
• Reduce your intake of foods that increase production of histamine in the body
• Reduce excess oestrogen in the body

Foods that are high in histamine: 

• Alcoholic drinks, including wine (particularly red wine), beer and whiskey
• Highly processed or smoked meats such as salami, bacon, hot dogs, and pepperoni
• Fermented foods, such as kombucha, kefir, kim chi, sauerkraut and even vinegar
• Fermented and/or aged dairy products, including yoghurt and aged cheeses like cheddar, parmesan and swiss cheese
• Dried fruits
• Processed and pre-packaged foods, including condiments such as tomato sauce
• Leftovers, particularly once 24 hours or more old
• Coffee
• Fish and seafood
• Beef
• Strawberries, pineapple, citrus fruits
• Avocado, spinach, eggplant

Foods that trigger histamine release:

While these foods themselves do not contain high amounts of histamine, they can trigger the release of histamine in the body when we eat them, so are best avoided if histamine is triggering your menstrual health issues.

• Bananas, papaya, citrus fruits
• Tomatoes, beans
• Wheat germ
• Chocolate
• Walnuts, cashews, peanuts

Foods that block DAO production:

Remember the enzyme that helps to clear histamine? These foods can stop our body from producing sufficient amounts of DAO and should be avoided.

• Tea, including black, green and mate
• Alcohol
• Energy drinks

Foods that Help to Reduce Histamine

• Vegetables: broccoli, rocket, asparagus, Brussels sprouts, cabbage, carrots, cauliflower, fennel, garlic, kale, onions
• Fruits: apples, blueberries, blackberries, cherries, mangoes
• Dairy-free substitutes such as coconut milk and almond milk
• Gluten-free grains such as rice and quinoa
• Eggs

Supplements to Reduce Histamine

• Quercetin: Quercetin is an important micronutrient when it comes to immune health and can reduce histamine by preventing mast cells from releasing stored histamine. Quercetin can be found in a wide range of low-histamine foods, including apples, berries (except strawberries), onions and green leafy vegetables.
• Vitamin C: Vitamin C is also a powerhouse micronutrient for preventing mast cells from releasing too much histamine. Vitamin C is also an important nutrient for the production of DAO, thus helping to boost the body’s ability to break down histamine. Boost your intake of vitamin C with low-histamine foods such as berries (except strawberries), broccoli, capsicum, and rockmelon.
• Vitamin B6: Vitamin B6 is another nutrient important for DAO production. Increase your intake of vitamin B6 by including freshly cooked meats such as kangaroo, salmon and chicken in your diet.

Other Tips for Reducing Histamine Load

• Purchase your fruits, vegetables and meats as fresh as possible
• Eat foods immediately after cooking
• If you do need to store leftovers, freeze them rather than refrigerating, as this will slow down the production of histamine
• Eat plenty of fibre, which helps to bind and expel excess oestrogen to help naturally balance oestrogen levels
• Avoid inflammatory foods such as gluten, fried foods, and highly processed sugary foods – histamine is released as part of the inflammatory response
• Increase your intake of Brassica vegetables such as broccoli, kale, cauliflower, and Brussels sprouts, which support liver detoxification of excess oestrogen 

References

Carr, A. C., & Maggini, S. (2017). Vitamin C and immune function. Nutrients, 9(11).

Ede, G. (2017). Histamine intolerance: Why freshness matters. Journal of Evolution and Health, 2(1).

Fogel, W. A. (1986). Diamine oxidase (DAO) and female sex hormones. Agents Actions, 18(1–2), 44–45.

Jing, H., Wang, Z., & Chen, Y. (2012). Effect of oestradiol on mast cell number and histamine level in the mammary glands of rat. Anatomia Histologia Embryologia, 41(3), 170–176.

Kalogeromitros, D., Katsarou, A., Armenaka, M., Rigopoulos, D., Zapanti, M., & Stratigos, I. (1995). Influence of the menstrual cycle on skin-prick test reactions to histamine, morphine and allergen. Clincial and Experimental Allergy, 25(5), 461–466.

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