If you Google any common inflammatory condition you are bound to see numerous attributions to histamines. Anti-histamines (benadryl, zyrtec, claritin, etc) can be found in abundance in any grocery store and in most people’s medicine cabinets (even my dog takes it!). But what the heck is histamine? And if it’s a normal part of our physiology, why is everything so against it? How are histamines related to eczema? To understand, we need to take another trip down the wormhole of our immune system. Keep in mind that our immune system evolved at a time when food exploration was at its infancy – and eating the wrong berry or plant found in the forest could lead to death in the absence of an efficient defense mechanism.
Enter the mast cell – possibly the most bad-ass defender in our entire immune system arsenal. The mast cell is basically a roaming Pinata waiting to be smashed open by the stick wielding blindfolded kid at the party. Except in the case of the mast cell, it is filled with histamine rather than candy. And rather than a stick wielding kid releasing the histamine, some food, chemical, pollen, or other substance is causing the massive release of the potent histamine chemical.
Histamines – Friend or Foe?
Each time our body encounters a new or foreign substance, it must decide whether the newcomer is friend or foe of the system. As discussed earlier, an elaborate chain of events in our immune system helps make this determination. But in the case of eczema, and many other inflammatory driven diseases -asthma, hay fever, ADHD, food allergy – the immune system begins to overreact to substances which should be considered friendly. The type of antibody our immune system decides to make is determined by how big the threat is deemed; the highest threat invaders will warrant the production of an antibody known as IgE. And once a substance or food has an IgE against it, it’s like having most wanted posters all over your body for that invader.
The mast cells then roam around our tissues and bloodstream, searching for any IgE activators – and when it finds one – kapow! It releases its entire load of histamine on the spot. And those histamines start an entire chain reaction of events. The most severe form of this reaction is known as anaphylaxis which can be fatal if untreated – this is the type of reaction occurring in someone allergic to bees who is stung and needs emergency epinephrine.
Histamine was first discovered in the early 20th century and 2 Nobel prizes have been rewarded from its research. Histamine has a number of effects on different tissues. In the nose it leads to runny itchy nose and itchy watery eyes in response to pollen and other allergens. In the GI system it causes the production of stomach acid – thus reflux medications like Zantac are actually antihistamines. In blood vessels it causes dilation and leaky walls allowing other inflammatory cells to move into tissues and into the skin – hello eczema. In the lungs it causes the pipes to tighten – bronchoconstriction – which leads to breathing difficulty. Histamines also have a number of effects in the brain – including making you alert or in some people drowsy and brain foggy (likely not a word), which is why antihistamines often cause drowsiness in some people and alertness in others. Interestingly, histamine abnormalities in the brain have even been implicated in schizophrenia. There are many more actions of histamines and likely even many more yet to be discovered.
For our discussion we will focus on histamines and the skin. When a child already has an overload of histamines, and then eats a food or encounters a substance which elicits even more mast cell release, the histamine reaction is often manifested in the skin. As capillaries leak and allow the white blood cells into the skin, itching, redness, swelling, and ulceration can occur. And as we discussed earlier, histamines are just one branch of the inflammatory tree – the entire immune system is typically playing a role in the eczema skin condition.
So the next question becomes why are they developing potent IgE antibodies against harmless substances like peanuts or pollen? Although poorly understood, much is likely from an overactive immune system, a leaky gut, and possibly even our historical treatments. A number of factors can influence our baseline amount of histamine including diet, stress, environment, nutritional deficiencies, drugs, and hormones. As overall histamine load in the body increases, so do the effects seen by progressively increasing amounts of inflammation and ultimately anaphylaxis if left unchecked. And so even though pollen may be the substance which takes the body into full allergic reaction, the body had already been primed with high levels of histamines from the numerous factors listed above. Which is why seasonal allergies get better with changes in diet, stress, nutrition, and hormone regulation.
Generally speaking, histamine are cleaned up by an enzyme called diamine oxidase (DAO). DAO is produced in the kidneys, thymus, and by our gut lining. Certain populations have a genetic predisposition to low levels of DAO. Once again our gut plays an integral role in the development and persistence of eczema. The leaky gut allows large immune activating molecules through which increase the immune response, increasing histamine levels. The sick gut then does not produce the histamine reducing DAO enzyme, leading to a vicious cycle of events. We also know that certain bacteria produce histamines and by disrupting our gut microbiome, we may also be allowing histamine producing bacteria to win out over our normal gut flora. (Also see the section on stress below) .
As I stated above, histamines are only one part of the eczema equation, and in my opinion it’s not the place to start from a treatment perspective. However, in patients who fail to improve with my typical approaches that we have outlined so far, I will then tackle histamines as a possible culprit. When tackling histamine overload, there are really 2 approaches – traditional medicine has aimed at pharmaceutically blocking the histamine release and response whereas integrative medicine aims at reducing the histamine load in the first place. My concern is that histamines are an important part of our physiology and blocking their effects has both positive and negative consequences. We simply can’t keep medicating every problem – Americans filled a record 5.8 billion prescriptions in 2018 — at a rate of 17.6 prescriptions per person!
Additionally, all medications have side effects – for example, medications such as Tylenol, Antibiotics, and Prilosec have been clearly shown to INCREASE eczema development when given to babies and children.
The first place to start histamine reduction is in the kitchen – the same place where most meaningful changes to our health occur. There are foods which contain high levels of histamine and there are foods which are more likely to cause a release of histamine from those mast cells. There are also foods which may block the DAO enzyme, resulting in more circulating histamine.
The following foods typically contain higher levels of histamine:
fermented dairy products, such as cheese (especially aged), yogurt, sour cream, buttermilk, and kefir
fermented vegetables, such as sauerkraut and kimchi
pickles or pickled veggies
cured or fermented meats, such as sausages, salami, and fermented ham
wine, beer, alcohol, and champagne
fermented soy products such as tempeh, miso, soy sauce, and natto
fermented grains, such as sourdough bread
Tomatoes, including Ketchup
frozen, salted, or canned fish, such as sardines and tuna
The foods in the following list may cause release of histamine from our immune cells:
Most citrus fruits – lemon, lime, oranges…
Cocoa and chocolate
Papaya, pineapples, plums, kiwi and bananas
Additives – benzoate, sulphites, nitrites, glutamate, food dyes
Foods reported to block DAO enzyme:
You may be overwhelmed at the list above – I sure was the first time I looked at it. Fortunately my health coach Lindsay Kingdon has found a way to navigate this confusing territory. The excerpt below is from her blog Seven Layer Charlotte and gives some wonderful substitutions and meal options.
Do Not Remove Too Many Food Groups From Your Child’s Diet
I’m going to be a bit of a broken record with this topic, but it is not safe to remove too many food groups from your child’s diet, especially all at once! With kids, we have to be careful that they do not become malnourished. There are some swaps we can make to reduce histamine overload, but we do not want to put our kids on too restrictive of a diet. When we are trying to heal our kids from something like eczema, we as moms tend to grasp onto the things that we can control. Food is one of those things, and we tend to think that’s the only thing that will help them. But we have to remember that food is just a part of an overall approach to healing. Try to gently replace food items, and also incorporate the methods of cleaning your air and bedding/fabrics in your home, as mentioned above.
Please keep in mind the fact that each person is an individual, and not every high-histamine food will bother everyone. It is good to change up what you are eating, and not eat the exact same things each day.
In working to heal leaky gut, food elimination can be daunting. Instead of focusing on all the things we can’t have in regards to histamines, we are going to approach it from an “eat this instead” point of view. We are already avoiding sugar, processed foods, gluten, and dairy. Some of the items below are still very healthy foods, but they can either be high in histamine, or are histamine-releasing foods.
LIMIT (maybe once per day):
-fermented foods like sauerkraut
-chocolate, cocoa powder
-processed vegan meat
-pepperoni, cured meats
-raw egg whites
-inflammatory oils, like vegetable and canola
Simple Family Meal Ideas
1. Fruit: blueberry, cherry, blackberry, melon, apples, dates, figs
2. Smoothies: blueberries, mango, kale, vanilla plant-based, soy-free protein powder, coconut milk, hemp seeds
3. Chia Seed Pudding with coconut milk; topped with seeds and blueberries
4. Make chia seed jam and serve on GF toast with nut butter (if tolerated)
5. GF organic oats to make oatmeal – cook in water and/or coconut milk
6. Apple cinnamon oat pancakes
*can sweeten the smoothies or pancakes with local, raw honey to help fight the allergy symptoms from pollen
7. Roasted sweet potatoes in coconut oil, cinnamon, sea salt
8. Pasture-raised, whole eggs (if tolerated)
9. Homemade granola (nut free) with coconut or hemp milk and blueberries
Sautéed shrimp and zucchini in plenty of garlic and olive oil, add basil, serve over lentil pasta with Violife parmesan
Roasted veggie bowl with quinoa
Bell pepper nachos with grass-fed ground beef, Violife cheddar, black beans, a little avocado
Roasted chicken thighs, seasoned with olive oil, garlic, herbs; roasted sweet potato, turnip, and carrot “fries” with carrot ketchup
Fresh, roasted salmon with herbs and garlic, sautéed kale, rice or quinoa
Crockpot shredded chicken rolled up in Siete cassava tortillas or B.Free pitas with Greek dressing, cucumber, red onion, Violife feta, dill
Lentil pasta with butternut squash sauce
Simple stir fry with rice and/or cauliflower rice, sautéed veggies and chicken/shrimp in ginger, garlic, coconut oil; season with Braggs coconut amino
Whole roasted chicken, seasoned with olive oil, fresh thyme, salt and pepper; cavity of the chicken has lemon and onion while roasting; serve with roasted potatoes and carrots; simple kale salad with basic vinaigrette
Other Sources Of Histamine Overload
Environment can also play a role in histamine production and release. Pollen and dust mites can bring in unwanted, extra histamine so checking your air quality is also a must! Here are ways you can help with this:
-Buy an Air Doctor. Dr. Temple and other functional medicine doctors and practitioners swear by these. Adding one to our home is on my to-do list. Click on the pic for $300 off your Air Doctor
-Change your Heat/AC filters!
-Brush your pet outside.
-Leave your shoes at the door.
-Change your pillows: Avoid feather/down pillows and use dust covers.
-Wash anything fluffy every week, like blankets and stuffed animals.
Think about the last time you were really stressed – did you feel it in your gut? Feel the stress in the “pit of your stomach”? Many of us readily sense stress in our guts. Stress plays a central role in gut health and there are a number of physiologic responses in our intestines when we are stressed including increased motility (ever have to poop when you’re stressed?), nausea, and pain, and yes histamine release. In fact, a number of studies have shown that the abdominal pain felt in stress or in irritable bowel syndrome may be directly from mast cell release and histamine response. So managing stress can be a key component of histamine reduction. Here are a few tips:
Understand that the body and brain need rest and sleep to function properly. When we sleep the brain uses 1/5 of the blood supply to repair itself, make new cells, make new connections and memories. A lot of work happens when the mind is at rest. During sleep – the brain heals from anxiety, the belly fat gets burned off, the immune system powers up, stress levels are reduced, hormones are balanced, etc
No phones in bedrooms (unless you are a doctor on call)
Limit the use of electroinc devices 1-2hrs before bedtime.
Take a Social Media Holiday
Say NO more often.
Make Time For Free Play
Learn to do Yoga and Meditate
Feed Your Stress Hormones Nutritious Food