An antihistamine diet is recommended for patients with an abnormal reaction to histamine and involves the elimination of foods rich in histamine and those that trigger its release in the body. Such foods include certain fish, ripened cheeses, cured meats, alcohol and some fruit and vegetables. The latest guidelines from the German Society of Allergology and Clinical Immunology suggest a three-step antihistamine diet regimen: quieting symptoms by eliminating certain products (10-14 days), gradually introducing histamine foods (6 weeks) and determining the optimal diet for the patient. If the diet does not work, further diagnosis and, if necessary, the implementation of appropriate pharmacotherapy is recommended.
The antihistamine diet is only recommended for patients diagnosed with an abnormal reaction to histamine. It involves the elimination of foods rich in histamine and those that can trigger its release in the body. These include certain fish, ripened cheeses, cured meats, alcohol and some vegetables and fruit. What is the current dietary support for patients with histamine tolerance disorders according to the latest guidelines?
Intolerance or adverse reaction to histamine? Opinions of researchers
Histamine is a biogenic amine that is secreted in high amounts when the body comes into contact with an allergen. It is a mediator of inflammation to fight off a pathogen or allergen. In healthy individuals, its levels are regulated by the enzymes DAO (diaminoxidase) and HNMT (histamine N-methyltransferase).
Antihistamine diet: what is it?, photo: panthermedia
Histamine is also present in certain foods. In some people, symptoms similar to food intolerancecan be observed after consuming these. In this situation, the most common disorder is what was usually referred to as histamine intolerance. However, the body's response to an ingested histamine-containing product does not proceed in the same way as a classic intolerance. In a 2017 study, researchers therefore tentatively proposed to call this abnormality an adverse reaction to ingested histamine until the full mechanism of the body's response to histamine ingestion is established [2].
How should patients be introduced to an antihistamine diet?
Individuals reporting distressing symptoms after ingestion of histamine-rich foods should be put on a temporary elimination diet. According to the guidelines of the German Society of Allergology and Clinical Immunology, this is the suggested dietary regimen:
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Phase 1 - aims to calm symptoms. Lasts 10 to 14 days. It is based on the exclusion of foods rich in histamine and other biogenic amines. These include, in particular, tomatoes, pickles, spinach, fatty fish, citrus, hard and long-ripened cheeses, alcohol, strawberries, processed meats.
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Phase 2 - involves the gradual introduction of histamine foods. It lasts approximately 6 weeks. It aims to determine the individual adverse reaction after histamine ingestion.
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Phase 3 - during this phase it is crucial to maintain the patient's health and well-being. During this phase, the optimal diet for the patient is determined in terms of individual histamine sensitivity [2].
Antihistamine diet: for whom, photo: panthermedia
If the diet is unsuccessful, further diagnosis of the patient and appropriate pharmacotherapy tailored to the individual are necessary. An abnormal reaction to histamine may go hand in hand with other diseases and disorders, e.g. intestinal dysbiosis, inflammatory bowel disease, ulcerative colitis, coeliac disease and non-celiac gluten intolerance [1].