Histamine‐free diet: treatment of choice for histamine‐induced food intolerance and supporting treatment for chronical headaches

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Abstract
Summary: Histamine‐induced food intolerance is not IgE‐mediated. Skin‐prick testing and specific IgE to food allergens are typically negative. Food rich in histamine or red wine may cause allergy‐like symptoms such as sneezing, flush, skin itching, diarrhoea and even shortness of breath. The suspected reason is a diminished histamine degradation based on a deficiency of diamine oxidase. As diamine oxidase cannot be supplemented, a histamine‐free diet was implemented to reduce histamine intake. Forty‐five patients with a history of suffering from intolerance to food or wine (n=17) and chronic headache (n= 28) were put on the diet over months to years. Fish, cheese, hard cured sausages, pickled cabbage and alcoholic beverages had to be avoided. Complaint intensity and drug‐use per week prior to and 4 weeks after a histamine‐free diet were compared. After 4 weeks on the diet 33/45 patients improved considerably (p < 0.01), eight of them had total remission. In 12/45 patients, however, no changes in symptoms were observed. Symptoms of food or wine intolerance significantly decreased (P < 0.02; treatment of choice), headaches decreased in frequency (P < 0.001), duration and intensity. After eating histamine‐rich food symptoms were reproducible and could be eliminated by anti‐histamines in most patients. These data indicate the role of histamine in food and wine intolerance and that histamine‐rich food causes a worsening of symptoms in patients suffering from chronic headaches. Results obtained support the hypothesis of a deficiency of diamine oxidase in patients with intolerance to food or wine.