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My mom recently turned 80 and celebrated her birthday with some wonderful friends and a toast of champagne. After taking a sip from her glass, she began to cough and wheeze. “Oh, boy,” she announced, “this seems to be happening to me lately when I have a glass of wine. Time to give it up, I guess.”
Her nose suddenly runny and some burning in her throat, it indeed seemed that my mom may have developed a histamine intolerance! Or could it be something else?
Histamine is a substance responsible for many reactions in our body, such as increased mucous production and muscle constriction (leading to runny nose, sneezing and cough), increased stomach acid production, flushing and itching of the skin, low or high blood pressure, rapid heartbeat, headache, dizziness, nausea, difficulty sleeping and other symptoms commonly experienced by those with allergies. However, histamine gets released in our body not only in response to allergens, but also to trauma and injuries, inflammation and even to alcohol. Certain foods (such as fermented cheeses and processed meats, smoked or canned fish and fermented foods (like soy sauce) may contain histamine or its precursor, histidine. To make things more complicated, several other foods (such as citrus fruits, strawberries, spinach, tomatoes, chocolate, nuts, eggs, pineapple, and a few more) as well as medications (such as amitriptyline and narcotic pain killers) are also suspects in making our cells release their own histamine. Usually, we degrade histamine quickly, but some lack the ability to degrade it either due to genetic predisposition or another (often digestive) disorder, leading to histamine intolerance. An estimated 1% of the population suffers from this often-undiagnosed condition, vast majority being middle aged or older.
Very similar “pseudo-allergic” reactions to wine may be due to other substances such as sulfites or tyramine. Finally, some people can develop a true hypersensitivity reaction to some of the wine proteins, ingredients used in winemaking (enzymes), or contaminating the grapes (molds).
According to Swiss allergologist, Dr. Wuthrich, intolerance to sulfites are more common to white wine in asthma patients, while intolerance to histamine is more common after drinking red wine in those of us who have deficiency in the histamine degrading enzyme diamine oxidase (DAO).
Some have DAO deficiency from birth while others can develop it at any age – especially those with inflammatory bowel conditions or irritable bowel, and in those with gluten sensitivity. In fact, DAO activity (and thus our ability to get rid of ingested histamine) may be an indicator of the health of our intestinal lining. DAO deficiency appears (perhaps, not surprisingly) quite common in people suffering from migraines.
So, how do we diagnose histamine intolerance? Could it really be what my mom has? I recommend working with a physician who will rule out a true food (or wine) allergy as well as a mast cell disorder, and likely recommend a 4-8 weeks-long low histamine diet to see if symptoms improve. Supplemental DAO enzymes are also available for those with established DAO deficit.
If a true allergy is ruled out (in which case even the smallest amount of the trigger substance can set off a potentially dangerous allergic reaction), with histamine intolerance it boils down to the total amount of histamine and thus everything else the person drank or ate, and the underlying gut health (including the gut microbiome). Perhaps my mom will still be able to have a little toast for her next celebration but getting to the root cause and doing a proper work up is what I advised first.
About the Author
Tereza Hubkova, MD
Tereza Hubkova, MD, is a Board-certified integrative medicine physician focused on one goal: Your good health. For more than 20 years, she’s studied many different healing tools — from nutritional medicine to the principles of Chinese medicine and much more. She uses that knowledge and experience to guide her patients along a path to whole health and healing.