histamine intolerance after menopause

Posted by bjklemme @bjklemme, May 26, 2023

Just a few months after menopause I got a strange cluster headache (it was like being electrocuted on one side of my head every few seconds) that lasted for days and would only go away after an ER visit and prednisone. Prior to the headache my ears were ringing, I had rhinitis, my ears would start to itch in the evening and my blood pressure was low. I thought it was a one-off but then it repeated 1 1/2 years later on the other side.

Accepting that I had a chronic migraine I put up with tinnitus on and off in my left ear. About a year ago I got chronic diarrhea and gastric reflux. I thought they were unrelated until the symptoms got so bad that I noticed there was a direct connection between the symptoms and eating food with histamine. Basically, within minutes of eating the food, my left ear itches, then starts to ring, and my nose runs. The same night I will have heart palpitations while falling to sleep and then pulsatile tinnitus during the night. I wake up every morning between 3 and 5AM flushed, with my ears ringing and nose running. I also get rosacea, eczema, (and now dermatographia), which correlate with the histamine reactions. Benadryl is very effective in aborting the reactions but other antihistamines don't work or seem to make it worse. Propranolol also works but I don't like taking it because my blood pressure is already low.

I could get no help from doctors and specialists. Now a year later (on a low histamine diet) I am free of the diarrhea and reflux but still cannot eat histamine. I talked a gynecologist into measuring my estrogen level and it came out to 17 pg/ml, which strikes me as very high for 5 years past menopause. I started on progesterone cream and used a lot ( a blood test confirmed that I had increased my progesterone a lot) and for the first time my symptoms abated.

I am still trying to figure out what is going on and what I should do. I am not sure I should keep using so much progesterone. Also, I have recently noticed that my symptoms are consistent with high prolactin levels. That is why benadryl, propranolol, and progesterone all seem to work but other antihistamines don't (if my guess is correct). An MRI has shown a normal pituitary.

I read that this could be caused by gluten sensitivity, although I don't seem to be reaction to gluten. My current plan is to go cold turkey on gluten, histamine, and progesterone and then measure my prolactin. Then add the histamine, and gluten back individually.

Any help would be greatly appreciated! This has turned my life upside down. I am unable to eat normally, in restaurants, and travel is difficult. I continue to have the "migraine" symptoms every single night.

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@bjklemme

It is actually not possible to be allergic to histamine itself. But if you look up "histamine intolerance" on the internet you will come across a lot of bunk. A better term is "vasoactive amine sensitivity". It is thought to be do to a deficiency of the enzyme that degrades histamine and other biogenic amines in food in the gut. The enzyme is called DAO. If you have it, nothing will show up on any tests, and there is no reliable test for it, or DAO deficiency.

In my case, I am having severe reactions to foods with either histamine or biogenic amines. I don't have the symptoms if I stay off the foods (which is nearly impossible). The reactions happen within 30 minutes at which point I start to go into a vasodilation process, which triggers the pulsatile tinnitus and migraine. I also can get hives, rosacea, and diarrhea.

If I try to eat while on Pepcid, it's like eating dynamite (probably because if you block the H2 receptors it can increase histamine in the gut). My reactions are very intense and Allegra is not strong enough. Also, it alters my alertness -I have a job basically doing math all day.

I was not treated well at Mayo Allergy. They acted like they did not believe what I was saying and just making stuff up from the internet. It was a horrible experience. And they sent me home with intense, frightening symptoms and no place to go.

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I know exactly how you feel. I've been treated the same way by Doctors. First they don't even know what you are talking about, like you rae crazy and it's all in your head, so they don't help you and then when you go and search your symptoms and conditions trying to understand what going on they get mad and say to stop reading nonsense online! Unbelievable.

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@bjklemme

One other think that is often overlooked, is that if you are "histamine intolerant" in the sense that you are lacking diamine oxidase (DAO) enzyme, there is no reason in particular that your mast cells would be unstable so the people connecting it with MCAS and mastocytosis and pushing quercetin and other mast cell stabilizers are really muddying the issue. If you go to an allergist because you are having allergic-type reactions to foods, they will do some blood work and measure your serum tryptase which is a pretty good indicator of the stability of your mast cells. It's not really that mysterious. They are checking for mastocytosis and you can find out that way. Also, if your mast cells were not stable you would be having reactions to other things, which I am not. It's really a separate issue.

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I was going to ask you, since you mentioned that this started after a bad respiratory infection, that now you think it was Covid, like me, don't you think that if we have long Covid, meaning that the virus load is still high, our mast cells are still battling the virus then liberating a lot of Histamines as a response of our inmune system? Please let me know what you think.
Thank you

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Hi there!

I am sorry to hear that you are suffering from this. I would like to convey some key concepts that helped me the most so that you and others may (hopefully) benefit:

The key effect of histamine in the body is vasodilation. It's a nonlinear system, so once you get vasodilation it's easier to get more vasodilation. If you are histamine intolerant and eat a food with histamine in it you will get a LOT of vasodilation. It takes a few hours (maybe even days) to die down so that if you then eat other foods that just happen to be vasodilators it will seem like you are reacting to them. A lot of healthy fruits and vegetables as well as environmental factors, and things in the body (like hormones) also produce vasodilation. So it can seem like you are getting symptoms uncontrollably and can hardly eat anything.

The thing you have to do is go off a few foods that are absolutely known to have a lot of histamine in them, let it calm down, and then see that you can eat the other foods. The foods that absolutely have histamine in them and that I cannot eat are as follows:

any fermented food or vegetable (things like pickles, sauerkraut, etc.)
buttermilk
sour cream
sourdough
hard cheeses (pretty much any cheese except fresh mozzarella -parmesan is esp. bad)
yogurt
homemade yeast breads
a very common food additive called "natural flavorings"
vinegars
raisins
processed and slow cooked meats (salami, hotdogs, etc.)
alcohol
chicken that is not fresh
pork
fish
spinach and eggplant also have histamine but I can currently eat small amounts of spinach

Some excipients in pills will also stir up histamine from mast cells in the get. The only one that definitely did this for me was povidone, unfortunately found in many, many pills including Allegra and Zyrtec.

It is not true that Benadryl, Allegra, or Zyrtec will block DAO. There is absolutely NO evidence for it and sites that promote that idea are irresponsible. However, I did have to order a generic brand of fexofenadine (Allegra) without povidone.

Good luck with your symptoms and I do hope you get well.

Best Regards,
Beverly

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@bellapazzia

I was going to ask you, since you mentioned that this started after a bad respiratory infection, that now you think it was Covid, like me, don't you think that if we have long Covid, meaning that the virus load is still high, our mast cells are still battling the virus then liberating a lot of Histamines as a response of our inmune system? Please let me know what you think.
Thank you

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I think that the possible covid was incidental. In fact, I was very asymptomatic during it because I was taking a lot of antihistamines and vasoconstrictors. What happened is that I got a sinus infection afterward and took antibiotics. I've noticed that I get a lot of symptoms on antibiotics (I think it depends on the specific ones) because some of them do block DAO. That caused me to have an attack big enough that it became obvious that I was reacting to foods -foods would hiss in my ear. I didn't do an elimination diet. I simply reacted to foods and wrote down those foods.

There is a lot of confusion regarding histamine and mast cells. If you are histamine intolerant because you don't have enough DAO, then that has nothing to do with your mast cells. In fact there is some evidence that histamine binding will actually reduce mast cell activity overall. I have shown no evidence of allergies or reactions to any other substances.

Also, if it's because you have some autoimmune condition then that is also a completely different mechanism and you would have symptoms of that condition. I do not have the symptoms of any autoimmune condition. In fact, the extra vasodilation makes me feel great (when I am not actually in the midst of a reaction). Also, autoimmune conditions are relatively common and doctors would recognize my symptoms. Every single doctor I went to said they had not encountered the symptoms before. One factor in my case is that I have very good cardiovascular fitness so my vascular resistance is low. This makes vasodilation easier and I will be more symptomatic.

Beverly

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Beverly thank you for all that information.I don't think I have an autoimmune problem. I just was wondering since I have read so many things about histamine intolerance after covid. But I'm going to have my hormones checked after you mentioned your estrogen was very high. I've always been estrogen dominant in the past, so maybe I'm still are even if not having my period. I have read that high estrogen = high histamines.

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@bellapazzia

Beverly thank you for all that information.I don't think I have an autoimmune problem. I just was wondering since I have read so many things about histamine intolerance after covid. But I'm going to have my hormones checked after you mentioned your estrogen was very high. I've always been estrogen dominant in the past, so maybe I'm still are even if not having my period. I have read that high estrogen = high histamines.

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I read that too and thought it was worth pursuing. I do want to clarify that when I took a more accurate test my estrogen was not high at all. So it was not that in my case. I did have a very, very bad reaction to estrogen supplementation though. That's because estrogen is a vasodilator.

Best

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Welcome to Mayo Clinic Connect. I hope you find encouragement in your discussions with folks have similar situations.

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I would like to say that things have stabilized and I am perfectly OK eating and cooking for myself at home. I eat a wide variety of foods, and the only whole foods that I cannot eat are eggplant, fish, and pork. I buy chicken carefully, cook it immediately, and freeze leftovers.

The main issues now are associated with contacts with our medical system. It's also difficult to travel. I am currently on vacation in CA; became caught up with other's expectations; ate carelessly, and then developed a cluster headache after attempting to eat pork. The resulting severe headache required a course of prednisone, which lowered my immune system. I caught a bad cold and had to go to urgent care. I've been coughing all night but not able to take the usually liquid OTC cough medicines. (Liquids can be especially bad and it doesn't say exactly what's in them.)

So the familiar and demoralizing routine: having to explain to yet another set of doctors why an underlying condition could effect my symptoms and I could have a bad reaction to antibiotics. I have to say: In this case they were especially attentive and actually listened. A doctor prescribed an epi-pen when I described the nighttime facial, lip, tongue, and throat swelling that sometimes comes with bad reactions. I cry when I see it. The problems with doctors and getting care are worse than the symptoms themselves and I am especially touched when a doctor actually cares.

It's been 2 years and I should say that of all the practitioners that I saw for this, it was actually conventional MDs who finally believed me and did what they could. It just required persistence, and very detailed descriptions of the foods and symptoms. They operate under a horrible system, don't get much time to speak with patients, and are generally overwhelmed with people who have made crazy self-diagnosis on the internet. But I currently have a PCP, neurologist, and allergist/immunologist all caring for me. It's been an incredible journey.

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@bjklemme

I think that the possible covid was incidental. In fact, I was very asymptomatic during it because I was taking a lot of antihistamines and vasoconstrictors. What happened is that I got a sinus infection afterward and took antibiotics. I've noticed that I get a lot of symptoms on antibiotics (I think it depends on the specific ones) because some of them do block DAO. That caused me to have an attack big enough that it became obvious that I was reacting to foods -foods would hiss in my ear. I didn't do an elimination diet. I simply reacted to foods and wrote down those foods.

There is a lot of confusion regarding histamine and mast cells. If you are histamine intolerant because you don't have enough DAO, then that has nothing to do with your mast cells. In fact there is some evidence that histamine binding will actually reduce mast cell activity overall. I have shown no evidence of allergies or reactions to any other substances.

Also, if it's because you have some autoimmune condition then that is also a completely different mechanism and you would have symptoms of that condition. I do not have the symptoms of any autoimmune condition. In fact, the extra vasodilation makes me feel great (when I am not actually in the midst of a reaction). Also, autoimmune conditions are relatively common and doctors would recognize my symptoms. Every single doctor I went to said they had not encountered the symptoms before. One factor in my case is that I have very good cardiovascular fitness so my vascular resistance is low. This makes vasodilation easier and I will be more symptomatic.

Beverly

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Thank you for your info. Is there any test to know if one is Low in DAO?

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@bjklemme

I would like to say that things have stabilized and I am perfectly OK eating and cooking for myself at home. I eat a wide variety of foods, and the only whole foods that I cannot eat are eggplant, fish, and pork. I buy chicken carefully, cook it immediately, and freeze leftovers.

The main issues now are associated with contacts with our medical system. It's also difficult to travel. I am currently on vacation in CA; became caught up with other's expectations; ate carelessly, and then developed a cluster headache after attempting to eat pork. The resulting severe headache required a course of prednisone, which lowered my immune system. I caught a bad cold and had to go to urgent care. I've been coughing all night but not able to take the usually liquid OTC cough medicines. (Liquids can be especially bad and it doesn't say exactly what's in them.)

So the familiar and demoralizing routine: having to explain to yet another set of doctors why an underlying condition could effect my symptoms and I could have a bad reaction to antibiotics. I have to say: In this case they were especially attentive and actually listened. A doctor prescribed an epi-pen when I described the nighttime facial, lip, tongue, and throat swelling that sometimes comes with bad reactions. I cry when I see it. The problems with doctors and getting care are worse than the symptoms themselves and I am especially touched when a doctor actually cares.

It's been 2 years and I should say that of all the practitioners that I saw for this, it was actually conventional MDs who finally believed me and did what they could. It just required persistence, and very detailed descriptions of the foods and symptoms. They operate under a horrible system, don't get much time to speak with patients, and are generally overwhelmed with people who have made crazy self-diagnosis on the internet. But I currently have a PCP, neurologist, and allergist/immunologist all caring for me. It's been an incredible journey.

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I am so glad to hear you are finding some balance. I am still experimenting to see what works and doesn't. Of course, every time I pick something that doesn't work I feel I go back to square one and I get all my symptoms back. It's very frustrating and debilitating, but reading comments like yours give me some hope I would also some day would learn how to navigate all these problems and get my life back, or at least some.

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