188: Histamine Intolerance + Skin Rashes (PART 1)

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If you’re taking lots of antihistamines and still struggling with what you think is histamine intolerance, you need to hear this!

Histamine intolerance is a huge problem — something I see in my clinical practice in about 50% of my clients.

It’s tricky (and frustrating) because they’re often taking multiple antihistamines (though getting minimal results), having trouble sleeping, and feel like their doctors don’t fully know why they’re either so reactive to everything or their allergy panels come back “completely normal”.

Whether you’re dealing with eczema, rosacea, chronic hives and psoriasis (though this pattern is much less common in psoriasis), your case should be evaluated for what I describe as Histamine Overload.

Ultimately, identifying this pattern is crucial to knowing how what else to consider and potentially address that could be making you miserable.

While you need histamine (it’s an important neurotransmitter), too much in your body can be really problematic!

It’s my hope that this first part of the Histamine Intolerance + Skin Rashes series will help you to unravel this complex problem by connecting dots for you that you might not be familiar with!

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In this episode:

• What is Histamine Overload + your Histamine Cup?
• Skin issues that can be connected to excess histamine
• How to tell if you have Histamine Overload
• Your gut’s hidden role in driving histamine higher
• Histamine breakdown in the gut (and medications that can impair it)
• Histamine supportive supplements

Quotes:

Some bugs cause mast cells to dump histamine (thus increasing the level) while other bugs can actually produce histamine.

If you have histamine overload, antihistamines may be a necessary bandaid while you work on underlying issues.

Histamine Intolerance + Skin Rashes, PART 1 (FULL TRANSCRIPT)

Welcome back to episode #188 of the Healthy Skin Show!

In today’s episode, you’re in for a real treat especially if you’ve been struggling with what I call a “histamine overload” picture in your case which is often described as histamine intolerance.

If you’re taking antihistamines daily, struggling with itchiness that your doctor is having difficulty explaining, or have a ton of allergies, this is for you!

A histamine overload picture is often complex and isn’t usually fixed by any one thing.

It’s not solved by a low histamine diet (though the diet may be a required part of your path forward while working on other underlying issues).

Histamine overload is more common in cases of eczema, rosacea and chronic hives and much less common in those with psoriasis (though I have a few psoriasis clients who struggle with it).

That doesn’t mean that every case of eczema or rosacea is automatically a
histamine overload picture which is why it’s important to get assessed.

If you do have histamine overload, know that antihistamines are a bandaid. But they can help manage your daily experience to help you get through the day.

This is because your “histamine cup” is always so close to overflowing that the smallest issue can trigger a problem.

Underlying concerns that can prematurely “fill your histamine cup” include IgE allergens, cross-reactive pollen food allergies, suboptimal DAO enzyme production, high in histamine foods in your diet, unfriendly gut bugs, genetic SNPs, estrogen dominance, mold/mycotoxin exposure, and heavy metals.

Having varying combinations of these issues can create a perfect storm. Don’t think that you have to have all of these issues going on at the same time to have histamine overload.

The result can really be detrimental to your quality of life especially if you’re not able to sleep at night.

In my clinical practice, about 50% of the total skin rash cases I work with fall into this category so I’m very familiar with the daily struggle that you’re going through.

And that’s why I’m planning on this being the first of a series of podcasts on this topic so let’s dive in!

Do You Have Histamine Overload?

Before I go into the more nitty-gritty about what’s driving your histamine issue, it’s important to figure out IF that’s your problem in the first place.

Many people mistakenly assume that because they’re really itchy and have eczema that they have histamine overload, but that’s not always the case.

Itchy skin can happen for many reasons and may be due to a skin infection (which must be ruled out).

So having eczema or a rash is usually not enough to qualify you for histamine overload.

To start identifying if you have histamine overload, do you have…

1. Use of anti-histamines daily (using one or more daily)
2. Experience hives (urticaria) or even dermatographia (where raised welts can form just from a scrape or running something over your skin)
3. Intense itchiness (after ruling out a skin infection)
4. Asthma
5. Confirmed IgE allergies (not sensitivities or intolerances)
6. Have certain lab markers high such as Total IgE + Eosinophils
7. Reactive to high histamine foods

It’s not about experiencing one or two of these issues, but rather having at least four of them in my clinical experience.

I should also clarify the different types of antihistamines I was referring to a moment ago.

You are probably familiar with Benedryl, Singulair and Zyrtec, but the list can also include H2-receptor blockers (more commonly used for heartburn). These would be medications like Tagamet HB, Pepcid AC, and Zantac.

Sometimes antihistamines help… and other times, they don’t. 

It all depends on how much your “histamine cup” is already overflowing and IF histamine is even the true or only issue you have going on.

Also in terms of diet, high histamine foods can contribute to histamine overload.

So whether you’ve gotten some relief from eliminating high histamine foods such as fermented foods (ie. vinegar, wine, beer, alcohol, sauerkraut, yogurt) and cured meats and cheeses…

Or you’ve gone a step further and done a true low histamine diet elimination, typically you’ll notice an improvement from doing so.

And of course, keeping out cross-reactive pollen allergy foods that you know are issues. For example, if you have a ragweed allergy, you should probably avoid stevia along with dandelion and milk thistle supplements.

{Check out my Cross-Reactive Allergen Food Guide HERE}

How Your Gut Increases Histamine

What’s often overlooked is that histamine can be increased by your gut microbiome!

Some bugs cause mast cells to dump their histamine (thus increasing the level) while other bugs can actually produce histamine.

H.pylori is an unfortunately common bacterial infection that can cause mast cells to degranulate releasing histamine into your system.(1) I’ve discussed its connection to eczema, rosacea and other skin issues in episode 135.

Other sneaky microbes that I’ve encountered in my clinical practice that actually produce histamine include bacteria such as Morganella spp. and certain Klebsiella spp. that essentially makes you a histamine production factory!

Parasites can also play a role that’s too often overlooked given the frequency with which people will complain that “patch testing came back normal” and yet they seem to be allergic to everything.

I’ll discuss this more soon, but for now, keep in mind the conclusion of one study that found there to be “…a fourfold increase in the total serum IgE levels of patients detected with protozoa when compared with patients in whom protozoa were not detected.”(2)

So if you have histamine overload, it is crucial to evaluate what’s going on in your gut microbiome using a comprehensive stool test (rather than those which are commonly marketed to consumers online).

Breaking Histamine Down In Your Gut

It should be no surprise that your body has a system in place to naturally break histamine down from food (whether it’s naturally high in histamine or it releases histamine upon digestion).

Specifically, an enzyme called Diamine Oxidase (DAO) is tasked with tackling histamine in your gut.

Under normal circumstances, DAO will deal with histamine in food and the gut such that you won’t react to it.

But histamine intolerance develops when you have a SNP in the gene that codes for the DAO enzyme (such that the enzyme doesn’t end up working as well)…

OR your DAO enzyme production drops to a point where it becomes inefficient (and you basically don’t have enough of the enzyme available to get the job done).

There are several factors that can impact the amount of DAO that your body makes.

As I mentioned earlier, it’s not uncommon for people who have histamine overload to be taking one or more antihistamines.

Unfortunately, some medications can cause a drop in DAO production.

Certain antihistamines such as Benedryl and cimetidine (Tagamet) may lower DAO production making it more difficult to break down histamine. Other drugs that can impact DAO include chloroquine, clavulanic acid, codeine, naproxen, Lasix, and verapamil.(3,4)

I’m not suggesting that you stop taking medication that’s been prescribed by your doctor. But if you are taking one or more of these medications, you might want to have a conversation with your provider about this potential issue.

In Part 2, I’ll discuss hormonal imbalances that can impact DAO production, so stay tuned!

Histamine Intolerance Supplements To Try

While you work to uncover your root causes triggering Histamine Overload, some supplements may be helpful.

They are known for supporting histamine imbalances!

Before adding them in, always check with your practitioner or doctor to make sure they’re right for you.

Bioflavonoids like Rutin and Quercetin can be helpful (this tasty powder is my GO-TO recommendation for clients to get in bioflavonoids) — we discussed them in the past in episode 32.

Stinging Nettles are a botanical that can be taken as an herbal supplement or as a tea.

Vitamin C is also important + why I recommend THIS to clients (Unless you’ve got Interstitial cystitis — then you’d need to be really careful with Vitamin C supplementation no matter the form.)

Immunoglobulins like Mega IgG2000 (capsules or powder) can support the gut by “sopping up” waste products within the GI tract helping to reduce how reactive you are –> THIS IS WHAT I USE WITH CLIENTS.

DAO supplementation may be worth testing out for a couple of weeks to see if you notice any difference rather than getting tested for a genetic SNP since doing so is very expensive. Honestly, most of my clients don't feel any improvement on them. Typically these supplements are derived from pigs (so they are contraindicated if you have an allergy to pork).

Generally, a DAO supplement is taken 10 minutes before every meal. If you currently take a digestive enzyme, a DAO supplement would be taken in addition to the enzyme product.

An alternative “plant option” is to purchase or sprout Pea shoots that also contain DAO (though I can’t quite say how effective this option is compared to the DAO supplement).(5) Here’s some information on how to add the pea shoots into your daily regimen.

As you can already tell, I could go on and on about Histamine Overload because I have so much to share with you on this topic, but I feel like this is a good place to stop for now.

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them in Part 2 of this series.

And if you know someone struggling with histamine issues, this is a great podcast to share with them especially if they feel incredibly frustrated and out of options because all their “tests come back negative” but they still desperately need those antihistamines.

Thank you so much for tuning in and I look forward to seeing you in the next episode!

REFERENCES

1. https://pubmed.ncbi.nlm.nih.gov/15275970/
2. https://www.sciencedirect.com/science/article/pii/S1027811712000523
3. https://www.deficitdao.org/en/dao-deficiency/origin-of-dao-deficiency/pharmacological-factors/
4. https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-4-S3-P23
5. https://daodeficiency.org/learn/diet-and-supplementation/