Histamine: A topic in the eczema realm that does not get enough air time. You've heard the term before but most likely can not explain its role in our skin health.
What is it? Why do we need it? How can it affect us? Fortunately, a trusted friend and clinical nutritionist, Jennifer Fugo, has our answers.
What is histamine?
"It's an important neurotransmitter that plays many roles in the body such as supporting protein digestion, triggering an immune response and inflammation, as well as being a signaling messenger within your body," Fugo begins. "What's crucial here is that histamine is broken down after its purpose is completed so that it cannot linger longer than is necessary."
We need histamine. Plain and simple. However, as Fugo states, we must ensure it is broken down. What happens, contrarily, is that some people, for one reason or another, are not able to process the histamine correctly. It leaves a wake of problems.
How is it broken down?
"So, in the GI tract, the enzyme diamine oxidase (DAO) breaks down histamines there. While histamine-N-methyltransferase (HNMT) breaks down histamine throughout the body."
Lost yet? If these enzymes are compromised by genetic issues or if too much histamine is present, it can lead to major downfalls. It's like a revolving door. If you get your shoe stuck, other things besides yourself are now affected - people trying to get in, as well as out.
Problems with overload
So, what are some symptoms of histamine overload? Quite a few, believe it or not.
"Excess histamine can make you absolutely miserable," Fugo says empathically. "It can trigger asthma, allergic reactions (with the possibility of anaphylaxis), hives, swelling, itchy skin, runny nose, itchy eyes and throat, diarrhea, and even feeling awake (unable to go asleep since it is stimulating)."
None of that sounds fun or inviting. Moreover, puzzling how these symptoms come into play can be exhausting.
"While you may be aware that environmental and food allergies can increase histamine," she continues, "so can a number of other issues that I've seen in clinical practice. These include parasitic infections, opportunistic bacteria in the GI tract that actually produce histamine, H.pylori infections (a bacterial infection), chronic mold exposure, estrogen dominance, and high histamine foods (like fermented foods)."
Basically, a slew of horrific factors can tip us over into histamine overload. These issues, such as H. pylori, will need testing to be assessed. That takes time and money - two things eczema patients tend to lack. But, when speaking to Fugo, there is no argument: Our health is worth it.
Is it really histamine issues?
Where exactly do we go for answers? Fugo knows this is a tricky road.
"Some common signs that you could be dealing with too much histamine include hives (especially when they’re unexplained), increasing IgE** allergies (not sensitivities or intolerances), asthma, oral allergy syndrome (OAS), and worsening of symptoms after eating fermented or high histamine foods."1,2
If signs are not indicative enough, there is always testing.
"Certain lab testing can also point towards a histamine overload picture such as elevated eosinophils (EOS) on a complete blood cell count panel (CBC) and total IgE (serum)."3
It is best to test if unsure. Concrete evidence trumps uncertainly every time.
**Immunoglobulin E (IgE) is an antibody that is produced by the body’s immune system in response to a perceived threat.4
How do antihistamines fit in?
Most of the time, antihistamines are taken while experiencing an allergic reaction or hives. Itching, too, can call for popping an antihistamine pill. Nonetheless, this helpful tool comes with consequences.
"Some antihistamines like Benedryl (and other medications) can cause a drop in the level of the DAO enzyme in your GI tract that I mentioned before," Fugo explains. "Other types of antihistamines (specifically H2 blockers commonly used for heartburn) lower stomach acid production. Unfortunately, H2 blockers can contribute to nutrient deficiencies, small intestine bacterial overgrowth SIBO), and even gut infections since the chemical barrier that is your stomach acid isn't sufficiently present."5
Although these are some hefty issues, Fugo reassures that these medications have a time and place. Always consult your doctor.
"No one should demonize your choice to use medication especially when your quality of life and mental health need relief."
Fugo understands the mental toll a skin condition can have on her patients.
Eczema and histamine intolerance
"Having eczema doesn't necessarily mean you have an intolerance to histamine," she asserts. "There are certainly cases of histamine overload in those with eczema, but in my experience, not every eczema case has a histamine component."
Score. It's comforting to hear. She further went on to say that antihistamines don't always help when we are itchy simply because histamine may not be our agitating factor. "That's where I think it warrants digging deeper to better understand if you have a histamine overload picture and then determining what's hindering your body's ability to handle varying histamine levels to keep you relatively comfortable."
Steps to help
First, stay away from environmental allergies. Fugo feels this is key.
Second, get an allergy panel. This should also include a CBC panel and total IgE.
Third, try a DAO supplement before meals. She warns, however, that if you are allergic to pork, do not take these.
Fourth, check for mold. "Mold doesn’t have to be obvious or visible," Fugo prefaces. "Knowing the history of your home can be helpful especially if you've had known leaks or floods in the past. Also consider looking at the seals in front-loading washing machines, the water filter and ice maker of the fridge, and inside of your dishwasher for possible mold." Mycotoxins, produced by mold, suppress our immune system.6
Next, try taking out any high histamine foods from your diet. Some find following a lower histamine diet to be helpful. However, consult with a nutritionist if this will be a lifestyle change.
Last, keep track of all of these symptoms. One way to do this is by using EczemaWise.
Jennifer Fugo's knowledge is vast and ever-growing. Her podcast, The Healthy Skin Show, has been a game-changer for my own skin journey. I urge eczema patients looking for answers to check it out. There is so much happening inside of our bodies. Eczema is more than skin and we deserve relief.
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