This is a clinician-led YouTube full-guide (Matt Kelly) explaining histamine intolerance as a real clinical condition. The presenter frames it as an imbalance between histamine supply (overproduction or triggers) and removal (slowed degradation), lists diverse presentations (allergic and non-allergic: skin rashes, GI symptoms, joint swelling, sleep disturbance, palpitations/PVCs, blood-pressure changes), and outlines an evaluation pathway using history, targeted labs (direct and indirect histamine measures), allergy assessment, and consideration of mast cell activation disorders.
Chapters
Hey, you ever wonder if histamine intolerance is a real health problem that people have? Is it just the same as having allergies or is there something else to it? Well, today we're going to break down histamine intolerance. This is something I've been working with patients who have for decades now. I don't want to just get into the basics of histamine intolerance, what it means, where it comes from, and some strategies you can use to work with it. So first, histamine intolerance is a real health condition. Basically, it comes from one of two pathways. The primary one is that the body knows what to do with histamine, meaning get rid of it when it is produced in the body. But in some people, the way of getting rid of it or the pathways of getting rid of it are slowed down for a number of reasons. So that can be one of the reasons. And then there is also a, what we might call a supply side problem where maybe the body can do okay with regular amounts of histamine, but we have maybe some hyperreact triggering of the production of histamine. And so then we have an imbalance in supply and removal. So again, it's either the removal is a problem or the supply is too excessive, or maybe a little bit of both. So you might say, well, you know, I have a sense, or maybe you have allergies and you feel like, well, I get respiratory problems when I have allergies, or I get just a stuffy nose or my skin gets itchy or something like that. You can get all of those things with histamine intolerance, but you want to keep in mind that beyond that, you can get skin rashes. You can have a lot of digestive problems because histamine is used in the digestive tract as a signaling molecule and it's also irritating to the digestive tract. And you can have blood pressure changes due to histamine excess or histamine removal problems, changes in your heart rate, even the development of some types of heart dysrhythmias or arrhythmias, you might call them. So histamine intolerance can present in classic allergic ways, and then it can present in non typical allergic ways, which is a very important thing to consider while we're thinking about histamine intolerance. But from the science and from my experience, how could this happen specifically, and probably more important, what can we do about it? So the first one would be on the supply side. So remember we said there's this balance of supply of histamine and removal of histamine. Histamine. Now, you might think, and I. I'm a person who has allergies myself, so you might think, well, I don't like my allergies. They're very, you know, discomforting, and they create a lot of symptoms I don't want. So why would the body make histamine like it seems like it's just a big problem. Well, histamine is used as a neurotransmitter in your brain. If you did not have histamine in your nervous system, you would literally not be alive. So it's kind of important there. Histamine is used in other pathways in the body as well. And so it's produced naturally as a part of the way that our body works. But like everything in our body, there is a balance to it. And so we're supposed to have the right amount of histamine to run all of the processes that it does. But we're also not supposed to be unable to get rid of it. We're also not supposed to have too much coming in. So on the supply side, the first thing that, that we think of clinically when somebody has histamine intolerance picture is let's take a look and let's do maybe some labs and some history, et cetera, first to see if there are markers in the labs that might indicate that they're indeed having more histamine production. Now, there are some direct and some indirect measurements. These are getting better in the labs, but they are like all laboratory tests, subject to, you know, limits of sensitivity and specificity, et cetera. But the next step, then, beyond these gross measurements in the labs and looking at your history and keeping in mind that you don't always have to have a respiratory problem or you don't have maybe itchy skin, but you might develop rashes that are unusual, or you might have joint swelling. That's another histamine problem. You might have sleep disturbances. That's another histamine problem. As I mentioned, you might have aggravation of PVCs or other types of heart dysrhythmias. That's another histamine sign. Not the only reason that happens, but one of the reasons that that happens. So the history leads you to then saying, well, are known and unknown allergens that are going on so quickly, what is an allergen? An allergen is anything that the body perceives as an invader that generally it shouldn't perceive as an invader. So it's an immune system mistake and an overreaction to something that comes along. That could be pollen, that could be mold or a mycotoxin, that could be a fragrance, that could be a food. It could be all sorts of things, right? So the first thing when we're asking people questions is do you have a history of asthma, allergy, hay fever, any other. Do you have food allergies that you can't eat? Shellfish, something like that? So that's the first layer, that's the known category. And they'll say, yeah, when I was a kid, I had really bad hay fever and they said I had grass allergies or whatever. And then I kind of grew out of that. And maybe now they don't have that, but they have other things like they have joint pain or asthma or something. Then they may say, oh, yeah, there's three foods. If I eat them, I have to keep an EpiPen because I'll have an anaphylactic allergic reaction. Well, it's pretty high grade. You usually know about those. So, you know, whatever it is, shellfish or, you know, avocados or something like that. So those are all the known ones. The other thing is, are there things that you don't have a big time allergic reaction where you might need an EpiPen, but you have just a irritation reaction, such as you eat a particular food that you've narrowed down through trial and error, and that food cause you to, you know, have your throat close up or have anaphylactic symptoms, but it causes you to have other inflammatory symptoms that makes your joints swell, it makes your digestive system go off in some way, it triggers dysrhythmia in your heart. That can be maybe an allergic sensitivity, which is in the same category and can trigger histamine intolerance on the supply side. Then the final area that needs to be considered, which may be in the history and maybe you don't know about, would be do you have mass mast cell disorder, family mast cell activation syndrome, et cetera? Because the mast cells are part of a four part quartet of cells led by the mast cells that release inflammatory mediators for the immune system. And when you have mast cell activation syndrome, they do that too much. So histamine is one of the things, it comes along with mast cell activation. So if we go and you could be anywhere on the spectrum with histamine intolerance, you can know all sorts of things that you're allergic to, sensitive to, you have muscle activation syndrome. We already know a whole lot about that. Or you could say, I don't know. I've never had any of that checked. I don't know.
