Idiopathic anaphlyaxis – could histamine be the cause?

If all other possible causes have been investigated then yes, says Dr Joneja, it would certainly be worth looking at a histamine overload as a contributory cause.


I’m female 32 years old and this began nearly two years ago I started waking up in the middle of the night having anaphylaxis reactions.
Symptoms include: stomach cramping, diarrhoea, swelling of tongue, lips, tingling hands.
I had one reaction during the day after drinking apple cider.
I had allergy testing done came back as not allergic to anything. A few weeks later I found out I was pregnant, had a couple more reactions at night.
After having my baby (second child no symptoms before) I had no reactions for one year and now have started having them again – at around 5am – 6am having not eaten anything during the night. Last meal say around 6pm.
I have had more blood testing done, even testing for autoimmune – nothing.

I’ve been told it is idiopathic anaphylaxis. Could it be histamine intolerance?

Dr Joneja says:

A diagnosis of idiopathic anaphylaxis means that you are experiencing symptoms typical of an anaphylactic reaction, but your doctors and other health care providers have been unable to detect any cause.  You state that allergy testing has all been negative.  However, as you will see from my various articles, there are several other causes for the symptoms you are experiencing including mast cell activation disorders (MCAD) among others.  I hope that all these have been considered; if not I would suggest that appropriate investigations should be undertaken as soon as possible.

If these investigations are all negative, it would be worthwhile to investigate the possibility that you are indeed experiencing histamine sensitivity as a result of a deficiency in the enzymes that break down excess histamine, especially diamine oxidase (DAO).  Unfortunately we do not have any tests that definitively diagnose either histamine intolerance or sensitivity, or DAO deficiency.  Although “histamine excess” can have a number of different causes, the most important feature of them all is that an overload of histamine is responsible for the symptoms.  Consequently, a histamine-restricted diet should lead to resolution, or significant reduction, in the severity of the symptoms if indeed histamine sensitivity is an issue.

In addition to the obvious causes of histamine excess, such as allergy, autoimmune diseases, chronic inflammation, MCAD, and DAO deficiency, several situations can increase histamine.  Two of the most common are hormonal fluctuations, especially in oestrogen and progesterone levels, and stress.  From your description of the onset and course of your symptoms it is possible that either or both of these may be contributing.  The fact that you experience symptoms at about 5.00 – 6.00 AM further suggests histamine buildup in excess of your limit of tolerance as it takes time for this to occur.  As you will understand from my numerous articles, you will not experience an immediate reaction to a histamine-rich food, as you would in the case of an allergy, but usually up to several hours later as the level increases over time. 

I would strongly urge you to follow my histamine-restricted diet for a trial period.  If your symptoms resolve or significantly improve on this regimen it would be advisable for you to follow the diet for the long term.

December 2015

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If you found this article interesting, you will find many more articles on anaphylaxis here, and reports of research into anaphylaxis here.
You can also find articles on peanut and tree-nut allergy here, cow's milk allergies here, egg allergy here, histamine intolerance hereand articles on a wide range of other allergic and intolerance reactions to a wide range of other foods here.


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