<table><tr><th>From:</th><th>Karyna Shuliak</th></tr><tr><td>Sent:</td><td>Saturday, July 16, 2016 2:34 AM</td></tr><tr><td>To:</td><td>Jeffrey</td></tr><tr><td>Subject:</td><td>First Steps | Histamine Intolerance</td></tr></table>

http://www.histamineintolerance.org.uk/about/first-steps/

First Steps

Things to =iscuss with your doctor & what to consider before you start a =ow-histamine diet

Making sure you really do have HIT

Under normal circumstances your GP should be able to make a =iagnosis, or send you to the right medical department that could =nvestigate further. That would be for example a gastroenterologist if =ou have stomach or bowel problems, a dermatologist if you have skin =roblems, an allergologist or an immunologist, because they need to make =ure that you don't have any other illness.

As =he information becomes more available there are more and more people =ho are able to get a diagnosis from doctors who have been able to read =p on the subject. Only in recent years has this been possible. Some =till have to really struggle to get to this point, but it is worth the =truggle.

What is =istamine Intolerance in short?

Histamine =ntolerance is an intolerance of histamine ingested with food. It is =aused by a deficiency of the histamine-degrading enzyme diamine oxidase =DAO) or an imbalance between histamine and DAO. As far as experts are =oncerned it is not normally caused by genetic factors but is an =cquired disease, often identified as a secondary condition to =nother.

Differential =iagnosis

non-allergic reactions Differential such diagnosis, as fructose the malabsorption, =xclusion of possible lactose other intolerance causes such sorbitol as genuine =alabsorption, food allergy, or Coeliac cross Disease =eactions, <https://www.coeliac.org.uk/home/> and the exclusion of any other illnesses =nd other imminently life-threatening disease such as cancer for =xample are of utmost importance. Some people may even have a rare =isease such as mastocytosis or mast cell activation syndrome (MCAS).

HIT can be a secondary feature of all of these, but it is not = given that it will be.

There are enough complaints =hat look like HIT but are not and vice-versa. That is why you put =ourself at risk if you self-diagnose.

Getting =ested for HIT — Diamine oxidase activity and =istamine levels

A test for diamine =xidase activity can bring you closer to piecing the puzzle together. If =he differential diagnosis has not solved the problem then it makes =ense to look into HIT.

The diagnosis is established by =edical history taking and the determination of histamine and diamine =xidase before and after a 14-day histamine-free(sic) diet.'

Details of the interpretation of results of these tests and =heir results can be found in the book Histamine Intolerance — =istamine and Seasickness by Reinhart larisch et al. (Spinger =ublishing, 2015).

In the UK your GP can refer you to a =ab, where they can measure the DAO activity in your blood serum and =our histamine levels. Low DAO activity and high histamine levels are an =ndicator of HIT. Results are likely to be inaccurate if you are on a =ow-histamine diet when being tested.

A diagnosis of =istamine intolerance is considered positive if two or more typical symptoms are present and improvement results from =ollowing a low-histamine diet and/or taking antihistamines.2

Keeping a food diary is essential so that you can track your =eactions to certain foods. This is also very helpful if you start an elimination diet. This would need to be worked out with a =a title="Useful Links" =ref="http://www.histamineintolerance.org.uk/index.php/useful-links/" =lass="">registered dietician. You will need to find out what your =hreshold is in what is called a re-introduction phase.

## Supplements

Some scientific =esearchers recommend that HIT patients should take supplements of =strong class="">Vitamin B6 and a higher dosage of Vitamin C. Talk to your doctor about this =ecommendation.

## Antihistamines

It has also =een recommended that as a precautionary measure HIT patients who tend =o have very severe reactions, such as anaphylactic shocks, should have = small emergency pack with them at all times. This would include some =orm of antihistamine. This is not a replacement for the diet, as =ntihistamines only block histamine and don't break it down the =ay DAO does. They may help reduce the symptoms, but they are not the =ure.

The type of antihistamine: your doctor will need =o tell you which type is suitable for your individual situation.

## DAO food =upplements

There are capsules containing =he enzyme diamine oxidase on the market but they do not in any way =eplace a low-histamine diet where you need to establish your threshold. =hether a constant long-term supplementation can lead to a worsening of =he condition still needs to be discussed further.

Some pharmaceuticals =nhance symptoms

If you are already =aking medication for the relief of symptoms or any other health reason, =our doctor will need to work out if this medication is =ounter-productive and you need to change to another product.

There are substances used in different pharmaceuticals that =ave a negative effect on the DAO. For someone with HIT that means that =ymptoms get worse, not better. Do not change =edication before you have talked to your =edic, otherwise you may harm your health.

## DAO food =upplements (cont.)

Only =nce you find out what is causing the symptoms in the first place can =ou start on the road to recovery.

Help us make a change

If you =ould like to help us make a change, please let us know about your =xperiences — positive and/or negative — via the contact page. We are not able to give any diagnosis or =edical advice, but we are actively campaigning for more awareness, and =our information helps us flag up the problems you are facing.

You can also copy and paste the link of this website on pages =n the net wher you think this information might be helpful to other =eople.

Useful information about Histamine Intolerance =or your GP can be found here:

Histamine Intolerance – Histamine and =easickness
Reinhart Jarisch
Publisher: Springer
ISBN: 978-3-642-55446-9 (Print) 978-3-642-55447-6 =Online)

²Histamine and Histamine Intolerance <http://www.ajcn.org/content/85/5/1185.full>
Laura Mainz, Natalija Novak (2007)
American Journal of Clinical Nutrition85 (5) p. =185-1196