Some women notice heightened allergies when they reach menopause, and there are various reasons why this might occur. In this blog, we’re looking into the relationship between menopause and allergies.
What is an allergy?
An allergy is a damaging immune response by the body to a substance that it has become overly sensitive to. Common allergies can include foods, pollen, insect stings, fur or even dust. Disorders linked to this include hay fever, food allergies, eczema, asthma and even anaphylaxis. When the body is exposed to an allergen, it produces a chemical known as histamine.
What is Histamine?
Histamine is a neurotransmitter or nerve communicator. It makes the blood vessels leaky to allow the passage of cells to attack an allergen. It also plays a role in sleep, mood, libido and thought processing and is critical to bodily functions. You may have heard of ‘anti-histamines’ such as Piriton that you can buy over the counter to combat the effects of histamines for people with hay fever, for instance.
What is Histamine Intolerance or HIT?
HIT is often mistaken for an allergy when it is, in fact, due to an accumulation of histamine in the body due to a mismatch in its production and rate of excretion. Most sufferers will have tried to identify an allergic trigger for their symptoms and/or undergone inconclusive allergy testing.
HIT is unpleasant but never fatal like an allergy can be. It is more common in women and more common in midlife, and therefore, our hormones and, indeed, menopause may play a role. It is thought to affect at least one in every 100 people.
Symptoms of Histamine Intolerance (HIT) may include:
- Skin: flushing, itching, hives, eczema
- Respiratory tract: runny or blocked nose, sneezing, coughing, wheezing and shortness of breath
- Blood vessels: fluid retention and swelling, palpitations, dizziness and fainting, migraine
- Bowel: heartburn, belching, bloating, nausea, diarrhoea or constipation.
- Neurological: insomnia, fatigue, irritability, anxiety, brain fog, migraines, tinnitus
How does Histamine accumulate in our bodies?
Our bodies can produce histamine in response to a trigger such as an allergen and even due to stress. Histamine is also ingested from numerous dietary sources, such as alcohol, fermented foods, cured meats, smoked fish and various fruits and vegetables.
As a general rule, unripened and very fresh foods are likely to contain less histamine when compared to overly ripe or leftover food that is eaten later. Fermented foods, such as yoghurt, are best avoided by HIT sufferers.
Histamine is excreted via two enzymes (DAO and HNMT), and in the ideal scenario, histamine production/ingestion equals its excretion. Some people simply have faulty or less effective enzymes due to their genetics or concurrent use of medications such as non-steroidal anti-inflammatories (ibuprofen, naproxen), painkillers and antidepressants.
Bowel conditions such as coeliac, inflammatory bowel disease and even an impaired gut microbiome can also reduce the effectiveness of these enzymes.
What is the relationship between menopause and allergies, namely histamines?
You might be wondering why histamine intolerance can become a problem at menopause, and we’re here to offer guidance and support.
Women approaching menopause may start to perceive new allergies or intolerances to things such as alcohol. They may also develop new or worsening hayfever, eczema or asthma.
Whilst overall, at menopause, our oestrogen levels are declining, at times, we will experience surges in oestrogen. Think of a car running out of petrol but at times being able to inject a final chug! Oestrogen and histamine have a relationship in which oestrogen triggers the release of histamine, and histamine then triggers the release of more oestrogen, thus entering a vicious cycle. To make matters worse, oestrogen impairs the enzyme DAO, which is pivotal in excreting these very same histamines.
You may be able to identify times in your past when your symptoms have been at their worst during periods of high oestrogen. These times may include your teenage years when periods first started, mid-cycle at ovulation, during combined contraceptive pill use and now during peri-menopause with or without HRT. Interestingly, women often feel great during pregnancy despite markedly raised oestrogen levels. This is because the body has a mechanism of increasing the levels of DAO to excrete more histamine in order to protect the baby.
How to diagnose Histamine Intolerance
Diagnosis is largely symptom-based. Since HIT is not an intolerance to one particular food, it can be very challenging to identify the triggers. It requires a very detailed food, symptom, and cycle diary over time and is best supported by a Dietician or Nutritionist to ensure you don’t become deficient in nutrients.
It may be, for instance, that at certain times in your cycle, you can tolerate a bottle of wine, but at other times a glass will cause significant symptoms. Equally, it can be that you cannot tolerate a meal consisting of multiple histamine-rich foods, but you can enjoy them individually. This causes great confusion and is why you may not have identified HIT previously and need help from an expert to interpret your diary.
Unfortunately, there is no diagnostic test for HIT. There are several commercially available tests whereby you can check levels of the enzyme DAO or a substance called Tryptase (related to the activity of the cells producing histamine), but, like our hormones, these are unreliable as they fluctuate day to day. You can also check your genetic pathways for histamine production and excretion via companies such as Lifecode Gx.
How do I manage HIT?
Hopefully, your GP has already excluded other causes for your symptoms. This is especially true for changes in your bowel habits, so if you have not discussed this with your doctor, it is important to do so.
This can involve trying to eradicate histamine from the diet for a minimum of a month and keeping a diary. It is incredibly difficult and, ideally, should be overseen by a Dietician or Nutritionist. As a minimum, you will likely need to abandon alcohol, dairy products and fermented foods. This should improve gut health, but in addition, you may wish to take a probiotic such as Symprove, which is vegan.
You may find this website helpful, certainly the food diary.
|Low histamine foods – safe foods||Medium histamine foods – OK in low quantities||High Histamine Foods (best avoided!)|
|Freshly served meat and poultry||Processed, aged, fermented, cured meats such as salami, bacon, hotdogs|
|Fresh fish||Smoked or tinned fish
Oily fish – mackerel, sardines, herring, anchovies
|Brown rice, quinoa and other gluten-free grains||Gluten-free soda bread||Foods containing yeast – bread, sourdough and cakes
Foods containing gluten
|Eggs baked in food
Goat or almond butter. Fresh cheese such as mozzarella, ricotta, cottage cheese
Fresh milk, plant milks inc. nut milk
Extra virgin olive oil, rapeseed or coconut oil, ghee
‘Vegan’ cheese may contain artificial colouring and preservatives
Fresh uncultured, unfermented butter
|All fermented dairy products from cow/goat/sheep
Yoghurt inc. coconut, kefir, kombucha
Fermented or cultured butter
|Fresh vegetables except->||Peas
|Vegetables; avocado, spinach, aubergine, mushrooms, pickled and canned vegetables
Pulses; chickpeas, beans, lentils, butter beans, black beans, kidney beans. Including spreads and dips such as houmous.
|Fresh fruit except->||Most citrus fruits, bananas, pineapples, tomatoes and strawberries, kiwi
Dried fruits containing sulphur dioxide or preservative
|Macadamias, pistachios, almonds, brazils, pecans, hazelnuts, chestnuts and pumpkin, sesame, hemp & chia, flax-seeds||Most nuts and seeds except
Includes nut butters and spreads
|Herbal teas||Spirit – gins and vodka||Green and black tea
|Sugar and sweets except->||Honey, cane sugar and maple syrup
|Chocolate, cocoa, cacao, artificial sweeteners|
|Fresh and dried herbs, spices, distilled white vinegar, salt, pepper. Homemade vegetable stock & homemade white fish stock||Garlic
Hot spices – cayenne, chillies, curries
Apple cider vinegar
|Pickled and fermented foods inc. vinegar, soy sauce, mayonnaise, tomato ketchup, olives, capers, miso, fish sauce, tamari, Marmite, cumin, bouillon, broth, animal/poultry stocks. Many artificial preservatives and dyes|
These act as an antidote to surplus histamine to reduce symptoms, but they don’t prevent its production. You can buy these over the counter: cetirizine, loratadine, and fexofenadine, and they can be taken up to four times daily. If you suffer from acid reflux, the addition of a prescription medication, famotidine, can be helpful.
As previously mentioned, stress is a trigger for histamine production, and this should be managed with lifestyle techniques such as yoga, meditation and mindfulness as far as possible. Aerobic exercise can have a variable effect on histamine release and should be individualised.
DAO supplements are widely available but can be expensive. They are most effective when taken shortly before a meal that is known to be high in histamines.
Vitamin C and L-glutamine act as natural antihistamines. Quercetin, found in some fruits such as apples, can also be helpful.
Hormone replacement therapy
Whilst HRT is very effective at managing menopause symptoms, for some, oestrogen can exacerbate their HIT symptoms. For those women who need or want to take HRT, optimising the diet will often allow for the slow titration of HRT. Progesterone and testosterone may have a positive effect on HIT symptoms.
You may find these links helpful regarding menopause and allergies:
We hope this article has been helpful regarding menopause and allergies. Check out our blog on Crashing Fatigue during Menopause. Please don’t hesitate to contact our menopause specialists in Manchester – we’re happy to answer any questions and provide expert advice.
Dr Summerhill is a GP and Menopause Specialist. She qualified from Guy’s, King’s and St Thomas’s (GKT) School of Medical Education in London in 2007. She qualified as a GP from the Royal College of General Practitioners (RCGP) in 2015 and has undertaken specialist training in women’s health having achieved diplomas from the Royal College of Obstetricians and Gynaecologists (DRCOG) as well as the Faculty of Sexual and Reproductive Health (DFSRH). She has the Letter of Competence from the FSRH for both coils and implants. Dr Summerhill has undertaken extensive training in menopause management and holds an Advanced Menopause Specialist certificate with the Faculty of Sexual and Reproductive Healthcare.