The Low Histamine Chef

Hi Mel,

Thanks so much for saying that :) I've been biting my nails all day waiting to hear what people think!

Dirk Budka tested me by blood sample. I'll ask where you can get it done now (as Dirk is ill and not practicing at the moment). In the meantime, here's something to take to a GP to request referral (if it's possible on the NHS?).


"Diagnosis (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696737/)
Taking the history is of primary importance during the first visit to the doctor, who must attempt to establish the link between salicylate contact and the occurrence of the symptoms. This is only successful if they occur at close intervals. The doctor must therefore ask whether asthma, skin symptoms, swelling of the nasal mucous membrane, gastrointestinal symptoms or the (very rare) cardiovascular shock have occurred immediately after salicylate consumption. Polyps in the nose and nasal sinuses occur later and grow slowly; the decisive clue is then provided by their rapid and repeated recurrence after operative removal.

The accepted gold standard is the exposure or provocation test. However, these can only confirm or exclude the suspicion for rapid reactions such as asthma. Longterm developments such as polyps cannot be adequately followed.

Acetylsalicylic acid is normally administered orally or nasally (2, e4). This should only be done by persons familiar with these problems. Emergency precautions should be taken, as there may be violent reactions, such as asthma. This includes the possibility of observation in hospital and follow-up care. This diagnostic measure requires the proper equipment and is demanding for the personnel.

Fine tissue studies on biopsies can give valuable clues, particularly from eosinophilia (5, 9, 10, 11). This is an invasive approach, with the usual contraindications and risks.

Diagnosis can also be based on imaging techniques, including imaging procedures such as computed tomography (CT) for polyps and tests of lung functions to measure obstruction after exposure or provocation (2, 11, e6, e20). In individual cases, it may be necessary to perform endoscopy for local inspection and for the isolation of biopsies (9, 10, 11, 15, e14, e15, e17, e18).

Functional ex vivo tests are based on the detection of indicators in the patient’s tissues exposed to the test substances. Table 2 gives the sensitivity and specificity of functional in vitro tests and table 3 summarizes the positive and negative predictive values. This procedure is derived from the techniques and methods used for "genuine allergies." The following systems are currently commercially available:


Table 2

Sensitivity and specificity of functional in vitro tests

Table 3

Positive and negative predictive values of functional in vitro tests
Measurement of the released quantity of LT from prepared basophiles (6, 16, e8). This corresponds to the LOX-dependent metabolic pathways.
Measurement of the lysozyme-associated membrane protein CD63 by flow cytometry. This has been reported to occur on degranulating basophiles (6, 16, 17, 18). The measurement of enriched basophiles is a less suitable approach to diagnose salicylate intolerance (e21). The activation marker CD203 is a transmembrane metalloenzyme. Its activation by CD63 can be used as a consistent marker. This can be detected by flow cytometry for allergy diagnosis (19, e9).
An extended functional eicosanoid test (FET) can be used to measure the eicosanoids LT and PG released after exposure to salicylates or other substances (4). This gives a more quantitative measurement of the metabolic pathways of LOX and COX under both normal conditions and conditions equivalent to the disease, together with the dependence on symptoms such as polyposis, rhinitis, and others. These values from blood samples are naturally exceeded by those from the affected tissues – which are only rarely demanded.
The FET is also capable of detecting other pathological features of eicosanoid metabolism, e.g., in gastroduodenal ulcer (e19), malignant processes in the intestinal tract (e17), sepsis, and "systemic inflammatory response syndrome" (SIRS) (e22). These are not cases of intolerance. Measurements are usually performed on blood samples (4, 7, 12, 14, 20, 21, 22, e17, e19, e22). As comparative studies have not been performed on the same patient, the value of the different tests cannot yet be rated. Only released substances, such as the eicosanoids, can be measured on tissues or biopsies (9, 10, 11). Flow cytometry cannot be used for this."

SO...I will ask about where to get testing done - I'm due to receive a list of labs for reliable DAO and histamine testing any day now, will post everything here and on the blog.

Remember the bucket analogy in the book though...I was convinced I was sal intolerant...it was just that every little bit of histamine was making me spill over.

Hope this helps!

I'm pretty sure that Dirk tests everyone for it. I think it's part of the standard package. I'm MAO too! It's hard to do both. 

You still keeping a food diary? If you like email it to me and I'll see if there's something I can spot. 

What about cosmetics? Are you using them? Perfume, bath/shower gel, shampoo, make up, mascara, remover, nail polish, hairspray, dishwashing liquid etc. 

I realised many of my neurological symptoms (dizzyness, migraine, brain fog, eye twitching) were caused by them. 

You're so sweet thank you! I'm glad it's looking good :) That's one of the questions I'm getting answered. I already reached out to a doctor in NYC for you, but was worried by their non-scientific approach. When I challenged their practice of diagnosing histamine issues based on a questionnaire and patient observation - I knew to not bother pursuing it. There's some dangerous people practicing out there!

Will let you know as soon as I have the list of labs and tests.

I saw that you recommend going off of any cosmetics, bath/shower supplies etc...so what can be used for cleansing? handwashing, etc etc? I would appreciate any help you can offer!

Thank you so much for your reply! I have been using baking soda to wash my hands and hair (cause the "lists" say it is safe, but it is drying out my hands like crazy). And I was also wondering about that in particular because I noticed in your books as well as on your site that you said that baking soda is not necessarily tolerated by those who are histamine intolerant? And heaven knows I don't want to keep using something that may be a problem! Thank you for your replies - I really appreciate it! (and I am really looking forward to using your recipes - it has already emboldened me to try some new foods that I was scared to before!)