'Botanical Support for Histamine Hypersensitivity, including Histamine Intolerance, MCAS and Mastocytosis'
sponsored by Rio Health

Please note, this is a transcript of the questions received and have been reproduced verbatim in relation to any grammatical errors.

NOTE: Whilst there is much literature about natural therapies for allergies and hay fever, there is a lot less natural therapy information about histamine hypersensitivity conditions than there is for many other health issues.  This was one of the reasons I wanted to research this topic and collate what information I could find on these conditions for this webinar presentation.  Definitive answers to the below questions are mostly not possible—in part because I have not found scientific support. Also, there are possibly many other useful supplements than those mentioned in the webinar slides—there is still much research to be done.  I believe that MCAS will be diagnosed more frequently—and may associate with Long COVID—which will mean more clients may present to practitioners with an MCAS diagnosis.  Systemic Mastocytosis is to be diagnosed or ruled out by the NHS and, in practice, practitioners likely would only be approached by those diagnosed with indolent SM.  Histamine Intolerance is an exclusion diagnosis—after other health conditions have been ruled out. The DAO level can be tested.  Finally, I repeat my caution, given in the webinar, that a low histamine diet removes too many healthful foods and so should not be used long-term except when specifically required and then, only if carefully monitored.  The less-healthy high histamine foods (for example, processed meats) can, of course, be avoided long term.  Best use of the information about histamine in foods is to ensure meals don’t contain only or primarily high histamine foods.  Use the list of low-histamine foods to buffer the effects of the high histamine foods.  And remember, FRESH is BEST. And stress is the biggest enemy.

Below are my replies to the questions:

Do you know if LTP allergy can be brought on by MCAS?

Interesting question.  I admit, I had to look up LTP allergy which I now understand to be Lipid Transfer Protein allergy and involve a reaction to vegetables, fruits, nuts or cereals, with LTPs mainly found in the peel and pips of plant foods. 

Lipid transfer proteins (small, soluble, cysteine-rich proteins) are found in plant-based foods and are designed to protect the plant. LTPs can move lipids between membranes via hydrophobic cavities that shield the lipids from the aqueous environment during transport. LTPs are considered true food allergens as they can sensitize via the GI tract with IgE reactivity to LTPs often associated with severe systemic symptoms.

Allergies (presumably, including LTP allergy) CAN associate with MCAS but I found no evidence that any allergy can be ‘brought on’ by MCAS.  Allergies of ANY type can increase endogenous histamine so may contribute to the ‘histamine bucket’ and trigger histamine symptoms.

In a post-menopausal woman, would HRT reduce mast cell activation symptoms?

It is possible that HRT may reduce MCA symptoms if hormonal change is the trigger for the symptoms of that specific individual—which may, or may not, be so for all post-menopausal women—or, indeed, for menstruating-age women.

Re HRT, note that there are different types of HRT and oestrogen-only HRT and combined (oestrogen and progesterone) both contain oestrogen. Oestrogen excess can downregulate DAO and thus worsen MCA symptoms.

Note that asthma and asthma-like symptoms associate with MCA and a 2012 study that discusses the role of female sex hormone (oestrogen and progesterone) on mast cells[1] found that post-menopausal women receiving HRT had an increased risk on new onset asthma (and those who have asthma may suffer worsening symptoms). So conventional HRT may not be recommended in mast cell activation diseases.

Progesterone, on the other hand, inhibits mast cell secretion.  It is possible that progesterone replacement therapy may reduce mast cell activation symptoms.

I know of an individual diagnosed with indolent systemic mastocytosis whose symptoms began after removal of a mirena coil (these are progesterone only) and I have long suspected the association between progesterone and her diagnosis—something the NHS seems to disbelieve.   I am particularly interested in exploring this possibility and if any practitioner would like to share experience of this or of trusted progesterone therapies I would welcome this (rose@riohealth.co.uk)

Progesterone levels can be naturally supported by including magnesium-rich foods alongside ensuring good levels of vitamin B6.  It is also important to avoid xenoestrogens (e.g. plastic containers used in microwaves). Note that in age, progesterone drops significantly more than does oestrogen.  In addition to magnesium and B6, zinc, healthy fats and vitamin C may benefit.  Limiting caffeine and reducing stress may also help.  And maca may help increase progesterone over time.

Where can you get Tryptase tested? Also, can quercetin be taken long term?

Tryptase levels would be tested by the NHS system (specialist, not GP) as this would either confirm or rule out systemic mastocytosis.  I was not suggesting that practitioners test tryptase levels and am not sure if this is even possible.

In some cases, a cutaneous manifestation (skin spots re Urticaria pigmentosa) is the only really tangible indication that something is not quite right (other symptoms may be non-specific or suggest allergy which tests may confirm or rule out) and the GP may first refer to a skin specialist.  If Urticaria pigmentosa is confirmed by the dermatologist, they will request a tryptase test to rule out mastocytosis. 

I do know that there are fewer conventional labs that do the tryptase test and there is often a delay in receiving these results. 

Once the level of tryptase is known to be raised, the NHS specialist doctors will regularly check these levels (usually every 3 to 6 months in cases of indolent systemic mastocytosis. 

If practitioners do know of a lab that tests tryptase for practitioners I would appreciate being informed by email rose@riohealth.co.uk

Re quercetin—I know of no reason why quercetin can not be taken long term.  As with any antioxidant, it is useful to take several.  If the client does not have an antioxidant-rich diet, then it might be useful to ensure supplementing with other antioxidants.  Vitamin C works synergistically with quercetin so that would be recommended as a minimum.  

Can we please have some practical examples of these nutrients in action in a real case study? In complex conditions such as MCAS this would be extremely helpful.

I would love to be able to supply you with a case study on one of these histamine-hypersensitivity clients.  I don’t, unfortunately, work directly with clients as my work for Rio Health is almost full-time. 

I do, however, know of an individual with indolent systemic mastocytosis who daily uses quercetin, bromelain, vitamin C, Chamomile, Nettle, Curcumin, and Rhodiola alongside vitamin D and magnesium, and who occasionally uses: Chinese Skullcap, Houttuynia, Clove, Kalmegh, and Ginger.  This person is NOT using a low histamine diet (though is mindful of which foods are high histamine) and has maintained the tryptase levels—mostly without increase—except when stressed—hence the need for Rhodiola as well as magnesium and vitamin C.

If any practitioner has worked with a client and would like to share their experience with me, please do email me rose@riohealth.co.uk   We occasionally have Ambassador articles in the IHCAN magazine and someone who has used our products with an MCAS client to good effect who would like to write such an article should contact me.

Is there any functional testing you can carry out to test someone’s histamine levels?

I am sorry.  I am not up-to-date with the functional testing available since I don’t work directly with clients.  I am sure there are tests to determine if DAO is deficient.

If any practitioner would like to share information about histamine testing with me, I would be happy to share this with practitioners.

Thoughts on CoQ-10?

Interesting question.  During my research, I did not find any specific information to indicate CoQ-10 would be advantageous or disadvantageous in MCAS, histamine intolerance or systemic mastocytosis. 

As an antioxidant, CoQ-10 may be useful alongside use of quercetin (see above), but I think Vitamin C holds first position here as Vitamin C has synergism with quercetin. 

Since many MCAS clients are likely to be older in age, they may benefit from CoQ-10 for age reasons.

[1] Zierau, Zenclussen, Jensen (2012) Role of female sex hormones, estradiol and progesterone, in mast cell behavior.  Front Immunol 3: DOI=10.3389/fimmu.2012.00169