MC and Histamine

[Joefnh]

As I have been getting my life back from MC and Crohns I have been dealing with an increase in my long time foe of environmental allergies. In comparing notes with Gabes it seems we both are affected in a similar ways including GI symptoms, increased gastric acid, nausea, headache and fatigue.

I have come to wonder how is it that now that we are 100% GF,DF and SF. We have identified our reactive foods even through MRT testing, yet we still have some symptoms. So the question is what else is contributing to these symptoms that we may have been attributing to MC.

What started this was some research I began after taking with Gabes about how well she tolerated both the local anasthetics used in dental work and anasthetics used during a colonoscopy. In both cases Gabes had significantly exacerbated MC and other systemic affects from the administration of those compounds, a rare reaction

In particular the intolerance to the local anasthetics is quite rare and is a possible indicator of eithier histamine intolerance or a mast cell reaction. Similar to Gabes, I have noticed that I do not tolerate some of the narcotic based pain medications used after surgery particularly morphine which was given to me during the last 2 surgeries.

In both of our cases we have noted that these medication intolerances and general allergy symptoms have gotten worse after we had gained control of MC through diet alone and in my case diet and meds. This seemed strange as we have been eliminating our problem foods and it would seem we would have less allergy symptoms. In one of our conversations we have wondered if this is a similar or related pattern, that several members here have reported as additional food intolerances that seem to crop up one after another over time. It was this thought that launched this bit of research

After a great deal of research I have come to a possible conclusion that the affects of elevated levels of histamine and/or an intolerance to histamine most likely exacerbates the GI symtoms we have with MC.


This article from the American Journal of Clinical Nutrition presented one of the best papers on this topic.

http://www.ajcn.org/content/85/5/1185.full

Histamine and headache
Headache can be induced dose-dependently by histamine in healthy persons as well as in patients with migraine (53, 61). Histamine-induced headache is a vascular headache caused mainly by nitrate monoxidase 

Histamine and gastrointestinum
Besides headache, gastrointestinal ailments including diffuse stomach ache, colic, flatulence, and diarrhea are leading symptoms of histamine intolerance. Elevated histamine concentrations and diminished DAO activities have been shown for various inflammatory and neoplastic diseases such as Crohn disease (17), ulcerative colitis (67), allergic enteropathy (39), food allergy (33, 68, 69), and colorectal neoplasmas (24). In the colonic mucosa of patients with food allergy, a concomitant reduced HNMT (70) and an impaired total histamine degradation capacity (THDC) (69) have been found (33), so that the enzymes cannot compensate each other. Therefore, an impaired histamine metabolism has been suggested to play a role in the pathogenesis of these diseases.

Within the full text link you can select from above there is a good summary of the medications which seem to play a role in the release of histamine that potentially causes the GI symptoms listed above

TABLE 5 Drugs releasing histamine or inhibiting diamine oxidase

Substance class Agent interfering with the histamine metabolism

Contrast media: Pancuronium, alcuronium, D-tubocurarine

Muscle relaxants : Thiopental

Narcotics
Analgetics: Morphine, pethidine, nonsteroidal antiinflammatory drugs,
acetylsalicylic acid, metamizole

Local anesthetics: Prilocaine

Antihypotonics: Dobutamine

Antihypertensive drugs: Verapamil, alprenolol,

Antiarrhythmics: Propafenone

Diuretics: Amiloride

Drugs influencing gut motility: Metoclopramide

Antibiotics: Cefuroxime, cefotiam, isoniazid, pentamidin, clavulanic acid, choroquine

Mucolytics: Acetylcysteine, ambroxol
Broncholytics: Aminophylline
H2-receptor antagonists: Cimetidine
Cytostatics: Cyclophosphamide
Antidepressants: Amitriptyline

As far as personal experience, I have found that I cannot tolerate morphine or amitriptyline. Prior to my diagnosis of MC and Crohns I was put on Elavil (amitriptyline) to help deal with cramps and muscle & joint pains that I now realize was most likely gluten and other dietary intolerances. I did note that the Elavil did make my cramps actually worse and caused an increase in mucosal production in my sinuses. Here Gabes also has had a reaction to the use of prilocaine as a local anasthetic during dental work.

The effects of histamine on our bodies is far reaching and does have several of the same features that are noted with IBDs including MC which include cramping, D, meteorism and nausea. In relation to the same article listed above, here is a good chart which shows the affects H1,H2,H3 or H4 histamine release has and their related symptoms.



So whether it is due to mast cell disease or a more general release of histamine, overall it does seem that histamine plays a key role in our symptoms of which many are the same in both MC or high levels of histamine.

As a part of this research Gabes and I have been performing a trial of antihistamine therapy for the past week, and have had some surprising results. For the trial we both have been taking 10mg of Claritin (Loratedine) in the AM and between 12 to 25 mg of Benadryl (diphenhydramine) at night.

After about the fourth day I have noticed significantly improved stool formation (all normans), vastly improved energy, clearer mind (less brain fog) and overall a better sense of just feeling well. I thought I was doing pretty well before this especially compared to how I was doing when MC first really kicked in, but I can see now that there was still room for improvement. Gabes also has begun to see improvements in some of her symptoms, I'll let her update her progress as she has a differrent list of symptoms that she deals with that is also strikingly similar to the chart shown above.

I'm hoping Tex can weigh in here on this.... I have a theory that in systemic and chronic histamine release, increased mucosal production is seen throughout the mucosal membranes which include the GI tract. Is it possible that a chronic release of mucous, or the chronic presence of histamine in the GI tissues to result in the buildup of lymphocytes in the mucosal layers of the tissues that make up the GI tract?

I will be continuing to look into this topic, but can't help to wonder if for many of us if histamine is playing an aggravating role in MC, complicating our symptoms and potentially playing a role in the development of new food intolerances. As a thought is this why the MRT testing and related avoidance of the highly reactive foods is so successful in some of us? While I'm not sure of this the MRT testing is based on (IgE ?) level testing which is generally used for determining allergic reactions, an avoidance of the highly reactive foods would lower the histamine levels we experince daily.


Joe

[nancyl]

Joe,
If I understand this correctly then it does seem possible that treatments such as N.A.E.T. by a certified acupuncturist can help. I am just completing the series of treatments and do think that it has helped quite a bit. Tomorrow should be my last treatment, but I will continue to see her once a month just for maintenence with a non-specific acupuncture treatment.

Nancy

[Joefnh]

Hi Nancy that would seem to be the case, as the NAET treatments are targeted at allergies (IgE mediated) and it would stand to reason that the treatment as it allows you to tolerate a food you previously did not tolerate would reduce the release of histamine.

I know this is an interesting link to make between allergic reactions and MC symptoms, but I think a good way to think of it is that the symptoms of MC and other IBDs do overlap with the symptoms of higher levels of histamine. This would make it confusing as to what the cause of a particular symptom is.

Since there is this level of overlap and potentially interdependence, I believe it would be prudent to consider allergies whether they are food based or environmentally based to be a possible or contributing cause to our overall symtoms lists.

Let's remember that an allergic reaction is hypersensitive immune system repsonse

http://en.wikipedia.org/wiki/Allergy

An allergy is a hypersensitivity disorder of the immune system.[1] Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid. Allergy is one of four forms of hypersensitivity and is formally called type I (or immediate) hypersensitivity. Allergic reactions are distinctive because of excessive activation of certain white blood cells called mast cells and basophils by a type of antibody called Immunoglobulin E (IgE). This reaction results in an inflammatory response which can range from uncomfortable to dangerous.

Something like NAET should be viewed as a good potential treatment to not only allow for the safe consumption of a previously intolerated food but to also potentially reducing the levels of histamine in our systems.

Good observation Nancy

Joe

[tex]

Joe,

I don't have time to look up any old threads, right now, but we've discussed this in the past. In a sense, it's connected with mastocytic enterocolitis, (though not necessarily by the same mechanism).

I've posted several times in the past, how my common life-long "nuisance" allergies disappeared while I was reacting with MC symptoms, and after being in remission long enough to reach a significant stage of healing, my classic allergy symptoms began to return, and not only did they return, but they returned with sensitivities to "new" allergens.

For example, previously, I was never sensitive to tree pollen in the spring, but I had hay fever in the fall, due to ragweed. Molds never bothered me, before MC. Now, I've picked up an additional sensitivity to tree pollen in the spring, molds, (year round), and cedar pollen in the winter. I blame it on my theory of the immune system being unable to properly address more than one major issue at a time. Do you recall what I've posted about that? IOW, the inference here is that the "nuisance" allergies are the last in line in the hierarchy of issues that confront the immune system, (gluten is the first, and most potent "allergen"), and consequently, as we achieve remission from our MC issues, and our gut heals, we should expect that our old histamine-based allergies will return, and probably stronger than ever, (at least that's what my theory implies).

Tex

[DebE13]

How does one know if histamine is an issue? Through a test or trial and error with various symptoms? This is new to me and I am very interested because I continue to have eye pain, sinus stuffiness,and a frequent runny nose in spite of eliminating gluten and dairy along with eggs & soy most recently.

[Deb]

I'm not very knowledgeable about the histamine issues but here goes. I had terrible allergies in my teens and early 20's (pets, dust, trees, ragweed, mold, and a few food allergies, etc). I had 5 years of allergy shots and my symptoms improved tremendously. I currently have very few issues. I do still have a nickel allergy and maybe latex or rubber.
I've been in remission from MC for about a year and my allergies haven't gotten worse.....at least yet.

[Joefnh]

Tex I must have missed those posts, thanks for reminding me of those. When I first came to this site it was like drinking from a fire hose at times...it would not surprise me that I missed them.

It is interesting that as we progress in treating MC that we can have a increase and change in our allergies. That certainly says something about the immune systems reaction and the role that histamine can play. Thanks for pointing that out Tex.

Deb, like you as a youngster I had lots of environmental allergies, dust, mold, pollens etc... I had allergy shots for years and things did improve. Now that I'm approaching year #2 with MC I am finding my allergies really starting back up.

Overall I am finding that the trial with claratin and Benadryl has had very positive effects on digestion, brain fog and overall well being.

Joe

[mbeezie]

Joe,

I've long theorized a conneciton between MC and mast cells. Here are a few previosu threads.

http://www.perskyfarms.com/phpBB2/viewt ... mast+cells

http://www.perskyfarms.com/phpBB2/viewt ... mast+cells

http://www.perskyfarms.com/phpBB2/viewt ... mast+cells

MRT captures many inflammatory mediators but not IgE (that's what RAST/ELISA tests do). The symptoms of IgE alleriges and mast cell disease are the same but the mechanism is different. You must impose histamine restricitons on top of MRT results as many foods either contain histamine or liberate histamine from cells, and this is something MRT would not pick up.

www.tmsforacure.org lists common symptoms of mast cell disease and you will find a complete list of medications to avoid. Once you dive into the mast cell literature you will see many similarities between MC and mast cell disease. Histamine is the most notable and troublesome mediator released from mast cells, but there are many, many more - they can also cause symtoms.

Glad to hear the H1 blockers are providing some relief. Since this is working I would also suggest a low histamine diet.

Take care,

Mary Beth

[tex]

Deb,

I didn't note the exact time when my allergies returned, (because I thought that I was home free, after so many years clear of them, and they returned gradually, at first), but as best I recall, it was roughly 3 or 4 years after I initially achieved remission, before they became a significant problem again, which sort of correlates with my healing time, (because a fecal fat test showed that I still showed some small intestinal damage almost 3 years after starting the GF diet).

Your allergy shots may have resolved the problem permanently, though, if they worked properly. Time will tell, I suppose.

Tex

[tex]

Joe,

Those posts about my allergy issues were probably were made before you joined. I'll see if I can find any of them.

Here's the first - almost 6 years ago. This one was made before my allergies began to return. At this point, I thought that the diet had resolved my allergies. silly me

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=3204

Here is a post made when my allergies began to seriously act up again. This pinpoints the time accurately, because this was 4 years, and about 2 and a half months after I initially achieved remission, (5 years and 7 and a half months after I started the GF diet). Note that in a subsequent post in that thread, Polly, (and my reasoning), convinced me that I had the problem because it was just a particularly bad pollen year. Unfortunately, though, I've reacted every year since then, so apparently it wasn't temporary.

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=7424

Then, 2 years later, I posted this, after discovering that folic acid does seem to attenuate the symptoms.

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=11489

And about 15 months later, I posted this:

http://www.perskyfarms.com/phpBB2/viewtopic.php?t=14208

The good news is that if your allergies are becoming significant problems again, that implies that your Crohn's and MC are under control, and most of the damage to your intestines has probably healed. (There's always a silver lining for every cloud.)

Tex

[Joefnh]

Thanks for that Tex and MB thanks for the links as well.

That is good news Tex... You mentioned that my intestines are mostly healed..or in my case simply removed LOL... I would imagine that with the meds and diet now for a year that things should be healed somewhat.

I was talking with Gabes again about the colonoscopy report that she recieved a copy of and we compared some of the comments including the pathologist mentioning the following areas of note.

Gabes report:

Decrease in goblet cell mucin
Increase in mitotic figures
Slight increase in mast cells


My Report (excluding notes about Crohns)

Marked decrease in goblet cell mucin with luminal interspersion
increase in mast cell counts (compared to previous - inferred)
collagen band thickness 22um (down from 74um originally)


A question here Tex or Mary Beth would be, would a modest increase in the mast cell counts or the decrease in goblet cell mucin be an issue with ongoing perceived histamine issues or MC like symptomology.


Joe

[tex]

IMO, the decrease in globlet cell mucin is simply an indication of reduced inflammation, (less mucus is needed, so less mucin is produced). An increase in mitotic figures implies an increased rate of cell division, which I would assume refers to a faster rate of healing.

I can only make a guess at the cause of an increase in the mast cell count. For all I know, that may be a natural response by the immune system, after all of the more serious threats have been vanquished, and the immune system is simply trying to reestablish homeostasis, (IOW, maybe it's just restoring the mast cell count to it's former level). By "former level", I mean the level before your MC symptoms began, not the level seen with the previous colonoscopy.

This would also be in line with my theory about the existence of an immune system hierarchy, by which all threats are sequentially ranked, so to speak. IOW, with T-cell inflammation under control, (or under better control), other immune system components are likely to be positioned according to either current needs, or a "normal" default arrangement.

Did your reports show actual mast cell counts? IOW, are they above normal levels now, or simply higher than they were at the time of the previous colonoscopy? If you had an elevated mast cell count, prior to the advent of your MC, then your immune system may be in the process of restoring that level.

While your collagen band thickness is still more than twice the allowable limit, (for a normal histology finding), that's probably due to a time lag, rather than due to ongoing inflammation. IOW, it takes time for the body to reabsorb the extra collagen.

Those are just my unprofessional thoughts, though, and obviously I could be all wet.

Tex

[Gloria]

Interesting discussion, Joe. I, too suspect that mast cells and histamine issues are playing a large part in our MC symptoms. It seems that for some of us, MC subsides and the histamine issues take over.

Probably the easiest way to determine if there is a histamine problem is to take an antihistamine to see if it helps, and also minimize or eliminate high-histamine foods. That said, I didn't see any improvement using Claritin or Zyrtec, but did with Benadryl. I'd be interested in hearing if others noticed improvement using any antihistamines or only using certain brands.

Did you see my recent post about Benadryl:

I was reading a mast cell website post on Ketofin vs. gastrocrom: http://mastcelldisorders.lefora.com/201 ... astrocrom/ Someone made this comment:
Quote:
"I would also say to be careful of using Benadryl every day too--Benadryl effects an enzyme that allows mast cells to degrade faster. Benadryl is a great med--used as a rescue drug, not every day. I would use another antihistamine to replace it."

Has anyone seen research to back up this statement?

Gloria

[Gabes-Apg]

Gloria
it was your post about your success with the benadryl that prompted the conversation between Joe and I that sent him into a researching frenzy...
(a heartfelt thanks )

Since September last year, just as I cautiously celebrated MC being 'in remission' i started to have a gaggle of new symptoms like Tachycardia, high bp, edema and kidney issues, and the 'MC/Gabes usuals' started again joint aches, fatigue, foggy brain, gas, GERD, headaches, nausea, vomitting, swollen tongue, swollen gums, and they would be quite bad for 24-48 hours after any type of anthestic
No drastic changes with the BM's and no D.
Numerous tests could not ascertain a definate cause, they only confirmed that there was 'nothing structural causing it'. By December the gaggle of symptoms was taking its toll (physically, emotionally and financially) it was like i was having chronic MC reactions without the D. on the hot and humid days my feet were so swollen i could not wear shoes.

i started the daily Claratine (USA:Claritin Loratedine) last week, and within a few days there was a slight improvement on some of the symptoms.
Benadryl as 25mg of diphenhydramine is not available in Aus albeit, there is a 50mg variant sold as a sleeping tablet, i started having 12mg last friday night, the first 24 hours were a bit dodgy, in another thread, where i talked about C and D, and my scientific approach to my digestion, i know for sure my body does not like any change to the chemistry of any sort, any change either deletion or addition causes issues.

I have my fingers and toes crossed that this is the answer and i just have to figure out the treatment(s) that works for me.
Like when we get the MC Dx, we find this board, we read what others have been through, and the relief we feel to know that we are not alone and we are not going insane. As joe shared his findings with me last week, and we discussed it, it was a huge relief to have a credible answer not only for me, but for people like Gloria who seem to never escape the maze of chronic reactions or why when we think we have got MC management figured out, things change.

I will keep you posted on progress.

[mbeezie]

Hi Gabes,

You certainly sound like you have some mast cell symptoms.

i know for sure my body does not like any change to the chemistry of any sort, any change either deletion or addition causes issues.

That statement pretty much sums up mast cell activation for me. My body would react to changes (perceived threats by my immune system) with a mast cell overreaction. Everything from medication, food, barometric pressure changes, scents, hormone changes . . . you name it, caused me to have symptoms.

Joe,

The graphic you shared from the Maintz article is what caught my eye a few years ago when faithberry, a former forum member, brought it to my attention. I had every symptom listed on there. When I am in a mast cell flare I go on a strict low histamine diet, take antihistamines and try to get regular exercise, although exercise was a trigger at times.

You can have mast cell/histamine symptoms without having a big increase in mast cell numbers. Often people have normal levels of mast cells that behave badly and dump their contents.

I hope you both find some answers soon.

Mary Beth