Histamine Levels and Adrenal Fatigue Syndrome – Part 2

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Read Part 1 Now!

Histamine in Food

Histamine levels in fermented foods can worsen adrenal fatigueAnother way that inadvertently increases histamine levels is by eating foods high in histamine. Histamine is usually metabolized in the intestines and liver. However, some individuals may have low levels of the required enzymes to metabolize histamine and thus have increased circulating histamine. Histamine is typically found in foods that have been fermented or highly processed. Fermented cheeses such as cheddar and Gouda are high in histamine. Other dairy products such as yogurt and buttermilk also contain elevated histamine amounts. Salami, pepperoni, sausage, and other processed meats are also high in histamine. Vegetables such as tomatoes, spinach, and eggplant contain increased histamine compared to other vegetables. Berries have been shown to be high in benzoates, which release histamine. Spices such as cinnamon, cloves, and nutmeg also contain benzoate and release histamine when ingested. These are usually not an issue because the body metabolizes them automatically without a problem.

Harmful Effects of Histamine

Excessive histamine can wreck havoc in the body. Starting with the brain, histamine has the ability to inhibit almost every neurotransmitter and is a neurotransmitter in itself. Any unbalance in the chemical makeup of your brain is bound to cause unwanted effects such as brain fog, fatigue, and anxiety. It is also why histamine has been implicated in several major psychiatric disorders. Along with psychiatric disorders, histamine is also involved in the sleeping cycle, mainly stimulating the body to stay awake. This can only worsen the symptoms manifesting in the brain. At the cardiovascular system, with histamine being a vasodilator and opening up the vessels in the body, the heart will have to pump harder and faster to maintain the same blood flow. This can lead to tachycardia, heart palpitations and low blood pressure. Heart palpitations combined with increased anxiety can often lead to panic attacks too. Unchecked histamine can also lead to increased gastric acid secretions in the gut, contributing to irritable bowel syndrome and gastric ulcers.

On top of all these conditions, histamine actively plays a role in inflammation and the allergic reaction, having high histamine levels in your body is similar to being in a chronic inflammatory or allergic state. One can experience itching, nasal congestion, asthma, red eyes, hives, and even angioedema. These symptoms are largely modulated by the adrenal glands. We will go into these in more detail later.

Histamine Levels and Adrenal Fatigue

Elevated Histamine Levels and adrenal fatigueElevated histamine levels do not bode well for the adrenal glands. Histamine is an inflammatory molecule. Cortisol, released by the adrenal glands, is an anti-inflammatory compound. One can imagine the contrasting battle these two molecules go through on a daily basis. Any unnecessary rise in histamine levels only serves to burden the adrenal glands. Adrenal Fatigue Syndrome (AFS), especially those in advanced stages, invariably are overloaded with histamine internally without sufficient cortisol to counter its effect. It comes as no surprise that many are in a generalized inflammatory state with many nonspecific but bothersome symptoms of discomfort.

As a result of inflammation, many suffer from migrating pain of unknown origin, especially in the muscles and joints. There is no deformity in the joints, and the discomfort can come and go at will without a set pattern. Doctors are usually at a loss after a normal blood test without significant signs of autoimmune disease. Pain medications are usually prescribed but seldom necessary as the discomfort is generally nagging in nature and not very severe.

Sometimes pain can be in the lower back area surrounding the kidneys. There is no significant physical finding. Visits to family doctors are made and bladder and urinary track infection workups are usually negative. Abdominal CT scans are normal. Many will report a dull ache or a sensation of feeling heat in the adrenal glands area that is worsened under stress or when energy levels are low, or when certain type of food are consumed. There is no specific point of tenderness on palpation. The sufferer is usually told that it is all in their head.

Food sensitivity is common when histamine levels rise beyond what the body can handle. Intake of watermelon, for example, can lead to skin itchiness in distant parts of the body such as the ear lobes. Dairy products can lead to excessive nasal drip that can be postnasal in nature. Sufferers generally report a sense of congestion during the day, and wake up in the morning with a cough. Headaches of unknown origin, excessive bloating, and stomach pain are all common presentations.

Histamine levels and a runny noseIncreased sensitivity to seasonal allergens is also a common finding. Due to intrinsic high histamine levels within, the threshold for external allergens to trigger inflammation is reduced, especially from pollen and grass during the spring. Most sufferers of AFS will find themselves highly sensitive to such external allergens in addition to heat intolerance when outdoors. Runny nose, sense of itchiness at the throat, and sniffling are common presenting complaints. Steroidal nasal sprays and anti-histamine medications are prescribed frequently for what appears to be classic signs of allergic rhinitis. Without understanding the root cause and trigger, this medication only acts to reduce symptoms and bring temporary relief. With prolonged use, tolerance and dependency develop. Those with marginal or mild adrenal fatigue will find their condition worsens over time, as the adrenals will slow down production of steroids due to the ample external supply as the feedback loop is disrupted. Withdrawal and rebound symptoms may arise if the medications are stopped abruptly.


Reducing internal histamine load should be part of a total recovery program in AFS. The key is to first recognize that histamine does play an important role in worsening adrenal fatigue. The astute clinician should be on alert for symptoms mentioned above as clues for further investigation. Normal laboratory finds are actually supportive of the investigative process. The key rests with a detailed history conducted carefully by an experienced clinician. Nature has provided us with a battery of compounds with antihistamine effects. They are best used in a nutritional cocktail for optimal results.

Read Part 1 Now!

© Copyright 2015 Michael Lam, M.D. All Rights Reserved.

Histamine Levels

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  • Kim says:

    I see that I have been consuming a lot of foods that trigger histamine, such as watermelon, cheese, yogurt, fermented veggies and not sure what else!

  • Missy says:

    I have allergies and chronic fatigue which have been getting worse over the last 10yrs. I started out only needing a steroid nasal spray, to needing loratadine daily and now I’m on fexofenadine in increasing dosages just to be able to leave my air filtered room. I’ve had two several month long rounds of steroids in the last year because my allergies couldn’t be controlled. What I’ve read here makes sense because I keep taking stronger medication just to bring my allergies back to a baseline. I’m scared about my body stepping it up anymore and want to stop the cycle, but don’t know where to start with reducing my antihistamines. I don’t have much money and supplements and unprocessed food are very expensive in the UK.

    • Dr.Lam says:

      titrating off steriod is complex and not a simple task. talk to your doctor about a graduated plan. supporting your adrenals can help that process provided you do it right. Click Stimulants and Adrenal Fatigue for more information.

  • JANET says:

    My 5 year old daughter underwent allergy tests via blood samples and the results were an extreme allergy to dust mites and dog hair. Her scores were off the charts. She potentially has asthma as well. She has been put on an anti-histamine and flixotide asthma pump (one puff morning/one puff evening). Her teachers have reported though that she is constantly tired at school and loses concentration easily. Please advise if possible. Thank you.

    • Dr.Lam says:

      Long term medication can make things worse. It is best to support the body’s self-healing process naturally.

      Dr. Lam

  • chris says:

    If antihistamine meds prevent the binding of histamine to mast cells there by reducing symptoms, what happens to the histamine? Is it free floating in an unbound state stimulating all of the things mentioned above? Is it stimulating more cortisol release as well? By the way I thought this was a great, well formulated article. Thanks in advance for an answer

  • Michelle says:

    At the end of this article you state “Nature has provided us with a battery of compounds with antihistamine effects. They are best used in a nutritional cocktail for optimal results.”

    Can you share what these natural compounds are and how they should be taken?

  • Barbara Davis says:

    Hello doctor,
    I wrote you last week about my ideopathic hives which I’ve had for 18 yrs. I have hives every day. The allergist stated it is an autoimmune disease and said I actually need MORE antihistamines-not less. So… he told me to take 3 Allegra and 3 Zantac daily. If I don’t get relief from these H1 and H2 blockers, the next step is cyclosporine.
    He states there is no tachyphylaxis with antihistamines although I sure thought I experienced rebound 1 month ago when I d/c’d Zyrtec and switched to Allegra. My itching was horrendous even with Allegra which to me suggested tachyphylaxis from the Zyrtec. In any event, can you please comment on your experience with autoimmune disease causing hives and if you have had any success with Cyclosporine. Thank you.

    • Dr.Lam says:

      Auto immune disease is a very general term and the hives may nor may not be associated depending on the rest of the body’s reaction. Unfortunately, conventional medicine seldom makes the connection. For example, 10-15% of people with positive auto immune markers are healthy and normal. There is a large variation. Hives is an underlying issue that requires much more history. This can be done by a telephone interview and has to be more interactive than what can be done by an email educational forum like this. Everyone is different. You can call my office for more help if you need.


  • Barbara D says:

    Dear Dr,
    I have had chronic ideopathic hives for 18 years. My daily dose of Zyrtec helps tremendously with the itching although I still receive red welts throughout the day anytime something scratches me (or I try on new clothes.) Recently, I have developed IBS. I decided to switch to Allegra to see if it helped with IBS as I’m not sure of long-term consequences of Zyrtec. I am mediately found that Allegra couldn’t control the intense, burning itching and I needed to take 2 Allegra instead of one to control it. I am now wondering if years ago my hives went away but I didn’t realize it because of the rebound effect of Zyrtec. Thoughts? If so, what can control the itching I still have? I’m still on Allegra although I feel that is compounding the issue. Will Quercetin be a better alternative?

    • Dr.Lam says:

      It is not unusual to rebound. If your situation is severe, you need to seek your doctor’s help to get to the root problem on what is really triggering the hives.

      DR Lam

  • Kylie T says:

    Dear Dr Lam.
    I have been using a sleep aid containing the anti-histamine doxylamine succinate for many years. I suffer from extreme fatigue which I thought was caused by a ‘hangover’ effect of the drug but after reading your article I see that perhaps the fatigue is caused by an increased production of histamine to counter effect the anti-histamine in my system. I have been taking 50mg every night for at least 3 years. I have stopped taking them this week. In your opinion, what would be the expected time frame for the rebound effect to diminish? I am female and 43 years old. Also, can I ask when your article on “Progesterone toxicity” will be published on the site? Thank you for such an awesome website and for taking the time to answer the many questions you receive about your articles.

  • leah says:

    which comes first, histamine, or AFS, we’ve noticed some histamine symptoms with my mother over the past few weeks. but having been a smoker (she quit 25 years ago) and having taken prednisone for 18 months the research I’ve done suggests HPA axis involvement, leading to AFS. this occurred 15-ish year ago with sever weight gain which will not be removed. could the effects of smoking on neurotransmitters and the HPA axis along with the effects of the prednisone on cortisol have instigated AFS and then lead to histamine intolerance. prior to taking the prednisone there was no AFS symptoms, or histamine issues. could one lead to the other or was one always there. thanks for reading

  • Derek says:

    Is it possible for high/unchecked histamine to only cause gastrointestinal symptoms like ulcer, reflux, etc?

  • Derek says:

    Is histamine the reason why studies show ulcers & GERD are more prevalent in the Spring and Fall?

  • Michele McDonald says:

    I do have allergies and I am currently on immunology shots although I still need an over the counter antihistimine. Your articles have helped me understand somethings I have suspected. What is the answer for those of us allergy sufferers? I know that what I feel in my body with the allergies feels like it affects my whole body, it feels systemic in nature

  • Marler says:

    Dr. Lam please comment on the instance of histamines as it correlates to chronic full body itching, present with or without hives. I did not see that specifically mentioned. At first sight, the hives that I suffer from appear to be from dermatographia; and yes occur with the motion of rubbing the skin. However, the itching does not entirely match with the condition. It may be possible that dermatographia is present along with another condition causing the more severe itching, or another condition all together. Normally the itching with dermatographia is associated with the presence of the hives/welts. While I do get the hives, the itching I have is persistent even in the absence of the hives and is full body. My eyelids, fingers, body, etc. you name it and it is itching. Even when I do have the hives the itching is located everywhere, versus just in the location of the hives. The itching never goes away and regular antihistamines are of little help. Please comment on research you have regarding histamines as it correlates to chronic itching/pruritis with the adrenal fatigue. I would love to know if any connection exists and the possibility of treating adrenal fatigue to combat the pruritis. Thanks!

    • Dr.Lam says:

      Dermatolgraphia is an indirect reflection of the amount of histamine and your body’s sensitivity to it. Often times a host of factors are involved, and AFS , for example, can trigger and add to histamine load. Healing AFS often is very helpful to reduce overall histamine load, and that you should look into.

      Dr Lam

  • Hallie says:

    I’ve been taking an antihistamine nightly for 20+ years for allergies. If I want to try stopping it, what’s the best way to avoid rebound issues?

    • Dr.Lam says:

      generally speaking, you go very slow, but everyone is different. you may need some other natuarl compounds as reserve to cushion you . A strong adrenal is very important as it regulates the anti- inflammatoiry system driven by cortisol.

      Dr Lam

  • Maddy says:

    Over 18 months I watched my perfectly healthy child become seriously afflicted by allergy, migraine and hormone imbalances. It started with an itchy mouth from an apple and oh mom I have a headache, intermittent events. Quickly advancing food allergies to all tree fruits, almonds, carrot, cilantro (all things which cross react with birch), as allergies advanced headaches became chronic daily migraine. Anxiety attacks, intermittent insomnia, which I now recognize as histamine storms. Allergist said “nothing in scientific literature linking food allergy to migraine”. Neurologist said basically same. We went on Amitriptyline for migraine, which I later learned was potent anti-histamine, which eventually stopped working, surprise. DAO supplement helping with triggers. Here is my question, before you get to adrenal fatigue state, do you first get to high levels of adrenal hormones? The cortisol a.m. was always either right at the high reference range number, or just above it a point or two; have not had it tested post stopping amitriptyline. DHEA we know has literally doubled though, and it was in normal range before, is that always secreted in lock-step with cortisol? They have antagonistic ying/yang relationship also no? Like histamine/cortisol? Took the meds for around 8 months. What else can we do besides low histamine diet and DAO to keep histamine low?

    • Dr.Lam says:

      Histamin overload is a symptom of underlying problem and you need to focus on the root cause for long term recovery.
      In theory high level of adrenal hormone first surface follow by low. This is not universally true, and a detailed history by someone who really knows will know is far far better than any lab test. DHEA and cortisol has a lock step with cortisol early in AFS progression but will diverge as AFS advances and you have to be very careful not to follow the lab numbers too much without clinical correlation as numbers alone can be very misleading. Reduce inflammation can be helpful. Click 7 Adrenal Fatigue Recovery Mistakes for more information. Click Chronic Inflammation and Adrenal Fatigue for more information.

      Dr Lam

  • Joanne Lepp says:

    Thank you for this article. I have been using the SCD diet and fod-map diet for IBS and extensive food allergies. This spring, I realized I had leaky gut issues with adrenal fatigue. Following shingles, I crashed and saw a NPDR for adrenal issues. After a period of sleeping more restfully, I am very wakeful at night with agitation, restlessness and brain fog. Am recognizing and identifying symptoms of increased histamines. What supplements bind with histamine to remove it from the body?

    • Dr.Lam says:

      quecertin and bromaline in combination are good natural anti-hismaine. the key is dosage, as low dose will not work.

      Dr Lam

  • Brad McBlain says:

    Dr. Lam
    I hadn’t really thought about the “ying and yang” of cortisol and histamine. I have been on 25 mg/day of hydrocortisone for years. There are few foods that I can eat and I keep MCAS at bay with coconut kefir.

    I also have to heavily support they methylation system with methylcobalamin (2 needles daily) and methyl-folate. Do you subscribe to the theory that low methylation predicts high histamine?

    • Dr.Lam says:

      High histamine can be caused by many reasons, including genetic issues, metabolic issues, and feedback loop issues . Being on steriods for a long time can also affect the system. The connection between low methylation and high histamine is very complex. One need to really understand what is going on at the root and find the real cause. Aggressive methylation improves and patches symptoms sometimes at the expense often, but not always , of the underlying program, especially if you are on long term steroid. Lab values as a guide can be very misleading in such cases. Your situation is complex and the answer to your question is actually very convoluted and have many factors involved and not straight forward because the body has multiple regulatory loops in place for histamine.

      Dr Lam

  • Laura Campos says:

    I’ve been on allergy meds & nasal sprays for years….. I’m so dependent I have to use them all yr round. And I’m huge on spinach as I’m trying to get my health back. I obviously don’t know what I’m doing. How can I get started on your program & get tested? My anxiety has gotten so bad I can’t relax at night to be able to fall asleep. I’ve such severe bowel issues.

  • Marilynn says:

    Dr. Lam
    First my thanks for your above-and-beyond commitment to AFS education! Can’t say enough.
    I have AFS. Now that I am ‘educated’ and have your book, as I started my slow crash from likely stage 2 (totally unaware of AFS) into stage 3, in retrospect and looking back now, I did notice my histamine issues getting much worse as I slide downwards. For years (30+), I get a runny nose when I eat….usually within 5-10 mins. I blow it a couple of times and it ‘resolves’ and I continue to eat. It has increased with age. Sometimes, just how it hits me in the nose area, I sneeze 10-15x…then that is over. I’ve never had a rash or anything else to deal with…nor grass or any of that, nor have I taken anything for it. I do have some back nasal congestion all the time too.

    It seems that no matter what I eat I get this reaction and I eat a wide rotation of healthy, non-sugar, non-packaged foods. I don’t know where to start to try and isolate the response and lower my levels, reaction and ultimately improve my adrenal function…as I know histamines are partially in the mix of causing my AFS – which is definitely sympathetic dominance, adrenaline over-drive, high metabolized cortisol and high free cortisol (urine 4 pt test), wired, not sleeping, face flushing, heart pounding type of presentation.

    What approach to isolating food can I do to try to start to find the culprit foods to lower my load? I think I react to about everything the same way that I intake! YIKES. Lately, I’ve been off all dairy (never much of a eater of it), off wheat and all gluten, all sugar – except some fruit. Eat meat and veggies for the most part.
    Thank you so very much for any insight you can bring to my “eating table” LOL.

    • Dr.Lam says:

      Try a rotation diet by not repeating the same family of food for at least four days. And you can eat the same food throughout the day, just don’t repeat these food for the next four days. You can also try a low histamine diet by avoiding foods high in histamine.

  • Alfred says:

    Is it true that heart burn medications such as prilosec are anti-histamines? How does this work?

    • Dr.Lam says:

      antihistamines have been used to help with ulcers and heartburn but have been replaced by the more effective proton pump inhibitors(PPI) due to less cross reactivity with other histamine receptors. histamine acts on parietal cells to increase gastric secretions. inhibiting histamine thus serves to reduce gastric secretions.

  • Terrie says:

    What supplements and nutritional foods do you recommend for antihistamine appropriate treatment…I have adrenal insufficiency and I am not sure what is safe to use… Thank you so much

    • Dr.Lam says:

      Quercetin and bromaline both have anti-histaminic properties that can suppress undesirable symptoms of too much histamine. The long term solution , however, is to reduce reduce inflammatory triggers that lead to histamine release in the first place. This can be complicated when you have adrenal issues as the body’s ability to make cortisol as anti-inflammatory compound can often be compromised. As a result, histaminic responses can be exaggerated and anti-histaminic efforts are often not “strong enough” , so to say. There is no straight answer because the proper approach really have to match the body’s clinical state in real time in a comprehensive way. Many are in fact sensitive to nutritional supplements due to paradoxical reactions by this time.

      Dr Lam

  • Casey says:

    Hi Dr. Lam,

    I started having severe histamine intolerance symptoms after a very stressful family event. I realize that it was likely a result of my adrenal being overtaxed from the stress, as I was bed-bound most of the day every day for a couple of months. I have gotten better over the past 9 months, however I had a set back after starting graduate school this past December and burned myself out. Thus, I am having all the typical AFS symptoms again (although my histamine intolerance isn’t nearly as bad as before, and I’m assuming it’s because I am following a low histamine diet).

    But my question is this: does adrenal fatigue CAUSE histamine intolerance, or vice versa? You didn’t seem to address that in your article and I’d like to know if the histamine issues will disappear when I have healed my body from AFS.

    Thank you!

    • Dr.Lam says:

      Histamine issues tend to improve as AFS recovers, but can easily relapse as the body weakens at any time. Histamine response reflect an inflammatory state underlying the body and is systemic in nature. AFS acts as a trigger to allow inflammation to be rampant as the suppression mechanism start failing.

      Dr Lam

  • mike says:

    I have found that reintroducing tobacco that I quit 4 weeks ago has greatly helped reduce the constant histamine reactions I’ve been having that are causing daily crashes. I know that this is not a good idea. But iis it better to strengthen adrenals before discontinuing tobacco again or continue to allow adrenaline from constant high histamine levels cause daily crashes?

  • mf says:

    I am having constant histamine reactions all day after recent crash. Please tell me how to make them stop. I can’t find the answer in your book. I am constantly crashing because of nonstop reaction.

  • Ivanoka says:

    Can charcoal poultice or wraps help with inflamed joint pain resulting from high histamine levels?

    • Dr.Lam says:

      It can be helfpul, but that is only symptomatic treatment at best. Be aware that charcoal poultrice can also cause constipation. The best is to stop the histamine release at source to toally get rid of the problem. It is a process that requires first a detailed history to identify the source ( and lab test does not help in this ) and then giving the body to proper tools to self heal.

      Dr Lam.