Antihistamines for histamine intolerance? yes/no/maybe/sometimes
Using and not using antihistamines to deal with histamine intolerance, with some surprise antihistamines at the end
First: Welcome to the several new subscribers I’ve gotten recently. I have no idea where you came from, but I hope you are finding some answers or feeling well-accompanied here.
Dude. I have tried. I have tried eating only rice and almonds and eggs and olive oil and salt and broccoli and it made me strangely slender and exhausted and always starving. But this is not life. Over time (as you have read) I have expanded my choices. There are some foods I’m probably never going to be friends with. Looking at you with great sadness, black beans, my favorite of all of the legumes.
First we tried no meds
In my previous missive, I told you all about the supplements and potions I am aware of being available to mere mortals. But how can you wander around with all of these supplements running around your system and still be afraid of eating food? You can’t. I was talking to someone I know with histamine intolerance and you know what she (because most of us are shes) does? She takes antihistamines.
What?
Well, maybe not what? Maybe ohhhhh.
Despite a past bad experience
A long time ago, and forgive me if I have told this story before, I had dermatographism. This is when you can play tic tac toe on your arm and each of the little xs and os, and even the hash sign itself puffs up like a hive. It’s great fun. When I had this, in the way before times, we thought it was an environmental allergy, and my doctor prescribed me Cetirizine, and also Ranitodine (since pulled and generally replaced by Famotidine). Why both, I asked? Well, thing B makes thing A work better, he said. As an aside, this reaction may have been related to overactive mast cells or allergen exposure (I was refinishing furniture at the time, and I am allergic to wood dust, fun fact), but I have not been diagnosed with this so far, but if you have long Covid a) sorry and b) this could be you.
But back to the allergy medicine synergy of thing B making thing A work better. This is not exactly true. First, a little (very little) science. We have 4 different types of histamine receptors, handily named 1-4. There are medications called antagonists (blockers), which will block the receptors ability to well, receive the histamines, and therefore block or mostly block the reaction. Generally speaking, when we talk about antihistamines, we are talking about H1 and H2 blockers. (I don’t know anyone who takes H3 or H4 receptors, and I am not sure why this is).
That Cetirizine? It’s an H1 blocker. That Famotidine? It’s an H2 blocker. So while my doctor may have explained this to me (or I may have remembered this) incorrectly, taking both of these antihistamines at the same time each helped to block two different kind of receptors and worked to ease my crazy skin problems. However, in my particular case, I was then left with rebound itching which happened every time I tried to get off the Cetirizine, and it took me months of the slowest titration ever to finally be free of it. Ask me how, and I’ll tell you. You will need a pill splitter, and the patience of a saint. Months, I tell you.
So since then, I’ve been suspicious of antihistamines, occasionally taking some if my eyes were crazy itchy from environmental allergies, but not thinking of them for histamine intolerance. Until I talked to this hista sista, the one who takes the antihistamines and I thought, well… does this mean I could eat felafel? or maybe some food someone else made? Without the waiting game of will I or won’t I get sick or wandering around half sick and half not sick and being freezing and needing a nap?
I thought I’d give them a try
I did some research, and started cautiously taking antihistamines. First I started with some H1 blockers, and later added in the H2s. I cycled through the different H1s on the market where I live and finally settled on the Cetirizine. What I found was…
It worked. Kinda? I didn’t seem to have as many problems from the occasional splash out (though it’s not like I ever tried aged meat or miso). At the time, I checked with another friend with HI who said I had to take them every day or they wouldn’t work, that you couldn’t take them just sporadically. But it was hard for me to justify taking them every day so that maybe on a given day I could eat some vinegar or a piece of fish that had been cooked 5 hours earlier. I’m just not that much of a planner.
And then I stopped
So I tried the antihistamines for about six months, noticed some improvement but nothing spectacular, and decided to quit them. I accidentally did not titrate down so slowly, but rather stopped them suddenly, because a guest came to stay for a week and I got all confused about my evening routine, and kind of forgot. This time I did not get any rebound reactions except my sleep got all disordered, which to me is related to histamines and I can talk about that sometime, but now is not that time.
So I was on antihistamines and I was off antihistamines. Which was better for me?
For my peace of mind (and because I can control my diet and do not get close to anaphylaxis), I have decided for now not to take daily antihistamines.
And semi-started again
What I have done instead is, exactly what I believed I couldn’t do, which is to take antihistamines if I eat higher histamine foods, and/or if I have a reaction. One of my reactions nowadays in addition to general feelings of unwell and stomach upset is a migraine. I have found that if I don’t take the antihistamines before the food, I can take them to do what feels like preventing a reaction or clearing out my system, and that those, together with a nap, a ton of water and some of the previously-mentioned supplements allow me to get to a baseline that feels like surviving, though I will go back to eating rations for a day or two until I feel really balanced again.
I cannot say what exactly the amount of histamines that I can eat and have this work for, it’s all a bit random. But when I got poisoned by surprise secret meat recently, the antihistamines dug me out of that hole much more quickly than time and supplements alone.
And just last night, I took a DAO, made some Pad Thai, which has tamarind which I have not trialed, and soy sauce which I can have in small amounts, and fish sauce which ditto, but too much of either will make my body lose its mind, and I also put some shrimp in, and OMG was I trying to kill myself? And then I took some antihistamines and I slept like a baby, though sometimes my reactions take longer to surface, so I am still on tenterhooks, but also strangely optimistic because it’s been so many hours, and I’m still standing.
So what have we learned?
Some people can help control their HI with diet
Some people can help control their HI with supplements and potions
Some people can help control their HI with antihistamines
You may be all or some of these people on any given day. Use the resources available to you. I am personally not really excited about being on medications unless strictly necessary, but your mileage may vary. Also, I am just one person, and these are my experiences for now. I will continue to sporadically take antihistamines when I deem it necessary unless someone convinces me otherwise. If I could go back to not being terrified of food and having to eat mainly snacks instead of meals while out of the house (see: vacation), well, that would be just delightful.
And now, for more medicines that I don’t take for histamine intolerance, but maybe you will?
A couple of people I know take Singular/Montelukast. This is not a histamine blocker, but a leukotriene blocker. This is related to inflammation as well, and I am not sure how these all play together, but some people with severe environmental allergies or asthma may take this medication. It was offered to me for my asthma, but I went away to think about it and then developed HI and changed my diet and for me personally my asthma stopped being dangerous to my every day life. In fact, I very rarely have even the smallest of reactions, and I have a salbutamol inhaler for if I do, which I never use.
Friends in countries that are not in Chile report very good results with ketitofen, another H1 blocker, which is also a mast cell stabilizer. Unfortunately for me, this medication is only available as eyedrops in Chile, and while they are amazing eyedrops for itchy eyes, they seem to only work locally.
Antihistamines I haven’t mentioned but that you’ve probably taken
If you are like most people from the US, you have probably taken diphenhydramine (Benadryl) at some time, for a bee sting or some other allergic reaction. It’s one of the first generation antihistamines, and it makes you sleepy, which is why most people probably wouldn’t want to have to take it every day. Also people are mad about the dye, but I’m not that informed about that.
Another surprise antihistamine is our friend dimenhydrinate, also known as Dramamine in the US. This anti-seasickness medicine which also makes you tired, also blocks your H1 receptors. How this affects nausea I do not know, but I find this interesting because I am a champion seasickness person, really excelling at this event. One time I went on a five day boat trip and I was land-sick for weeks. Also, one of my main histamine reactions is feeling motion sick. So while I don’t know what the connection is, I’m not surprised that histamines and motion-sickness may be related in some way.
And so ends my tale (for now) about No! Antihistamines. And then Yes! Antihistamines and finally Maybe! Antihistamines. But please, you do you.
Need more intel about which receptors go with which antagonists? Look here (wikipedia link).
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