Talk:Histamine intolerance

Official diagnosis
I removed the word "medical", to address the concerns raised by https://en.wikipedia.org/w/index.php?title=Histamine_intolerance&diff=1189976734&oldid=1189331673 -- the sources are indeed low quality, still they satisfy formally the criteria of WP:MEDMOS, whereas the edit I mentioned is not backed up by a source that is more reliable than we already have in this article.

An editor who declared themself a practical allergist mentioned that there is no such official diagnosis. Still, the article didn't mention it as a diagnosis. There were "medical condition", and I removed it to simply "condition" to address the issue raised. Still, a practical allergist may not know about histamine intolerance since histamine intolerance is not an allergy.

Here are the main differences between allergy and histamine intolerance: an allergy is an immune system response that occurs when the body mistakenly identifies a harmless substance (such as a food protein) as a threat and produces IgE antibodies to fight it. This triggers the release of histamine and other inflammatory mediators, which cause symptoms such as rash, hives, swelling, wheezing, and anaphylaxis; whereas histamine intolerance is not an allergic reaction, but a metabolic disorder that occurs when the body cannot break down histamine properly due to low activity of the enzymes DAO (diamine oxidase) and HNMT (histamine N-methyltransferase), this causes excess histamine to accumulate in the body, which can mimic the symptoms of an allergy or cause other issues such as headache, fatigue, nausea, and digestive problems, but people with histamine intolerance usually have mildly elevated histamine and lower DAO serum activity compared to control subjects.

The main difference between an allergy and a histamine intolerance is the mechanism of histamine production and the severity of the symptoms. In an allergy, histamine is produced by the immune system in response to a specific trigger, while in a histamine intolerance, histamine is produced by the ingestion or release of histamine-rich foods or substances, or by the activation of mast cells (immune cells that store histamine) due to consumption of so-called histamine liberators, but is overall poorly understood, factors may be as different as stress, infection, or inflammation, still, this can be confirmed by low DAO activity and mildly elevated serum histamine. The symptoms of an allergy are usually more acute and potentially life-threatening, while the symptoms of a histamine intolerance are more chronic and mild to moderate.

The diagnosis of an allergy and a histamine intolerance is also different. An allergy can be diagnosed by skin tests or blood tests that measure the level of IgE antibodies to a specific allergen, while a histamine intolerance can be diagnosed by serum tests that measure the level of histamine and DAO activity, or by an elimination diet that excludes high-histamine foods and observes the improvement of symptoms in about 3 months.

The treatment of an allergy and a histamine intolerance also varies. An allergy can be treated by avoiding the allergen, using antihistamines or corticosteroids to reduce the inflammation, or undergoing immunotherapy to desensitize the immune system to the allergen. A histamine intolerance can be treated by reducing the intake of high-histamine foods and foods that are histamine liberators and foods that block DAO and HNMT enzymes, or addressing the underlying causes of mast cell activation or enzyme deficiency, however, it is still poorly understood how to fix underlying causes, so the diet is the surest thing.

Histamine intolerance is not an official diagnosis, but a term used to describe a condition that affects about 1% of the population. A practical allergist may not be familiar with histamine intolerance, since it is not an allergic reaction and does not involve IgE antibodies and is diagnosed not as easy as allergy. Whereas some people may have both allergies and histamine intolerance, which can worsen their symptoms, but this is usually rare. In most cases, people with histamine intolerance do not have allergy.

Whereas the diagnosis of allergy is easy, the diagnosis of histamine intolerance is hard, and is based on medical history, symptoms, and response to diet with low histamine, and that avoids histamine liberators and DAO and HNMT blockers.

There are no standardized tests to diagnose histamine intolerance, but some methods that may help suggest histamine intolerance are histamine serum levels (low diagnostic value), DAO activity measurement in the blood ((low diagnostic value), histamine 50 prick test or histamine provocation testing with a histamine solution, still the best diagnostic tool is the omission test for 3 months histamine-friendly diet (low histamine, no liberators or DAO or HNMT blockers). There are also genetic testing for variants with lower histamine degradation capacity (DAO & HNMT polymorphisms), but they also have low diagnostic value.

Still, a practical allergist has the same rights and obligations as any other person when it comes to editing Wikipedia, therefore, has to follow the same rules, and any claim should be backed by a reliable reference, which was not the case in the edit https://en.wikipedia.org/w/index.php?title=Histamine_intolerance&diff=1189976734&oldid=1189331673 Maxim Masiutin (talk) 21:28, 2 January 2024 (UTC)


 * I updated the article based on on clinical practice guidelines published by German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergology and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA) as well as the Swiss Society for Allergology and Immunology (SGAI) and the Austrian Society for Allergology and Immunology (ÖGAI). Maxim Masiutin (talk) 20:43, 23 February 2024 (UTC)

Advice on rebuttal article
Hello, User:Tom (LT), User:Bon courage, User:Mvolz, User:Boghog, User:Whywhenwhohow, User:Zefr, User:WikiLinuz, User:Iztwoz!

Please help.

I wanted to write an article on histamine intolerance but didn’t find suitable sources. Most of the sources were in MDPI, that worried me. I then found a clinical practice guideline that explains that there is no such thing in the medical science as histamine intolerance, and gives explanations for that. Still, the term “histamine intolerance” is very popular; many books are published on that, especially in German, and many articles in journals such as MDPI. Some authors of those MDPI articles share the point of view of the clinical practice guideline I mentioned.

How should we write articles like that? I think it would not be good if we just delete the information and/or the page because it will create an information vacuum and may be a cause of misinformation; it is better to rebut this misinformation with the encyclopedia.

How should we behave in such cases when we wish to make a "rebuttal" article? I tried to create such an article, but I’m not sure that it is the correct approach. Please suggest. Maxim Masiutin (talk) 04:23, 26 February 2024 (UTC)


 * Looks like Histamine intolerance needs some work! Bon courage (talk) 07:37, 26 February 2024 (UTC)
 * Copy that. There is a good page on Web MD which is an acceptable source. (Google hits give over 6 million) --Iztwoz (talk) 09:05, 26 February 2024 (UTC)


 * Think I misunderstood your request - imo a separate rebuttal article is not warranted - perhaps another section on Challenges (to perceived condition) may be more suitable.--Iztwoz (talk) 11:11, 26 February 2024 (UTC)
 * I thought that histamine intolerance can be classified as pseudoscientific diagnosis, similar to "adrenal fatigue", so that it can be attributed to the category "List of diagnoses characterized as pseudoscience", but I didn't find any reliable source that could attribute the term "histamine intolerance" to "pseudoscience". The reliable sources that I found (Gernal clinical practice guidelines) admit that the symptoms typically attributed to the term "histamine intolerance" indeed are manifested in connection to consumed food, suggesting food sensitivity, but they prefer the term "adverse reactions to ingested histamine" rather than "histamine intolerance", however, in my view, apart from techinical differences between the two terms, they are synonyms. Maxim Masiutin (talk) 13:55, 26 February 2024 (UTC)
 * What URL exactly on webmd.com do you mean? I didn't use webmd.com as a source because they made health claims but do not disclose sources, unlike the review articles in MDPI, which give sources for their claims. Therefore, I could not use webmd.com as a source. I now visited the following pages:
 * https://www.webmd.com/allergies/what-to-know-about-diamine-oxidase-histamine-intolerance
 * https://www.webmd.com/diet/foods-high-in-histamine
 * https://www.webmd.com/skin-problems-and-treatments/csu-low-histamine-diet
 * Still, my undestanding that these pages do not fit the criteria of WP:MEDRS because they cannot be classified as secondary sources, they don't give references to the studies to back up their claims as I wrote earlier.
 * Besides that, they don't give any addition information to that already found in MDPI publications. Maxim Masiutin (talk) 14:02, 26 February 2024 (UTC)
 * I kept the top banner about fringe theories, but removed the because the article is not based on primary sources. It refers to some reviews from MDPI which are secondary sources in peer-reviewed journals that are not considered predatory sources and fit WP:MEDRS, however, these reviews are only used to show a point of view rather than to make health claims; the health claims are only made based on German, Austrian and Swiss clinical practice guidelines. Therefore, I think that the article is properly sourced. Maxim Masiutin (talk) 14:07, 26 February 2024 (UTC)
 * I wrote in the article that (quote): "Histamine intolerance is a presumed set of adverse reactions such as flush, itching and rhinitis, to ingested histamine in food. The mainstream theory accepts that there may exist adverse reactions to ingested histamine, but does not recognize histamine intolerance as a separate condition that can be diagnosed". I also added the article to the category "Fringe theories" that include mostly nonmedical theories but also has at least one medical: Aspartame controversy. Maxim Masiutin (talk) 14:22, 26 February 2024 (UTC)
 * Would such classification be OK? Maxim Masiutin (talk) 14:22, 26 February 2024 (UTC)

I hope the article now gives proper weight to the mainstream view and explaining the responses to the fringe theories adequately
@Femke, I tried to write an article to explain the responses to the fringe theories as there are many books published on Histamine intolerance, especially in German-speaking countries. Many people as a result thought that histamine intolerance is real. However, the clinical practice guidelines explain that there are no analysis, food or symptoms that could reliably identify this supposed condition (histamine intolerance). Therefore, I tried to write an article where I explained that the theory of "histamine intolerance" doe not have scientific grounds. Before I completed the work on the article, the editor @Bon courage put a banner about fringe theories, but I think that I addressed these concerns and the article should be good enough now. "Histamine intolerance" is not a pseudoscientific theory, it is not a fake or pseudoscence. To a certain extent, histamine intolerance probably exists, but the current state of medicine cannot reliably identify the root causes, so the current guidelines prefer the term "adverse reactions to ingested histamine", still, they prefer to call these adverse reactions a set of conditions, this set is not a fixed set, still, it is not a diagnoses, but they acknowledge that such adverse reactions may indeed exists, however, they are not probably especially related to histamine - the clinical practice guidelines have no clue yet.

Is the article now OK and may I remove now the banner? @Femke, @Bon courage and all other editors - what do you think on this article? How can I improve it? What should I add to this article to be GA compliant? Maxim Masiutin (talk) 18:30, 10 March 2024 (UTC)