Eosinophilic Esophagitis and Histamine Intolerance

Did you know that eosinophilic esophagitis is another underlying cause of histamine intolerance to consider?... let's dive in.

Histamines? Check… You’re well aware of what they do, where they come from, and likely even why they cause you such bothersome histamine symptoms. 

What about eosinophils? Maybe you haven’t quite come across that term before… So we’re here to explain a little about these compounds your body releases, and why, most importantly, they can play a role in the symptoms you experience as a result of histamine intolerance. 

First things first: what the heck are eosinophils?

Eosinophils and histamine: a short lesson in immunity

As a result of your body’s incredible ability to fight off invasions, your immune system will release any number of products that are specifically targeted to the type of invasion you may be experiencing. These target compounds are part of a wide range of specific cells that will make up your white blood cells. 

If you have a bacterial infection, for example, you’ll see a high number of the specific white blood cells being produced, called neutrophils. If you were in need of antibodies to be made as a result of an invading virus, you may see more lymphocytes being produced, which are another type of white blood cell.

Eosinophils are yet another form of white blood cell whose formation and release can be triggered by an immune attack. Normally, eosinophils are already circulating in the blood, but in very tiny amounts. So, when there is a spike, which can be picked up in your blood results, it’s a great indicator that something is going on.  

Eosinophils are typically highly associated with invasions of a parasitic nature. They release a compound called major basic protein, which helps to kill off the invading critters, and is very helpful indeed for your immune system response. 

Another, more interesting feature of eosinophils that we are a little more interested in, is that they can recruit histamine producing cells and, in doing so, cause them to release their contents.

 

Histamine-producing and releasing cells, as you know, are mast cells. The research is pretty clear about the connection between them: eosinophils have a very powerful effect on mast cells, recruiting them and causing their stash of histamines to flood into your system (1). 

 

Destabilzed mast cells are a sure-fire way to raise your histamine levels and cause unwanted histamine intolerance symptoms. In fact, one of the most common therapies we use for those with histamine intolerance is to use mast cell stabilizer supplements, so this fact about the role eosinophils play is important to pay attention to.

Histamine intolerance and eosinophilic esophagitis

One of the more common areas of the body that we see being affected by both eosinophils and histamine is in the food pipe, or the esophagus. A condition called eosinophilic esophagitis is when these specific eosinophilic white blood cells build up in the food pipe, and every time you eat food, it can feel like the food is getting stuck there or you may even feel that your chest is tightening up and your throat is closing as a result. 

Some of the causes of eosinophilic esophagitis are acid reflux, food allergies, and anything else that can cause damage to the tissues making up your food pipe. You can see that it’s a case of the chicken or the egg when it comes to food allergies, and we find ourselves asking, is it a food allergy that has caused this or, is  eosinophilic esophagitis the cause of your food allergy? 

We say it can likely be both. 

You may have had a sensitivity to certain compounds in food, and over time, it has progressed to full blown allergic responses and now massive histamine release (2). 

I'm histamine intolerant - should I test for eosinophilic esophagitis?

Testing for eosinophilic esophagitis is a great idea, especially if you’re not responding completely to a low histamine diet or natural antihistamine therapy. If you're unsure if your current diet is suitable for you, please try out our low histamine foods list which also excludes common histamine liberators or mast cell destabilizers, which are foods that may not be high in histamine themselves but can cause histamine release in other ways. You can get a free copy of this foods list by clicking below.

 

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If you feel like you’re doing everything right when it comes to histamine intolerance, but you’re still experiencing significant food allergies, you continue to have breathing difficulties associated with asthma and you are still struggling with your skin it might be time to test for eosinophilic esophagitis. 

In addition to blood tests to determine the number of eosinophils your body is producing, testing would likely also be performed by a gastroenterologist, where they would take a small sample of the tissues in your esophagus and test the cells to determine the white blood cell count and eosinophils located in this area. 

Another area of testing that would be interesting would be in the area of parasites. Because we know that parasites trigger eosinophil release, it may be important to determine if a parasitic infection triggered an influx of eosinophils, and the food allergies compounded their activity.

 

Parasite testing needs to be done through a stool sample, again, something a gastroenterologist can offer, or you can choose to see a Naturopathic Doctor or Nutritional Therapist to order a stool sample kit on your behalf. 

Along with testing, you can begin following or continue to follow a low histamine food plan to reduce the additional mast cell triggers that may be at play.

 

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Also be sure to keep wheat, milk, egg, nuts, soy, fish and shellfish off the menu for at least 6 weeks, as these 6 foods have been shown to have the most impact when it comes to triggers relating to eosinophilic esophagitis symptoms.

The more we dig into histamine intolerance, the more we discover about the possible underlying causes. It’s important to consider these other avenues, especially if you’re not finding success on your healing journey with histamine intolerance alone. 

References: 

1. Piliponsky, A. M., Pickholtz, D., Gleich, G. J., & Levi-Schaffer, F. (1999). Eosinophils Activate Mast Cells to Release Histamine. International Archives of Allergy and Immunology, 118(2-4), 202–203.
2. Merves, J., Chandramouleeswaran, P. M., Benitez, A. J., Muir, A. B., Lee, A. J., Lim, D. M., … Wang, M.-L. (2015). Altered Esophageal Histamine Receptor Expression in Eosinophilic Esophagitis (EoE): Implications on Disease Pathogenesis. PLOS ONE, 10(2), e0114831.