Alcohol, Kava, Mast Cells, DAO, and Histamine Intolerance.
The fact of the day yesterday was regarding mast cells, and how they play a part in the “kava allergy” we sometimes see. Today’s fact will be adding ethanol to the equation which, for some people, seems to lower the threshold for acquiring the allergic type reaction we can sometimes see in individuals that combine them. We also open the door to the possibility of histamine intolerance playing an important part.
Kava has been known to cause a rare allergic type reaction in some individuals. This leads to flushing, itching, and hive formation on the skin. This has been traced back to mast cell activation and the release of heparin and histamine by the action of some component in aqueous kava extracts (traditional kava). It has been found that other aggravators can cause this problem in people sensitive to mast cell activation. This sensitivity is known as MCAS “Mast Cell Activation Syndrome”, or Mastocytosis. This is characterized by the accumulation of excess mast cells in various parts of the body in most diagnoses, however some types of MCAS do not present themselves in this manner. The most common form of this is found in the mast cells of the skin, with rarer forms being found in the digestive tract, bones and other areas of the body. This is quite rare, however people with this syndrome can display dermatographia, a condition known for being able to draw on the skin with a dull pencil or pen only to have that area raise up and turn red as if reacting to an allergen or surface abrasion.
The triggers of mast cell activation can be [1]:
Histamine Intolerance:
Histamine intolerance is not a sensitivity to histamine, but an indication that you’ve developed too much of it [3]. Histamine from foods is naturally broken down in the body by the enzyme called diamine oxidase (DAO). A deficiency of DAO will cause the body to retain an excess amount of histamine and can also cause the allergy type reactions we’ve seen. Alcohol has been seen to reduce the levels of DAO in the body even in healthy individuals. Ethanol was shown to aggressively attack DAO, so even with normal levels of DAO in the body histamine saturation may occur [4]. Going one level further; alcohol and histamine compete for metabolization because they share the common enzymes aldehyde dehydrogenase and aldehyde oxidase. The metabolites of alcohol can effectively compete with the metabolites of histamine. Alcohol in this scenario can both cause mast cells to release their histamine, and prevent the body from removing it at the same time [5]. This amplification of histamine with alcohol through compounding mechanisms combined with the activity at mast cells that kava can provide gives us a better look into a possible cause of this problem.
[1] Symptoms and triggers of mast cell activation. (n.d.). TMS - The Mast Cell Disease Society, Inc. Retrieved March 18, 2021, from https://tmsforacure.org/symptoms/symptoms-and-triggers-of-mast-cell-activation/
[2] Hamilton Matthew, J. Scarlata Kate. (2020). Mast Cell Activation Syndrome – What it Is and Isn’t. NUTRITION ISSUES IN GASTROENTEROLOGY. https://med.virginia.edu/ginutritio...6/Mast-Cell-Activation-Syndrome-June-2020.pdf
[3] Histamine intolerance: Causes, symptoms, and diagnosis. (2018, August 13). Healthline. https://www.healthline.com/health/histamine-intolerance
[4] DAO blocking foods—Deficitdao.org—Official Scientific Society. (n.d.). Deficitda
rg. Retrieved March 18, 2021, from https://www.deficitdao.org/en/dao-d...s-in-histamine-metabolism/dao-blocking-foods/
[5] Zimatkin SM, Anichtchik OV. Alcohol-histamine interactions. Alcohol Alcohol. 1999 Mar-Apr;34(2):141-7. doi: 10.1093/alcalc/34.2.141. PMID: 10344773.
(https://academic.oup.com/alcalc/article/34/2/141/192121)
The fact of the day yesterday was regarding mast cells, and how they play a part in the “kava allergy” we sometimes see. Today’s fact will be adding ethanol to the equation which, for some people, seems to lower the threshold for acquiring the allergic type reaction we can sometimes see in individuals that combine them. We also open the door to the possibility of histamine intolerance playing an important part.
Kava has been known to cause a rare allergic type reaction in some individuals. This leads to flushing, itching, and hive formation on the skin. This has been traced back to mast cell activation and the release of heparin and histamine by the action of some component in aqueous kava extracts (traditional kava). It has been found that other aggravators can cause this problem in people sensitive to mast cell activation. This sensitivity is known as MCAS “Mast Cell Activation Syndrome”, or Mastocytosis. This is characterized by the accumulation of excess mast cells in various parts of the body in most diagnoses, however some types of MCAS do not present themselves in this manner. The most common form of this is found in the mast cells of the skin, with rarer forms being found in the digestive tract, bones and other areas of the body. This is quite rare, however people with this syndrome can display dermatographia, a condition known for being able to draw on the skin with a dull pencil or pen only to have that area raise up and turn red as if reacting to an allergen or surface abrasion.
The triggers of mast cell activation can be [1]:
- Heat, cold or sudden temperature changes
- Stress: emotional, physical, including pain, or environmental (i.e., weather changes, pollution, pollen, pet dander, etc.)
- Exercise
- Fatigue
- Food or beverages, including alcohol (spirits and wine more likely than beer [2])
- Drugs (opioids, NSAIDs, antibiotics and some local anesthetics) and contrast dyes
- Natural odors, chemical odors, perfumes and scents
- Venoms (bee, wasp, mixed vespids, spiders, fire ants, jelly fish, snakes, biting insects, such as flies, mosquitos and fleas, etc.)
- Infections (viral, bacterial or fungal)
- Mechanical irritation, friction, vibration
- Sun/sunlight
Histamine Intolerance:
Histamine intolerance is not a sensitivity to histamine, but an indication that you’ve developed too much of it [3]. Histamine from foods is naturally broken down in the body by the enzyme called diamine oxidase (DAO). A deficiency of DAO will cause the body to retain an excess amount of histamine and can also cause the allergy type reactions we’ve seen. Alcohol has been seen to reduce the levels of DAO in the body even in healthy individuals. Ethanol was shown to aggressively attack DAO, so even with normal levels of DAO in the body histamine saturation may occur [4]. Going one level further; alcohol and histamine compete for metabolization because they share the common enzymes aldehyde dehydrogenase and aldehyde oxidase. The metabolites of alcohol can effectively compete with the metabolites of histamine. Alcohol in this scenario can both cause mast cells to release their histamine, and prevent the body from removing it at the same time [5]. This amplification of histamine with alcohol through compounding mechanisms combined with the activity at mast cells that kava can provide gives us a better look into a possible cause of this problem.
[1] Symptoms and triggers of mast cell activation. (n.d.). TMS - The Mast Cell Disease Society, Inc. Retrieved March 18, 2021, from https://tmsforacure.org/symptoms/symptoms-and-triggers-of-mast-cell-activation/
[2] Hamilton Matthew, J. Scarlata Kate. (2020). Mast Cell Activation Syndrome – What it Is and Isn’t. NUTRITION ISSUES IN GASTROENTEROLOGY. https://med.virginia.edu/ginutritio...6/Mast-Cell-Activation-Syndrome-June-2020.pdf
[3] Histamine intolerance: Causes, symptoms, and diagnosis. (2018, August 13). Healthline. https://www.healthline.com/health/histamine-intolerance
[4] DAO blocking foods—Deficitdao.org—Official Scientific Society. (n.d.). Deficitda
rg. Retrieved March 18, 2021, from https://www.deficitdao.org/en/dao-d...s-in-histamine-metabolism/dao-blocking-foods/[5] Zimatkin SM, Anichtchik OV. Alcohol-histamine interactions. Alcohol Alcohol. 1999 Mar-Apr;34(2):141-7. doi: 10.1093/alcalc/34.2.141. PMID: 10344773.
(https://academic.oup.com/alcalc/article/34/2/141/192121)
