Alcohol, Kava, Mast Cells, DAO, and Histamine Intolerance.
Alcohol, Kava, Mast Cells, DAO, and Histamine Intolerance.
The fact of the day prior was regarding mast cells and how they play a part in the “kava allergy” that 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 that histamine intolerance plays an important role.
Kava causes rare allergic reactions 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 components in aqueous kava extracts (traditional kava). Other aggravators can cause this problem in people sensitive to mast cell activation. This sensitivity is known as “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 in this manner. The most common form is found in the mast cells of the skin, with rarer forms 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 , chemical, perfume, 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, and vibration
Sun/sunlight
As evidenced, the list of triggers for mast cell activation in people who may be sensitive can be numerous, and differing amounts of these can trigger mast cell activation to different degrees. Today, we are theorizing that alcohol, when combined with kava, can lower this threshold to mast cell activation in combination with DAO reduction and lead to histamine intolerance, which can be expressed in an allergic type reaction.
Histamine Intolerance:
Histamine intolerance is not a sensitivity to histamine but an indication that you have developed too much of it [3]. Histamine from foods is naturally metabolized in the body by an enzyme called diamine oxidase (DAO). A deficiency of DAO will cause the body to retain an excess amount of histamine and can also cause allergy- type reactions. Alcohol reduces DAO levels in the body, even in healthy individuals. Ethanol was shown to aggressively attack DAO; therefore, even with normal levels of DAO in the body, histamine saturation may occur [4]. Going one step further, alcohol and histamine compete for metabolization because they share the common enzymes aldehyde dehydrogenase and aldehyde oxidase. Alcohol metabolites can effectively compete with histamine metabolites. Alcohol in this scenario can 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 insight into the 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/ginutrition/wp-content/uploads/sites/199/2020/06/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.). Deficitdarg. Retrieved March 18, 2021, from https://www.deficitdao.org/en/dao-deficiency/histamine/food-which-interferes-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.