*This article explains the role histamines play in Long COVID, how they affect the body, what triggers the histamine cascade, and what you can do to counter them.*

Updated February 20, 2024

COVID-19 and Long COVID cause histamine release from overactive mast cells.

In Long COVID, mast cell activation from the acute infection is out of control and leads to histamine release causing inflammation in the nerves. This can cause a wide range of symptoms like depression, anxiety, brain fog, tinnitus, diarrhea, constipation, pain, neuropathy, congestion, fatigue, shortness of breath, asthma. We have even seen it cause temporary diabetes and symptoms that feel like a heart attack. Left untreated, this can lead to adrenal exhaustion or adrenal fatigue making you vulnerable to other diseases and illnesses.

Histamines cause inflammation

Histamines are the cause of the acute inflammatory and hypersensitivity responses in Long COVID, causing chronic inflammation and disrupting the functions of the cells involved in the regulation of immune response.

According to the NIH, a combination of H1 and H2 blockers offers a safe and effective method to reduce the progression in symptom severity, presumably by minimizing the histamine-mediated cytokine storm and managing COVID-19 inflammation. Histamine intolerance means that you have a high level of histamine in your body. It can happen if your body cannot break down histamine. You can experience symptoms including headaches.

Histamine intolerance is not a sensitivity to histamine, but an indication that you’ve developed too much of it.

Histamine is a chemical responsible for a few major functions:

communicates messages to your brain
triggers release of stomach acid to help digestion
releases after injury or allergic reaction as part of your immune response

When histamine levels get too high or when it can’t break down properly, it can affect your normal bodily functions.

Symptoms of histamine intolerance

Histamine is associated with common allergic responses and symptoms. Many of these are similar to those from a histamine intolerance. When an allergen enters the body, the immune system responds to it by bringing white blood cells to the affected area where they secrete chemicals called cytokines and leukotrienes. These chemicals cause the five cardinal symptoms of inflammation in an attempt to get rid of that allereng:

redness
hotness
swelling
pain
loss of function, like not being able to move the affected area

These symptoms don’t have to occur all at once or together it depends on the type of inflammatory mediators that are being produced and the extent of the inflammatory reaction; some types of inflammation may even pass silently without symptoms at all.

While they may vary, some common reactions associated with this intolerance include:

headaches or migraine
nasal congestion or blocked sinuses
fatigue
hives
digestive issues
irregular menstrual cycles
nausea or vomiting

In more severe cases of histamine intolerance, you may experience:

anxiety
difficulty regulating body temperature
dizziness
irregular heart rate
high blood pressure
tissue or organ swelling
abdominal cramping

Medication protocols for long COVID prevention and treatment

Talk to your doctor about the top 4 concerns: Histamines, Inflammation, Depression, and Blood Clotting

The antihistamine protocol: Seasonal allergy medicines like Allegra or Zyrtec (H1 blockers) and antacids like famotidine or Pepcid (H2 blockers) to counter the histamine cascade.
The anti-inflammatory protocol: Such as steroids in severe cases, or NSAIDs like ibuprofen or other prescription medications to reduce inflammation, pain, and the risk of damage to nerves and organs.
The antidepressant protocol: SSRI and SNRI medications to reduce depression, anxiety or fatigue.
The anticoagulant protocol: Aspirin, baby aspirin or prescription medications to prevent micro-clotting or deep vein thromboses (DVT) that can cause neural damage, organ damage, or stroke by blocking the flow of blood to vital organs.

The value of Omega 3 Fatty Acids

As you recover, it is essential to help your body heal by reducing histamine exposure from foods and seasonal allergens and focus on supplements and foods that reduce inflammation, such as Omega-3 fatty acids in things like fish oils and flax seeds.

It can be difficult to find a quality Omega-3 product. We recommend this Krill oil blend. Not only is it good for you, but it's also better for the environment as a more sustainable source of oils. Plus, no fishy aftertaste!
Omega 3 Fish Oil formula helps your body absorb with better efficiency as well as help decrease critical joint stiffness and maintain cardiovascular functionality.

**Top recommendations from TWC Long COVID Doctors:**
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Things you can do to help yourself

Minimizing physical & psychological stressors is essential in recovery from Long COVID.

Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein, vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.
Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.
Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).
Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

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