WORDS BY — Sophia Ruiz, Founder, Integrative Esthetician, + Dermatology Researcher

Histamine, histamine intolerance, and the effects it can have on our health are finally starting to go mainstream.

What was once a cryptic cause of various symptoms is now becoming well-known for its contribution to:

• anxiety

• digestive issues

• sleep disturbances

• chronic skin conditions

• & more.

What most people are unaware of is that histamine’s influence on chronic symptoms actually includes acne.

Histamine is a widely under-appreciated trigger for breakouts. By causing adverse skin changes on a molecular level, histamine is directly connected to some of the root cause factors that lead to acne.

Note: If you’ve been a part of our Sana community for a while, this is likely something you’re already familiar with. You can read some of our articles featuring research on histamine’s role in acne here.

Needless to say, if you’re someone that deals with persistent acne, histamine is worth investigating as a potential contributor to breakouts. And if you know you have excess histamine levels, balancing high histamine levels can be a significant step in supporting your journey to clear skin.

As an integrative esthetician and having worked one-on-one with so many of our customers, I truly believe this is so crucial to be aware of. I’ve seen the power of addressing excess histamine first-hand – it truly can be the missing piece to achieving clear skin.

To help you identify whether histamine is contributing to your breakouts, understand how histamine influences acne, and what you can do about it (including how to adjust your skincare routine if you’re histamine-sensitive), I’m sharing this comprehensive guide to histamine’s involvement in acne.

How does histamine cause breakouts?

Histamine is a compound naturally produced by the body. It’s most well-known for its role in allergy, but plays a role in various different bodily functions like sleep, mood, memory, and skin health.

At a normal level, histamine is necessary for tissue repair after injury. However, at excessive levels, histamine can cause molecular changes that are known to contribute to breakouts:

• Histamine makes sebum more comedogenic. In the skin, histamine increases the production of squalene (note: squalene, not squalane – squalane is a stable compound with emollient benefits for skin). When increased, squalene increases the potential for sebum to clog pores.

• Histamine impairs the skin barrier. By impacting proteins in the skin that keep the skin barrier healthy, histamine disrupts skin barrier function. This means a loss of skin hydration, skin redness, and increased skin sensitivity. These changes drive inflammation and dead skin cell buildup, setting the stage for breakouts.

• Histamine promotes an inflammatory state. Histamine is a driver of inflammation, which is a major trigger for acne formation.

As a result, histamine has the potential to alter the skin environment, setting the stage for breakouts to form.

How do I know if I have acne caused by histamine?

There’s no sure fire way to determine whether your breakouts are linked to histamine levels. In many cases, acne is multifactorial, meaning there can be many underlying root causes contributing to your breakouts.

Resolving histamine issues can be a huge piece of the puzzle, but achieving clear skin may involve exploring other avenues, too.

That aside, there are a few ways you can gauge whether your breakouts are likely to be histamine-related:

1. You’ve been diagnosed with histamine intolerance. Histamine intolerance is when your body’s ability to break down histamine is impaired, causing reactions to foods high in histamine. While not every individual with histamine intolerance struggles with breakouts, those of us who are acne-prone may develop acne as a result of excessive histamine. If you’ve verified that you struggle with histamine intolerance, improving histamine levels will likely improve your breakouts (although, other factors may need to be addressed as well).

2. Your acne is accompanied by histamine symptoms. For example, you have itchy, irritated skin alongside breakouts or your breakouts are accompanied by symptoms of histamine excess (dizziness, anxiety, insomnia, rapid heart rate, headaches with fermented foods / cured meats, etc.). Keep in mind that histamine symptoms overlap with other conditions, so it’s a good idea to consult a physician to determine whether your symptoms are histamine-related.

3. Your acne flares with allergy season. If your breakouts tend to flare around allergy season, when histamine levels can be higher, your breakouts might be histamine-related.

To properly test for histamine issues, you can work with a functional physician to measure diamine oxidase and tryptase activity. Some practitioners also recommend trialing a low histamine diet to gauge whether histamine is involved in symptoms.

What causes histamine levels to increase?

While there are many reasons why histamine levels can increase in the body, research reveals there are a few major culprits:

1. Gut microbiome imbalances. Certain bacterial colonies in the gut have the ability to produce histamine. When these colonies overgrow, the amount of histamine we are exposed to can increase, leading to an increased histamine burden on the body (and, potentially, symptoms like breakouts). Not surprisingly, studies show that individuals with histamine intolerance have an increased number of histamine-producing bacteria in their gut. 

2. Leaky gut. Our gut barrier is the gatekeeper of our health. It allows us to extract nutrients and hydration from foods while keeping allergens, microbial components (like endotoxins), and other harmful substances out of the body. When the gut barrier breaks down, there are many things that can go awry. Relevant to histamine, gut barrier breakdown can cause food allergens to stimulate histamine release.

3. Diamine Oxidase (DAO) deficiency. DAO is the enzyme responsible for breaking down histamine. When your histamine breakdown can keep up with your histamine production, histamine is unlikely to cause symptoms. However, when DAO levels are unable to keep up with histamine production, this can lead to an increased histamine burden and histamine symptoms (like breakouts). DAO deficiency can be caused by gut inflammation, certain medications or supplements (like N-acetylcysteine), and genetic factors.

4. Allergen or dust exposure. During periods of high allergen exposure, histamine levels may be higher than usual. This can be during allergy season, when living in homes with poor ventilation, or during active wildfires or high winds.

5. Mold exposure. If you’ve lived in a water-damaged home, you may have been exposed to mold. While mold exposure affects everyone differently, mold may cause elevated histamine levels after exposure.

How can we reduce excess histamine levels to improve acne?

There can be many factors involved in excess histamine and / or histamine intolerance. As a result, it’s important to get the advice of a professional who has experience with histamine intolerance, especially before beginning any supplements.

That being said, research suggests there are some helpful strategies to support healthy histamine levels:

1. Eat a diet rich in antioxidants. Antioxidant compounds, found in high levels in superfoods like matcha, berries, ginger, turmeric, and more, help protect mast cells against excessive histamine release caused by free radicals. Antioxidants also support a healthy gut by encouraging a healthy microbiome and soothing gut inflammation.

2. Pineapple / bromelain. Bromelain, an enzyme present in pineapple (especially in the stem), has shown benefit for various allergy symptoms.

3. Avoid histamine-producing probiotic strains. Some probiotic strains express histidine decarboxylase (hdcA), the enzyme responsible for converting histidine to histamine. As a result, taking probiotics that express this enzyme may inadvertently increase your histamine levels. Strains known to express this enzyme are L. reuteri, L. bulgaricus, L. casei, L. lactis, and S. thermophilus. Not all probiotics made with these strains will increase histamine, but it’s important to be aware of if you suspect histamine sensitivity.

4. Opt for a low histamine probiotic. If you suspect histamine excess or intolerance, it might be helpful to opt for a probiotic made with strains not expressing the hdcA enzyme. This includes most Bifidobacterium strains, L. rhamnosus, L. plantarum, and Bacillus subtilis. 

5. Look into glutamate sensitivity. Glutamate, an umami amino acid present in foods, is an excitotoxin that can trigger histamine release. Under normal circumstances, glutamate is unlikely to cause histamine issues. However, if you are sensitive to glutamate or experiencing histamine overload, glutamate-rich foods may contribute to histamine overload. This includes foods like bone broth, collagen powder, soy sauce, and potentially glycinate-based supplements like magnesium glycinate and magnesium bisglycinate.

6. Ensure you’re getting enough B vitamins. Vitamin B6 is an important co-factor for the DAO enzyme, responsible for degrading histamine. While it’s important not to take too much vitamin B6, especially if you’re acne-prone, ensuring you’re getting enough vitamin B6 is important for optimizing your body’s ability to handle histamine.

7. If necessary, explore a low histamine diet. Many foods, including health foods, actually contain histamine. Alongside the histamine that our body produces, these foods contribute to our body’s overall histamine burden. For those of us already experiencing histamine overload, dietary histamine can be reduced to help minimize symptoms. These foods include fermented foods (including yogurt, kimchi, kefir, sauerkraut, etc.), cured meats, leftovers, avocados, some berries, citrus fruits, tomatoes, alcohol, and fish. 

Histamine intolerance skin tip: Try essential oil-free skincare

If you’re dealing with breakouts from too much histamine or histamine intolerance, there are not only changes you can make internally, but externally, too.

While I personally believe essential oils, when sourced carefully for quality, purity, and biocompatibility, can be helpful for skin (after all, they are just concentrated botanicals), I also know through experience as an esthetician that even the best essential oils are not for everyone.

Why can essential oils cause issues in histamine intolerance?

My theory on why this is the case is histamine. Some essential oils, especially citrus oils or oils containing limonene, have been shown to influence histamine levels when applied.

Many essential oils, not just citrus oils, contain limonene. And while limonene can be beneficial in many contexts (including providing anti-inflammatory effects), the benefits may be outweighed if you’re already experiencing histamine overload.

As a result, if you are dealing with excess histamine, it may be best to opt for essential oil-free and, more broadly, fragrance-free skincare formulas.

I’m proud to offer a line of essential oil-free formulas at Sana Haus, specifically formulated with histamine sensitivity in mind:

• Nectar Lipidic Cleansing Fluid: an ultra-gentle, oil gel-to-milk cleanser that traps dirt and impurities to reveal bright, hydrated, never-stripped skin.

• Vitale Nutritive Glow Elixir: a barrier-first serum designed to strengthen and revitalize skin with antioxidant-rich raspberry seed oil, rosehip, and vitamin E.

• Eden 7% Antioxidant Youth Complex: a potent antioxidant serum, featuring three powerhouse antioxidants that support skin vitality, firmness, and clarity, brighten skin tone, and support hydrated, healthy skin.

• Clarity Bioactive Clearing Serum, essential oil-free: we now offer an essential oil-free version of our cult-favorite blemish serum, powered by clarifying, barrier-repairing linoleic acid, purifying black seed extract, and a synergistic network of soothing, repairing antioxidants.

I highly recommend trying our essential oil-free formulas if you’re struggling with persistent breakouts. I’ve worked directly with customers who have seen a huge difference in their skin just by switching to our essential oil-free formulas!

Our formulas are also packed with skin-loving nutrients that may positively impact skin histamine levels, including black seed, french pine bark, omega fatty acids, and vitamin E.

Bottom Line: histamine can contribute to acne, but there are many ways you can support your skin

While histamine can be a significant contributor to breakouts, there are many different options you can explore to help alleviate excess histamine and support clearer skin.

If you suspect you’re dealing with histamine intolerance, I highly recommend working with a functional practitioner familiar with histamine issues. While the conversation around histamine is becoming more mainstream, it’s still something that most physicians are unaware of. Alongside practical dietary and lifestyle changes, someone well-versed in histamine issues can help you support your body individually.

In the short term, you can make targeted, mindful changes to your skincare routine to help support your skin’s unique needs. This includes opting for essential oil-free formulas and avoiding fragranced skincare ingredients. This can be hugely helpful in reducing the histamine load on your skin and, as a result, encouraging clear skin.

Have any questions about histamine and acne? Leave them below!