Is serrapeptase safe for individuals with a low histamine diet?

Serrapeptase Safety for Low Histamine Diets

Serrapeptase is not recommended for individuals following a low histamine diet due to its potential to trigger histamine release and exacerbate symptoms in histamine-sensitive individuals. 1

Mechanism of Concern

Serrapeptase is a proteolytic enzyme that has been used for its claimed anti-inflammatory, anti-edemic, and analgesic effects 2. However, several concerns exist regarding its use in individuals with histamine intolerance:

• Proteolytic enzymes can potentially trigger mast cell activation and histamine release
• The Joint Task Force on Practice Parameters for Allergy and Immunology notes that substances that trigger histamine release should be avoided in histamine-sensitive individuals 1
• Histamine release can cause symptoms mimicking allergic reactions including flushing, urticaria, pruritus, and gastrointestinal disturbances 3

Histamine Intolerance Considerations

Histamine intolerance results from an imbalance between accumulated histamine and the body's capacity for histamine degradation 3. For individuals on low-histamine diets:

• The primary enzyme for metabolizing ingested histamine is diamine oxidase (DAO) 3
• Substances that interfere with DAO activity can worsen histamine-related symptoms 3
• Proteolytic enzymes like serrapeptase may potentially interfere with normal histamine metabolism

Evidence Quality Assessment

The evidence regarding serrapeptase specifically is limited:

• A systematic review of serrapeptase found that clinical evidence supporting its use is based on studies with poor methodology 2
• No specific studies have examined serrapeptase in the context of histamine intolerance
• The American Academy of Allergy, Asthma, and Immunology recommends caution with substances that may trigger histamine release 4

Alternative Approaches

For individuals with histamine intolerance seeking anti-inflammatory support:

• Second-generation H1 antihistamines are preferred over first-generation due to fewer side effects 4
• H2 antihistamines may be helpful for abdominal symptoms 4
• A low-histamine diet remains the gold standard approach for managing histamine intolerance 5, 6

Monitoring and Precautions

If an individual with histamine intolerance still wishes to try serrapeptase:

• Begin with a very low dose and monitor for symptoms
• Be prepared to discontinue immediately if symptoms worsen
• Watch for signs of histamine reactions: flushing, headache, urticaria, gastrointestinal disturbances 1
• Consider measuring urinary histamine metabolites (24-hour collection) to assess response 4

Bottom Line

Given the potential for serrapeptase to trigger histamine release and the lack of high-quality evidence supporting its safety in histamine-sensitive individuals, it is prudent to avoid serrapeptase when following a low-histamine diet. Alternative anti-inflammatory approaches with better safety profiles should be considered instead.