Can Medical Cannabis Help with Histamine Intolerance or MCAS (Mast Cell Activation Syndrome)?

Histamine intolerance (HIT) is a persistent condition that can leave you itching uncontrollably or cause other allergy-like symptoms. About 1% of people live with this lifelong condition, and since it has no cure, many are looking for ways to manage it.

Cannabis is one option that’s gaining steam, thanks to its rising popularity for anti-inflammatory and immune-modifying benefits. But before delving into how marijuana might help soothe the symptoms of HIT, let’s clarify what histamine intolerance is.

What Is Histamine Intolerance?

Histamine intolerance occurs when your body produces and accumulates too much histamine. The high levels of histamine can trigger gastrointestinal and allergy-like symptoms, which may persist until your histamine levels drop or you control the underlying cause.

Your body naturally produces histamine to support your immune and digestive system and other functions. However, it may produce too much due to chronic inflammation, stress, certain medications, or consuming histamine-rich foods like aged cheese, alcohol, and especially wine and fermented products.

High levels of histamine may also be due to low levels of diamine oxidase (DAO), an enzyme that breaks down histamine to keep it at safe levels. Regardless of the cause, HIT is usually a lifelong condition that you can manage by avoiding foods or activities that trigger more histamine production.

Symptoms

Patients experience HIT differently, with some suffering one or more of these symptoms:

• Headaches or migraines
• Lips, tongue, or throat swelling
• Trouble breathing
• Flushing or redness of the skin
• Itching or hives
• Nasal congestion or a runny nose
• Fatigue
• Digestive issues like bloating, diarrhea, or stomach cramps
• Rapid heartbeat
• Low blood pressure (hypotension)
• Anxiety or dizziness

What Is MCAS?

Mast cell activation syndrome (MCAS) is a potential cause of HIT. Mast cells are part of your immune system’s first line of defense against allergies or infections. When they detect threats, mast cells release histamine and other chemicals to fight them off and protect your body.

However, if you have MCAS, your mast cells will produce too much histamine, even when there’s no danger. This overreaction causes histamine to build up in the blood, triggering inflammation in various parts of the body and allergy-like symptoms.

Symptoms

The symptoms of MCAS are similar to those of HIT because both involve high levels of histamine in the body. These symptoms include:

• Skin reactions like itching, hives, or flushing
• Swelling around the face, lips, eyes, tongue, or throat that is serious
• Digestive issues such as nausea, diarrhea, or cramping
• Respiratory problems like wheezing, nasal congestion, or shortness of breath
• Cardiovascular symptoms such as low blood pressure, rapid heartbeat, or dizziness
• Neurological effects, including brain fog, headaches, or anxiety

In order to diagnose MCAS or a severe allergic reaction, these symptoms must appear in two or more body systems. This means any combination of symptoms in your skin, lungs and airways, heart and blood vessels, or digestive system counts. Severe allergic reactions or a reaction involving swelling of the face or throat are considered serious medical emergencies – and you should call 911 right away.

What Living with HIT or MCAS Feels Like

No one has ever described allergies as fun, especially when they cause painful or debilitating reactions. HIT and MCAS are like worst-case scenarios because even if you avoid allergy-causing foods or substances, you can still experience symptoms.

An EpiPen (epinephrine) won’t help much either because it’s less effective against HIT symptoms. That’s because the symptoms are due to excess histamine, which isn’t what EpiPens treat. 

Instead, EpiPens target immune-triggered allergic responses and their immediate effects – making it useful in MCAS instead. The American Academy of Allergy, Asthma, and Immunology and the Cleveland Clinic recommend emergency epinephrine application in MCAS for anaphylaxis (but not HIT), followed by other first-line medications.

In summary, the condition can feel like a constant, unpredictable battle with your own body. Unpredictable because the symptoms can flare up without warning or obvious reasons. This unpredictability can make planning everyday activities difficult and can lead to anxiety or stress.

Living with HIT can also lead to distrust and other relationship issues, leading to misunderstandings and feelings of isolation. In one extreme scenario, a husband believed his wife was poisoning him and causing his HIT symptoms.

To keep HIT or MCAS symptoms at bay, you may have to make lifestyle changes, such as avoiding high-histamine foods like cheeses, fermented foods, and booze. This can feel restrictive, especially if you have to give up your favorite foods.

Many people with HIT or MCAS also rely on maintenance medications like antihistamines, mast cell stabilizers, or other prescriptions to prevent and minimize symptoms. For those who prefer natural remedies, cannabis is showing promise in helping manage HIT and MCAS symptoms.

Can Cannabis Help With HIT and MCAS?

Several studies indicate that various cannabis compounds may help alleviate HIT and MCAS symptoms, and possibly even reduce their frequency. Let’s dive into what the science has to say:

CBD and HIT

Cannabidiol (CBD) is one of the non-intoxicating cannabinoids found in cannabis. Research suggests that it has several potential therapeutic benefits, including reducing inflammation, relieving pain, and modulating immune system responses. But what about histamine intolerance?

A 2015 study published in the Journal of Immunology indicates that CBD may help calm overactive mast cells by activating their PPARγ receptors. Outside research tells us that activating PPARγ receptors is known to prevent mast cell activation and trigger mast cell death. This calming effect could lower the frequency of mast cell activation to prevent excessive histamine production.

There’s also a 2023 study that suggests CBD may help alleviate symptoms linked to mast cell activation and the excessive histamine release it causes. The study specifically looked at mastocytosis-associated pain because CBD reduces the activity of IDO1, a key enzyme that sensitizes pain. However, more research into CBD’s role in modulating histamine release is needed to confirm and fully understand its benefits.

Cannabinoids and Your Immune System

Histamine intolerance can cause chronic inflammation, which compromises your immune system by overstimulating it. An overstimulated immune system may become hypersensitive and react to harmless substances, causing symptoms like rashes, headaches, digestive issues, or fatigue.

Cannabis contains over 100 cannabinoids that interact with the body’s endocannabinoid system (ECS). By interacting with your ECS, these cannabinoids can help regulate functions like immunity, inflammation, and mood.

According to a 2021 medical review, cannabinoids can support your immune system by strengthening key immune cells like T-cells, B-cells, monocytes, and microglia. The cannabis compounds also reduce inflammation by lowering pro-inflammatory signals and boosting anti-inflammatory ones. Additionally, cannabinoids may interact with CB2 receptors to calm overactive immune responses and help the body avoid attacking itself.

Then there’s the study of the Effects of Cannabidiol on Innate Immunity, which focuses on CBD’s immune-balancing and anti-inflammatory effects. According to preclinical research, cannabidiol reduces the production of pro-inflammatory cytokines and decreases immune cell buildup in body tissues. There is still some mixed data that largely depends on cell type. But by calming inflammation and regulating immune activity, CBD may help ease HIT symptoms triggered by excess histamine and overactive immune responses.

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READ: Cannabis Etiquette: The Do’s and Don’ts of Cannabis Use

Cannabinoids and Inflammation from HIT or MCAS

Inflammation triggered by too much histamine can present as headaches, stomach pain, skin problems, and other forms of discomfort. Fortunately, cannabis shows promise in tackling various types of inflammation.

According to 2003 inflammation research, applying HU210, a synthetic cannabinoid similar to THC, to the skin helps reduce histamine-related itch and flare reactions. It achieved this by calming the nerve signals that trigger itching.

Another study identified the role of the ECS, specifically the CB1 receptor, in calming mast cells in the respiratory system to prevent allergic flare-ups. According to the research, natural or synthetic cannabinoids like THC or similar compounds can activate CB1 receptors to stop mast cells from overreacting and releasing histamine. 

For CBD and MCAS, the recent research is mostly supportive, as mentioned. But we should also mention that there is also some previously mixed data suggesting that CBD may trigger mast cell activation. This leaves us with a less clear picture for MCAS and CBD.

Unlike THC and CBD, endocannabinoids are made by your body. An endocannabinoid-like compound called PEA (palmitoylethanolamide) may synergize with anandamide and control mast cell degranulation. Interestingly, it may do so without using CB1 or CB2. This opens a new avenue of research and hope for MCAS and IBS patients.

Besides skin and airway inflammation, HIT symptoms can also include bowel inflammation, which may cause diarrhea and stomach cramps. A 2016 scientific review on the Therapeutic Use of Cannabis in Inflammatory Bowel Disease suggests that cannabinoids may help relieve gut inflammation. In one of the reviewed studies, all 30 patients with Crohn’s disease reported improved general well-being after using cannabis.

Terpenes and Inflammation from HIT or MCAS

Cannabinoids aren’t the only cannabis compounds that might help with inflammation caused by histamine intolerance or MCAS. Cannabis terpenes like myrcene, limonene, pinene, caryophyllene, and linalool also show promise as possible treatments for various inflammatory illnesses.

For example, according to a 2021 study on the Therapeutic Applications of Terpenes on Inflammatory Diseases, linalool and limonene can lower pro-inflammatory cytokines and oxidative stress to reduce nervous system inflammation. α-Pinene, a type of pinene, may also ease skin inflammation by reducing swelling, redness, and cytokine production. That means if you experience allergy symptoms like skin irritation or nerve discomfort, these terpenes could offer some relief (assuming you aren’t allergic to them).

How to Use Cannabis for Histamine Intolerance or MCAS

Cannabis’ versatility lets you use it in a variety of ways. However, some ways are better than others, especially if using cannabis for HIT or MCAS. For instance, while smoking or vaping can deliver cannabinoids into your bloodstream quickly for fast relief, they may not be your best choice.

Why?

Inhaling cannabis smoke or vapor can irritate your respiratory tract, potentially triggering or worsening symptoms like coughing, wheezing, or shortness of breath. One study even shows that long-term, heavy cannabis smoking may weaken your immune system and compromise airways, causing wheezing and coughing.

Safer ways to experience cannabis’ anti-inflammatory and immune-modulating effects for HIT or MCAS include oral and sublingual use. Oral options include ingesting cannabis oils, capsules, or edibles. However, swallowing cannabis can take 30 minutes or more to show effects.

If you want faster results, use a cannabis tincture sublingually – under your tongue. It typically takes effect within 15 minutes.

Also, since CBD may help calm mast cells and certain terpenes fight inflammation, a full-spectrum, CBD-dominant product may be more effective for managing HIT. In contrast, distillate or isolate canna-concentrates might lack the full range of cannabinoids and terpenes needed for optimal results.

What About Doses?

Studies show that cannabidiol is more effective at reducing inflammation and calming overactive immune systems at certain doses. As such, you may not experience HIT or MCAS symptom relief if you don’t use cannabis correctly. In the absence of clinical data regarding CBD and inflammation, one can only reasonably try gradually increasing doses. 

The right dose typically varies between individuals because of factors like body weight, tolerance, and metabolism. To find what works for you, start with a low dose and gradually work your way up until you experience relief. 5 to 10 mg of a full-spectrum or broad-spectrum CBD-dominant product is a good place to start if you’re new to cannabis. Increasing by 5 to 10 mg daily or weekly is a possible strategy to gauge the effects of higher doses.

But don’t forget that cannabis can’t actually cure HIT or MCAS. It can only help manage symptoms like itching, swelling, digestive discomfort, and brain fog by regulating immune responses and reducing histamine-related reactions. For continued relief, you’ll likely have to use prescribed medicines and cannabis as often as needed. Also, if your tolerance builds over time, you might have to up your dose to continue experiencing your desired results.

Who Shouldn’t Use Cannabis for Histamine Intolerance or MCAS?

While cannabis might help some people manage histamine intolerance or mast cell activation syndrome, it’s not for everyone. For instance, if you’re highly sensitive to THC or have a history of cannabis allergies, it’s probably not your best choice.

Also, you shouldn’t use cannabis if you’re taking medications that interact poorly with cannabinoids. Examples of such medications include antihistamines, blood thinners, sedatives, antidepressants, heart medications, and immunosuppressants.

Lastly, using cannabis is a no-no if you’re pregnant or breastfeeding, as it might affect the baby. For your safety, always consult a medical professional, ideally one familiar with cannabis and mast cell disorders, before using it for HIT or MCAS.

Alternative or Complementary HIT Therapies

For possibly better results, you could use cannabis alongside these therapies to manage HIT or MCAS:

1. DAO Supplements: DAO is an enzyme that breaks down histamine in your gut. By taking DAO enzyme supplements, you can replenish the enzyme to stop histamine from building up within your system.
2. Low-Histamine Diet: Avoiding cheese, wine, cured meats, and other histamine-rich foods can help get HIT under control.
3. Quercetin: This natural antioxidant and mast cell stabilizer can help reduce histamine release and inflammation. You can take quercetin supplements or eat foods with high levels of it, like onions and apples.
4. Vitamin C: Vitamin C has natural antihistamine and anti-inflammatory properties. Besides vitamin C pills, you can get this nutrient from fruits like oranges, strawberries, kiwi, and papaya.
5. Omega-3 Fatty Acids: Omega-3s can help reduce inflammation and support immune balance in conditions like HIT and MCAS. You can get them through supplements or by eating omega-3-rich foods like fish, flaxseeds, and chia seeds.
6. Stress Reduction: Since chronic stress can exacerbate histamine issues, stress-reducing therapies like yoga and meditation may help calm your nervous system and lower histamine levels.

So, Should You Use Medical Cannabis for HIT or MCAS?

Medical cannabis shows great promise in managing HIT or MCAS, especially in providing symptom relief. However, we need more clinical research to fully understand its long-term effects and how to best use it for symptoms.

If your doctor gives the go-ahead, experiment with a low dose of a full-spectrum, CBD-dominant cannabis product. You can up the dose as necessary to help with managing HIT symptoms like itching, swelling, digestive discomfort, or brain fog.

Just remember that cannabis isn’t a cure, but it may help with managing flare-ups. Since it affects everyone differently, some HIT or MCAS patients may experience more relief than others. Also, cannabis effects are typically cumulative, meaning you’ll likely experience the most benefit from consistent, mindful use over time rather than from a single dose.