Interview with Dr. Tina Peers Part I

This is the first part of our interview series with Dr. Tina Peers, a Consultant in Contraceptive and Reproductive Health in London, U.K. where she discusses her approach to treating patients with Histamine Intolerance (HIT) and Mast Cell Activation Syndrome (MCAS). Though Dr. Peers specializes in women’s health, the approach she discusses can be used to treat both men and women.

The content provided is for informational purposes only and is not intended to medically diagnose or prescribe a solution for your condition.

Keep a food diary for 1 week

Before visiting a doctor, Dr. Peers recommends that the patient keep a basic food diary for one week.

For many patients, removing high-histamine foods is a simple and straightforward way to lower your histamine bucket and reset the body’s histamine levels. Dr. Peers describes the three types of foods that can cause histamine levels to rise in the body:

  1. Foods that are high in histamine
  2. Foods that release histamine in your body (e.g. black tea, green tea)
  3. Foods that block Diamine Oxidase (e.g. alcohol)

Remove certain foods from your diet

The next step is to remove high-histamine foods, as well as those foods that block the production of DAO or release histamine in the body, for a period of 2-4 weeks. Many patients are inadvertently consuming foods that are high in histamine, release histamine in your body or block DAO on a regular basis. Patients should monitor their progress during this time and see if their symptoms gradually improve.

For some patients, making a minor adjustment to your diet may be enough. However, by the time most patients seek (or find) medical help, they are usually at the stage where they have had these conditions chronically and may require further treatment.


Dr. Peers also recommends taking Type 1 and Type 2 antihistamines twice per day while on the low histamine diet. For more information on histamine receptors and blockers, please see our post on histamines and how they work.

Antihistamines do not lower histamine in your body, they simply block its effect on the body. It’s very possible that patients may respond to one type of antihistamine more than others. As such, Dr. Peers recommends that it is worth trying different types of antihistamines, most of which are available over-the-counter.

If patients respond to the low histamine diet and antihistamines, they can begin to slowly reintroduce lo histamine foods and observe how their body reacts. Some patients may decide to stop taking the antihistamines if they have responded positively to the low histamine diet.

Mast Cell Stabilizers

If symptoms persist, Dr. Peers may prescribe a mast cell stabilizer, particularly for those patients that have a chronic history of numerous symptoms. For a subset of patients whose conditions are severe, they may need to remain on antihistamines and mast cell stabilizers for an indefinite period. I have spoken with patients who have maintained this protocol for many years, eventually weaning themselves off of medication once their symptoms have begun to improve. This process is gradual and requires patience and time. For individuals who have suffered from HIT and MCAS for many years, there will be no quick fix and finding a suitable protocol will take some time.

Natural Solutions

For those patients who do not want to take antihistamines and prefer to focus on solutions, Dr. Peers recommends taking low dose Vitamin C and L-Glutamine. The source and composition of the supplement may have an impact on patients. Some supplements may include buffers, such as sodium bicarbonate, so it may be necessary to try different brands in order to determine which is most suitable for you.

DAO Supplements

Patients may also choose to take a DAO supplement ahead of consuming a meal that may be high in histamine. DAO supplements are expensive and not widely available so patients may want to take these supplements on special occasions when they expect to be eating out. In those cases, Dr. Peers recommends taking two DAO supplements an hour or half an hour before you go out so that it’s in your system. DAO is not absorbed into the bloodstream. It stays in your gut but it will lower the histamine that you ingest. Therefore, DAO supplements are useful only when ingesting high histamine foods and not for lowering histamine levels in the body.

Investigate the root causes

One of the biggest problems that patients face is the wide-ranging symptoms that result from HIT and MCAS ranging from digestive problems, allergy-like symptoms such as a runny nose and watery eyes, dermatological issues such as eczema and dermatographism, menstrual problems, migraines, among others. As a result, seeing a doctor who is not well-versed on the condition can result in recommendations to see further specialists such as gastroenterologists, dermatologists, neurologists, gynecologists etc. However, what is needed for conditions like HIT and MCAS is a holistic approach and a doctor who understand the full picture to be able to treat the condition in a holistic way. Functional medicine doctors may be particularly helpful in this regard.

Once your symptoms have reached a manageable level, it’s important to investigate the root causes of your conditions. Gut-related conditions are a common cause. Dr. Peers explains that the gut wall is a prominent area for the mast cells to gather. Leaky gut can be a common cause, in which case mast cell stabilizers like sodium cromoglicate may be needed. 96% of it is not absorbed and it stays in the gut but it stabilizes the mast cells in the gut and reduces their numbers. Liquid probiotics like Symprove may also help to recolonize your gut with the correct bacteria.


To summarize, Dr. Peers’ approach to treating patients with HIT and MCAS consists of the following steps:

Step 1: Keep a food diary before visiting a doctor. For some patients, removing high histamine foods may be a simple and easy solution to improve your symptoms.

Step 2: For 2-4 weeks eliminate high histamine foods as well as those that block the production of DAO or release histamine in your body.

Step 3:In conjunction with Step 2, try taking Type 1 and Type 2 antihistamines twice per day. Reassess your condition after a period 2-4 weeks and begin to gradually reintroduce some low histamine foods and see how the body responds. This will continue for as long as it takes to assess how your body reacts to certain foods as well as the antihistamines. Some patients may find that they are about to stop using antihistamines.

Step 4: A mast cell stabilizer may be prescribed for persistent symptoms

Step 5: Natural solutions are also an option. Patients may choose to take supplements such low dose Vitamin C, L-Glutamine, and Quercetin instead of or in addition to antihistamines.

Step 6: Patients may choose take DAO supplement ahead of consuming a meal that may be high in histamine. These supplements will only work when ingesting food which are high in histamine and not for lowering the level of histamine

Step 7: It is important to investigate the root causes of your conditions and treat them accordingly. For example, gut-related root causes may be treated with mast cell stabilizers like sodium cromoglicate, which help to reduce the mast cells in the gut, as well as liquid probiotics such as Symprove, which may help to re-colonize the gut with the correct bacteria.

Lowering your histamine bucket

There are typically no quick fixes to lower your histamine bucket when it’s overflowing but some recommendations that Dr. Peers provided were:

  • Using sauna: it is possible that sweating can help to release the histamine in your body. I made the incorrect assumption that exercise may similarly help but Dr. Peers pointed out that exercise can also have the effect of increasing histamine levels.
  • Eliminate all high histamine foods
  • Take the natural supplements mentioned above
  • Yoga, deep breathing, and meditation may help to reduce your stress and lower histamine levels in the body but be careful if you’re hypermobile because yoga may not be suitable for you.
  • Toxaprevent: a zeolite made from volcanic rock may be an option. According to its website, Toxaprevent acts as a sieve that binds to toxins such as mercury, lead, and histamine and safely removes it from the body through natural bowel movements. Be very careful if you are on medications as Toxaprevent may reduce its effect.

Histamine-related conditions are highly individualized and one standard approach will not work for everyone. Patients suffering from Histamine Intolerance and Mast Cell Activation Syndrome are highly sensitive to many foods and triggers and therefore it is imperative that you consult a doctor before making any changes to your medical protocol.

The importance of self-management

Education is critically important for people suffering from HIT and MCAS. Dr. Peers emphasized that it is important to take a “low and slow” approach to these conditions. It is imperative that you reintroduce foods slowly into the diet as trying to accelerate the process may take you back to square one. It is necessary to be as patient as possible when experimenting with foods.

More information on Dr. Tina Peers

Since qualifying in Medicine at Guys’ Hospital London in 1983, Dr. Tina Peers has developed her skills and knowledge in Women’s health, first working as a GP in Surrey, then becoming a Consultant in Contraception and Reproductive Health in 1996, and leading these services in Surrey until 2018. Please visit her website for more information on how to get in touch.

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