Burning Mouth Syndrome. As part of her on-going Q&A on histamine intoelrance, Dr Janice Joneja was asked whether there could be a histamine connection in Burning Mouth Syndrome.


Thank you for the opportunity to get some feedback. I have a Naturopathic Dr but she knows that I continue to educate myself outside of her research.

Burning Mouth Syndrome

I've had Burning Mouth Syndrome for two years. It started out with me having shortness of breath. I've had other symptoms too such as runny nose, rashes, hoarseness, ear problems, vertigo, teeth hurting, headaches and tightness in my throat. I didn't put two and two together until recently. The Burning Mouth Syndrome is the absolute worst of all my symptoms.

I feel like the BMS is associated with Histamine Intolerance. The pain hardly ever goes away except when I sleep. It is a terrible pain that has taken over my life. I decided after terrible side affects with prescription medications that I would learn to get through each day without those medications. I only use natural supplements now. I've had many many tests done with no direct answer. I do struggle to keep my Vitamin B12 and D up. I have to take B12 injections and go to tanning bed and sunshine for some natural D. I am currently taking:
Quercetin plus non citrus C
Lowering histamine probiotics (just a few per week is all I can tolerate)
Calcium and Magnesium
Optimal Start vitamin from seeking health

Dr Joneja says:

Burning mouth syndrome (BMS) is a notoriously challenging condition to manage. There appear to be many possible causes, and based on the probable cause, a variety of different ways to treat the problem. Clinicians tend to classify BMS into primary and secondary types. In primary BMS, sometimes called idiopathic burning mouth syndrome, all the tests for an underlying pathology are negative (“idiopathic” means we have no idea what the cause may be!). Some practitioners have suggested that the problem originates in the nervous system, but evidence is lacking at the present time.

In contrast, secondary BMS may be a consequence of one of a number of underlying conditions such as an oral infection; lack of saliva (xerostomia); nutritional deficiencies in minerals such as iron, zinc and several B vitamins (in particular folate, thiamin, riboflavin, B6 and B12); allergy to foods, food additives, medications, dental materials and products such as toothpaste and mouthwash; reflux of acid from the stomach; other conditions such as diabetes and thyroid disorders; and psychological stressors such as anxiety and depression. It is apparent from the information that you have provided that your health care providers have considered just about all of these probable causes of secondary BMS, and have attempted to treat any that appear relevant, sadly without achieving any significant relief of your symptoms. It would therefore appear that you might be experiencing the primary type of BNS, which at the present time does not seem to respond to any of the treatments available.

There is no evidence that histamine intolerance plays any role in primary BMS. The little evidence available seems to suggest that a sensory defect in the central or peripheral nervous system may be a key factor in the condition. Histamine sensitivity would be suspected if inflammation were involved, but if the cause is a nervous system dysfunction, inflammation, and therefore histamine sensitivity, is unlikely to be involved. To confirm this, you might consider a time-limited trial, say 2-4 weeks, on a strict histamine-restricted diet. (See my article here.)

If your symptoms resolve, or improve significantly, histamine involvement would be strongly implicated and you would then need to continue the histamine-avoidance regimen to remain relatively symptom-free. If, however, following the histamine restrictions does not afford any symptomatic relief, you can confidently assume that histamine is not contributing to the cause of your symptoms and resume a normal diet.

I can see that you are attempting to help your condition with supplements. Just a few words on those in general.

Supplements and histamine

Quercetin is often suggested as a non-medicinal adjunct to antihistamine therapy; it is a bioflavonoid found in several fruits and vegetables. It is an antioxidant and reports suggest it to be a mast cell stabilizer. Certainly it would not be contraindicated: however, if inflammation and histamine excess is not involved in the cause of the problem, it probably would have very little effect in improving your symptoms.

Similarly, vitamin C has antihistaminic properties, but again, if histamine is not involved in your symptoms it may not help a great deal. For people who are experiencing histamine intolerance as a result of diamine oxidase deficiency, there is some evidence that vitamin C might reduce DAO activity slightly under some conditions, so there may be some contraindication to consuming high levels of the vitamin when DAO deficiency is the cause of histamine intolerance. However, in your case, since histamine intolerance and DAO are not indicated, you need not be concerned about this effect.

I am unclear exactly what you mean by “lowering histamine probiotics”. We do know that certain strains of micro-organisms produce histidine decarboxylase, which is the enzyme that converts histidine to histamine. When these strains are part of the microflora of the bowel they are able to convert histidine in residual protein from undigested food in the digestive tract into histamine that is absorbed into the body. However, we have no way to specifically remove these strains at that present stage of our knowledge. In contrast, we know that some strains of micro-organisms produce diamine oxidase and therefore might have the ability to break down histamine in the digestive tract. However, again, at the present time we do not have any probiotic that would deliver these specific micro-organisms to the digestive tract in the form of a probiotic.

Indiscriminately taking a probiotic as a treatment for histamine excess, which might be inferred by your question, would carry the risk of actually increasing histamine if one or more of the strains produce histidine decarboxylase. Until we know a lot more about the activity of each strain of microorganism in a probiotic and are able to select strains on the basis of their enzymatic properties it is unwise to take a probiotic in any attempt to manage histamine intolerance or sensitivity.

As I have mentioned many times in my articles, it is very important for anyone contemplating taking supplements to understand how each supplement acts in the body and to take only those necessary to balance a deficiency. Often the consumer is unaware of detrimental effects of taking unnecessary supplements that could actually cause harm by creating an imbalance. I strongly encourage all my patients and clients to become thoroughly educated in the risks and benefits of any supplement before making it part of their daily regimen.

August 2015

If this article was of interest you will find many other articles on unlikely allergies and allergy connections here – and links to many relevant research studies here.

• For many ore articles on histamine intolerance, go here.

For more on the more 'mainstream' allergies check in to our 'allergy and intolerance home page' – and for ideas on alternative foods go here.

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