Histamine intolerance symptoms are non-specific and may be due to many things, but consider histamine intolerance (HIT) if any of the following symptoms occur regularly.
- Rashes, Hives, or Eczema
- Headaches or migraines
- Unexplained itching
- Low blood pressure
- Itchy eyes/runny nose/congestion
- Premenstrual cramping or headaches
- See additional symptoms below
What Is Histamine?
Histamine is found naturally in the body.
Histamine is a chemical that is naturally found in the body. It is stored primarily in mast cells. It is also a natural component of many foods, a vital part of the immune and nervous systems, and plays an important role in inflammation.
What Is Histamine Intolerance?
Histamine intolerance (HIT) is thought to be related to a build-up of histamine.
In a healthy person, histamine is broken down by two enzymes: DAO and HNMT. When one of these enzymes isn’t working correctly, histamine intolerance can occur.
DAO is made in the intestines. If the intestines are not healthy, there may not be enough DAO to break down histamine normally. When build-up occurs, so do symptoms. Decreased DAO levels may explain why HIT symptoms are more common in persons with gastrointestinal disorders such as inflammatory bowel disease, IBS, celiac, and SIBO. Certain medications can also block DAO activity.
Symptoms Of Histamine Intolerance
The following are the most common symptoms of histamine intolerance:
- Rash /Urticaria (hives)/eczema
- Arrhythmia ( irregular heartbeat)
- Low blood pressure
- Runny nose
- Watery eyes
- Swelling of face/hands/lips
- Itchy skin
- PMS- Headaches around the menstrual cycle or painful cramps are the most common
Histamine Intolerance Is Connected To Other Health Problems
Histamine intolerance is more common in people with underlying digestive issues.
Conditions such as inflammatory bowel disease, celiac disease, IBS, and SIBO increase the risk of histamine intolerance. There is minimal information on the actual incidence of HIT. Its correlation with other health issues is emerging.
It Is Not A Food Allergy
Certain foods can trigger histamine intolerance symptoms. But it is different than a food allergy.
Some histamine intolerance symptoms mimic an actual allergic reaction. But the body’s response at the cellular level is different, so skin testing and blood allergy tests will be negative.
HIT is thought to be due to a build-up of histamine. Because of this, the symptoms may not be immediate. Symptoms may be triggered any time your “threshold” is reached. Because of this, it may be difficult to pinpoint a particular culprit.
For example, you may have consumed high-histamine foods in the morning but low-histamine food in the afternoon. Even though the afternoon food was low in histamine, it put you over your tolerance level. So, symptoms occur in the afternoon. You might think your symptoms were due to the afternoon food, but the morning foods were more problematic in reality.
What To Do If You Think You Have Histamine Intolerance
Speak to your physician to evaluate other possible “look-alike” conditions.
Conditions such as true allergies, mast cell disorders, or underlying digestive disorders can look similar to histamine intolerance. If these possibilities have been evaluated and addressed, an elimination diet may be initiated to see if symptoms improve. A food diary is essential. Underlying issues must be corrected first for the best outcome. Because the diet is restrictive, please consult a professional to ensure proper nutritional intake.
Histamine Intolerance Test
A trial of a low histamine diet is used to determine the presence of histamine intolerance.
There are currently no proven tests to diagnose histamine intolerance. It is possible to measure blood DAO activity (one of the enzymes listed above), and histamine levels. These results do not seem to correlate with symptoms. Typical blood allergy tests or skin testing will not be positive, as HIT is not IgE mediated (like true allergies).
It is important to remember that while considering HIT as a cause of symptoms you must evaluate for related disorders such as true allergies, mast cell disorders, inflammatory bowel disease, celiac disease, fructose malabsorption, small intestinal bacterial overgrowth, colitis, etc.
After the evaluation of related disorders, a diet eliminating high histamine foods may be pursued. If symptoms improve when histamine is lowered or eliminated from the diet you may be histamine intolerant.
Treatment For Histamine Intolerance
Treat any underlying disorder first. This may improve histamine tolerance.
I generally focus on dietary treatments because I prefer to do as much as possible with diet instead of medication. However, HIT truly requires an integrative approach, as it often occurs in conjunction with other disorders that need to be addressed beyond dietary modifications.
Diet: A low histamine diet is the treatment of choice (food lists are below). This can be challenging if someone is already on a restricted diet, such as a gluten-free or low FODMAP diet, and should be done under the care of a health care practitioner to maintain proper nutritional intake. The tolerance to histamine varies from person to person, and the foods tolerated must be deduced by trial and error. Some people can only tolerate tiny amounts, and others can be more liberal.
It is important to note that histamine tolerance seems to improve once underlying issues are addressed. For example, if IBS or SIBO are treated, symptoms often decrease. It is imperative to treat the underlying disorder in conjunction with dietary changes.
Once the elimination diet is completed, one must individually assess tolerance to particular foods and liberalize the diet as tolerated so that optimum nutrition and lifestyle are attained.
Sleep: 7-8 hours a night helps everything!
Support: Health issues and dietary restrictions are stressful and challenging. Seek help from family, community, faith organizations, online support groups, and local support groups. Avoid those who provide negative interactions. Negative interactions delay healing.
Exercise: Any exercise is helpful. Aim for 30-60 minutes daily. Don’t feel bad if you only fit in 15 – it still helps!
Relaxation: The benefits of relaxation techniques cannot be emphasized enough. Breathing exercises or progressive muscle relaxation are easy, portable, and free. Yoga and meditation are great as well. Relaxation for you may also be reading, enjoying time with friends, or playing music.
Medications: Antihistamines, topical steroids/creams, oral steroids, topical homeopathic or plant-based creams, and lotions for rashes.
Books: Try a low histamine cookbook. It will make preparing meals easier, especially during the elimination phase.
Supplements: There is little to no data on these, but the following are sometimes used. Vit C, B6, Zn, Cu, Magnesium, Mangosteen, Quercetin, DAO promoters, DAO supplements, and topical creams. Please use any supplement under the guidance of a practitioner. Supplements can be helpful when used properly, but supplements can also have toxic side effects.
Foods On A Low Histamine Diet
Low histamine foods
- Eat fresh food as much as possible
- Fresh meat and fish (avoid canned meat and fish)
- Fresh fruit, except strawberry, citrus
- Fresh vegetables, except tomatoes, spinach, and cabbage
- Grains: rice, corn, millet, oats, sorghum
- Oils: Most cooking oils
Foods High In Histamine
High histamine foods
The list below contains commonly accepted high histamine foods/histamine liberators. This list is by no means exhaustive. Available lists vary and consistent data is hard to find on the histamine content of foods.
Fermented and aged foods are some of the biggest culprits.
• Alcohol: Champagne, red wine, beer, white wine,
• Fermented or smoked Meats/Fish: Sardine, mackerel, herring, tuna, salami
• Pickled or canned foods: Sauerkraut, pickles, relishes, soy sauce
• Fermented milk products: Yogurt, kefir, buttermilk
• Aged cheeses: Parmesan, Gouda, Swiss, cheddar.
• Fruit: Dried fruit, strawberries, citrus
• Vegetables: Tomatoes and tomato products, spinach
• Legumes: Chickpeas, soybeans, peanuts
• Other: Cinnamon, chocolate
• Grains: Wheat
• Histamine releasers: Citrus, papaya, pineapple, nuts, strawberries, egg white, additives
• DAO blockers: alcohol, black and green tea
- The histamine content of food varies depending on the duration of storage, ripeness or maturity, cooking, and processing.
- Certain foods may also not be high in histamine yet are high in compounds known as histamine liberators which can trigger similar symptoms.
Medications That Can Trigger Histamine Intolerance
These medications block the DAO enzyme:
• Cimetidine (Tagamet)
• Contrast Media
• Diazepam (Valium)
• Metoclopramide (Reglan)
• Naproxen (Aleve)
• Narcotics-Thiopental (IV med. for surgery)