Histamine intolerance symptoms, diagnosis and treatment.


If your body reacts to a diverse group of foods, such as spinach, tomatoes, wine, and sauerkraut, with symptoms that can include a stuffy nose or migraines, you may not be allergic to these foods. Instead, you may have a so-called histamine intolerance, as all of these foods contain high levels of histamine.

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Histamine is a chemical that our body produces naturally and is also found in some foods. In "real" allergy situations, your body releases histamine, which triggers what we consider an allergic reaction.

Histamine intolerance is not a true allergic reaction . Instead, it refers to the reaction that some people have to foods that are high in natural histamine.


The most common symptoms of histamine intolerance are migraines , digestive symptoms such as diarrhea, hot flashes, hives, worsening eczema, nasal congestion, runny or itchy nose, and red, watery and itchy eyes.

Histamine intolerance can also cause more serious symptoms. It can cause asthma attacks or anaphylactic shock , it can make your heart beat erratically, and it can be associated with serious chronic conditions like Crohn 's disease.


People with histamine intolerance often have low levels of one of two very specific enzymes: diamine oxidase (DAO) and histamine N-methyltransferase (HNMT), which metabolize histamine in the body. Without a sufficient amount of these enzymes, histamine can build up and cause symptoms throughout the body.


If you think you may repeatedly experience symptoms after eating foods high in histamine, keeping a food diary can help you and your healthcare provider track the structure of the foods that are causing your symptoms.

Diagnosing histamine intolerance can be challenging. Eating foods high in histamine (or multiple foods at the same time) may be enough to push you to the limit one day, but not enough to push you another day.

By avoiding foods that are high in histamine, you can reduce histamine buildup, which can reduce or eliminate your symptoms.

Traditional allergy tests (skin prick tests and ELISA IgE blood tests) cannot diagnose histamine intolerance. The only way to know if you have this condition is to try a histamine-free diet followed by a double-blind food test.

Watch out

Treatment depends on avoiding a histamine-free diet. There are medications and other techniques that can be used in conjunction with dietary modifications.

You should also inform your doctor of any prescription or over-the-counter medications you are taking. Some medications can interfere with the action of the enzymes that work with histamine.

If you are taking this drug, your healthcare provider may adjust the dose, switch you to a similar drug that does not affect histamine, or, if possible, stop the drug altogether.

A histamine-free diet

Following a strict histamine-free diet is key to alleviating the symptoms of histamine intolerance. Your healthcare provider will explain which foods to avoid, but fermented and aged foods, as well as some vegetables that are high in histamine, are more likely to cause problems.

Most foods high in histamine are highly processed or fermented. These include wine (especially red), aged cheese such as Parmesan cheese, foods that contain yeast, and sauerkraut. Spinach and tomatoes are also rich in histamine.

Also, although citrus fruits are not considered rich in histamine, they can trigger the release of accumulated histamine in the body. Therefore, people who follow a strict histamine-free diet are generally advised to avoid oranges, grapefruits, and other citrus fruits.

'Red wine migraines' are often a histamine intolerance headache, and red wine contains a lot of histamine.

All alcoholic beverages can be problematic for people with histamine intolerance because alcohol can reduce the effectiveness of DAO. Therefore, avoiding alcohol is part of a histamine-free diet strategy.


Although a histamine-free diet is the only long-term treatment for histamine intolerance, there are several other treatments that may be helpful. Benadryl (an over-the-counter antihistamine) may be helpful if you accidentally eat foods that contain histamine or if you must take medications that can block the activity of an enzyme that converts histamine.


There are also supplements that some healthcare professionals recommend for people with histamine intolerance. These include high doses of vitamin C and vitamin B6 (which can stimulate the activity of histamine-processing enzymes in your body).

DAO enzyme capsules can supplement the body's natural reserves. Diem Labs, LLC is the only manufacturer to market the DAO enzyme in the United States; Look for the brand name Umbrellux DAO.

While these treatments can help, they are not a substitute for a histamine-free diet. Talk to your doctor if you want to try these supplements to see if they can improve your symptoms.

Frequently asked questions

How long does it take to get rid of the symptoms of histamine intolerance?

This can take three to four weeks. An observational study found that 90% of histamine intolerant patients on a low-histamine diet for four weeks had improved headache symptoms.

What healthcare provider can diagnose histamine intolerance?

Your healthcare provider can help you determine if you need to see a specialist. They may refer you to an allergist to determine if your symptoms are caused by food allergies or histamine intolerance.

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