A low-histamine diet can be suggested for people who have histamine intolerance. Histamine is a chemical released by mast cells in the immune system when the body encounters an allergen, which causes an allergic reaction.
Histamine intolerance, otherwise referred to as enteral histaminosis, is a rare condition that is estimated to affect about 1% of the population. It is very hard to diagnose and is often characterized by symptoms such as itching, hives, sneezing, watery eyes, asthma, headaches, abdominal pain, diarrhea, tachycardia, and hypotension.
Ingesting a large quantity of foods high in histamine can trigger this response, but figuring out which foods triggered the response can be complicated.
Once food allergies have been ruled out, people can try a low-histamine diet. Foods to avoid on a low-histamine diet include aged cheeses, processed meats, dairy products, alcohol, and certain fruits and vegetables. Eating whole, unprocessed foods is also important.
Although this type of diet may help in the management of histamine intolerance, it is very restrictive and can lead to malnutrition if followed long-term. People following a low-histamine diet should be seen by a registered dietitian or nutritionist to make sure they are receiving adequate nutrition.
Benefits of a Low-Histamine Diet
There aren’t many studies examining the benefits of a low-histamine diet, likely due to the difficulty of following a low-histamine diet and the complexity of diagnosing histamine intolerance.
A small study conducted in Italy in 2016 found that, when people restricted their intake of histamine-provoking foods, their symptoms improved. These people did not have food allergies or other gastrointestinal diseases.
There are many limitations in examining the role of histamine in the diet, and most of the time, individual cases need to be examined to determine the actual source of the intolerance. Part of the reason for this is because it’s not possible to avoid histamine altogether—exposure to histamine goes beyond diet.
Additionally, because some people are more sensitive to histamine, a dose-dependent response is plausible (meaning that the response may only occur after certain exposure threshold).
This makes following an elimination diet (where certain foods are avoided and then added back in at specific times) especially important. Keeping a food journal for a few weeks to track symptoms is also important in discovering the trigger foods.
Histamine Intolerance vs. Histamine Toxicity
Histamine toxicity, also known as scombrotoxic fish poisoning, is a form of food poisoning caused by eating spoiled finfish, such as tuna or mackerel. It is neither an allergy nor intolerance but is still treated with antihistamines and supportive care.
Diagnosing Histamine Intolerance
If food allergies and other gastrointestinal diseases such as celiac disease have been ruled out, your healthcare provider may try to determine if you are histamine intolerant.
To do so, they may ask you to take a skin prick test (which can be unreliable) or measure your blood to test your diamine oxidase activity (DOA), the main enzyme involved in the metabolism of histamine. Oftentimes, people with histamine intolerance have an imbalance of histamine due to a combination of too much histamine and lack of DOA.
How a Low-Histamine Diet Works
If you are histamine intolerant, you may be told to follow a low-histamine diet. Because everyone responds to histamine differently, an individualized meal plan should be created.
Most of the time, you will start slowly by taking out high-histamine foods and logging symptoms. If you find that your symptoms have improved after removing a trigger food, you can omit that food temporarily and attempt to add it back into your diet in about a month.
There is no specific scientific protocol for elimination diets, therefore, it will be important to work with a registered dietitian to make sure you are receiving adequate nutrition and are getting all your vitamins and minerals.
The rate at which you eliminate and add foods back in will be determined by your tolerance and symptoms.
A 2018 study in the Journal of Dermatology reported that people with severe histamine intolerance with urticaria (hives) can benefit significantly from a histamine-free diet. According to the researchers, after just four weeks, the diet helped reduce the severity of urticaria and, in some cases, led to the complete resolution of symptoms.
What To Eat and Avoid on a Low-Histamine Diet
Eating a diet rich in whole, non-processed foods will be important. Foods that are very ripe, aged, fermented, or soured should also be avoided. Certain fruits and vegetables can induce a histamine response, too.
Foods to Eat
Fresh meat: Including beef, pork, and poultry
Cooked ham: Only uncured ham with no preservatives or yeast extract
Eggs: Including chicken, quail, and duck
Fresh or frozen fish: Including pollock, cod, trout, whitefish, and perch
Fresh dairy: Including milk, butter, and cream
Non-matured cheese: Including cream cheese, mascarpone, mozzarella curd, and young Gouda
Vegetables: All, with the exception of those on the excluded list
Fruits: All, with the exception of those on the excluded list
Beverages: Herbal teas, rooibos nature, fresh juices, almond milk, coconut milk, coconut water
Condiments: Distilled white vinegar, apple cider vinegar, garlic, mild spices
Sweets: Honey, agave, jams made from acceptable fruits
Grains: Including breakfast cereals, oats, cream of wheat, and pasta
See AlsoWhat Is the Low-Histamine Diet?Nuts: Macadamia, chestnuts
Foods to Avoid
Excluded meat: Bone-matured or dry aged meat (particularly beef)
Processed meats: Including sausage, cured meats, dried cured hams, bacon, canned meats, meat spreads, and cold cuts
Excluded fish: Tuna, mackerel, herring, sardines, anchovies, and mahi mahi
Shellfish: Mussels, lobsters, crabs, shrimps, prawns
Processed fish and seafood: Including canned, marinated, salted, dried, smoked, or pickled fish or seafood
Excluded dairy: Buttermilk, yogurt sour cream
Matured cheese: Including hard, semi-soft, blue, and soft ripened cheeses
Excluded vegetables: Spinach, tomatoes, eggplant, mushrooms
Legumes: Lentils, beans
Excluded fruits: Citrus fruits, papaya, strawberries, pineapple, banana, raspberries, kiwi, pears, guavar
Excluded beverages: Sodas, sweetened juice drinks, energy drinks, tomato juice
Alcohol: Including spirits, aperitifs, brandy, wine, and beer
Excluded condiments: Wine vinegar, balsamic vinegar, fish sauce, ketchup, soy sauce, hot spices, yeast extract
Excluded sweets: Cocoa, chocolate, carob, licorice
Nuts: All with the exception of macadamia and chestnut
Fermented foods: Including sauerkraut, pickles, kimchi, kefir, and kombucha
Soy: Including edamame, tofu soymilk, tempeh, soy protein, and natto
Strawberries Are Incredibly Good for You: Here’s Why
In addition to your choice of foods, the way that you cook your food can increase or decrease your risk of histamine intolerance. For instance, the longer a food is left out, the more histamine will be produced. Plan to cook your meat or fish right away. Moreover, steaming or braising meat or seafood produces far less histamine than grilling.
Some people may also be advised to supplement with B vitamins, calcium, copper, zinc, and other micronutrients. Research suggests that a low intake of key micronutrients is linked to an increased risk of histamine intolerance.
Keeping a food journal can help because you may be able to determine how much of a food you can reasonably eat. For example, some people may be able to eat a strawberry or two without incident. Others may have a reaction with just one bite.
Considerations
While limited data have suggested that following a low-histamine diet can reduce the symptoms of histamine intolerance, more research needs to be done in this area. Keep in mind that because this diet is somewhat restrictive, it is not meant for everyone.
General Nutrition
Overall, if done right, this diet can be a healthy one. But it important to ensure that you are eating a variety of fruit, vegetables, healthy fats, and protein.
Because one of the main focuses of the diet is the elimination of foods, people can fall into the trap of eating too much of one type of food and not enough of another. To avoid this, meet with a registered dietitian who can help you select a healthy variety of foods.
Practicality
The diet is hard to sustain as you really cannot eat anything processed, packaged, canned, or pre-prepared. Many people rely on the convenience of these foods, particularly when they have a busy job or are managing a family. Whole foods can also be expensive.
Keep in mind that, most of the time, the diet is used temporarily until your symptoms are better managed. To reduce costs, buy local and seasonal foods whenever possible.
Other Diets
A low-histamine diet is one approach to overcoming histamine intolerance, but there are others that may help. Among them, a low-FODMAP diet was reported to help reduce the amount of histamine produced by the gut, according to a 2017 study in the Journal of the Academy of Nutrition and Dietetics.
FODMAP—which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—are short-chain carbohydrates that resist digestion, including certain fruits that high in fructose, dairy products that are high in lactose, and cereal grains that are high in fructans.
A low-FODMAP diet is frequently used to treat irritable bowel syndrome (IBS) but may help some people with histamine intolerance, particularly if they experience severe diarrhea.
A Word From Verywell
A low-histamine diet has been shown to help improve symptoms of histamine intolerance, which can produce allergy-related symptoms such as sneezing, headaches, and itchy skin.
As much as you may want to self-treat your symptoms with diet, it is still wise to speak with your healthcare provider before starting. While you may assume that you have histamine intolerance, there may be other causes for your condition, such as celiac disease, lactose intolerance, gallbladder problems, and others.
