What is Histamine Intolerance? 

Histamine Intolerance is a clinical food intolerance, not an allergic reaction. It happens when the body is not able to process/breakdown histamine from food fast enough. This results in symptoms caused by a buildup of histamine in the body.

This inability to break down histamine fast enough is often associated with Diamine Oxidase (DAO), which can occur due to genetic predisposition or mutation, may be medication-induced, or can be the result of other Gastrointestinal (GI) problems such as nonceliac gluten intolerance, ulcerative colitis, and Crohn’s disease.

What symptoms are associated with histamine intolerance?

A wide variety of symptoms include (not an extensive list):

• GI symptoms: bloating, gas, stomach fullness immediately after eating that lasts a long time, diarrhea, abdominal pain, constipation, nausea, vomiting
• Circulatory symptoms: fast heartbeat, weak muscle tone, collapse
• Nervous system symptoms: headache, dizziness
• Respiratory symptoms: runny nose, inflamed sinuses, nasal congestion, sneezing, difficulty breathing
• Skin symptoms: itching, flush/redness, hives, eczema, swelling

How is histamine intolerance diagnosed?

Typically, doctors will start by testing to rule out true food allergies (blood tests, skin allergy tests, etc.). If there are no true food allergies, then patient’s are advised to try a low-histamine diet for 4-6 weeks. If symptoms improve, this can be enough to diagnose a patient with histamine intolerance. New testing mechanisms are becoming available but are not widely used yet. 

How is histamine intolerance managed?

• The standard treatment is Low Histamine Diet which involves avoiding foods deemed high in histamine. There are a number of perspectives on which foods should be on this list. (See Appendix 1)
• Patient’s may also be advised to supplement with DAO to help bolster their DAO if it is low. My preferred brand is Seeking Health Histamine Digest, which you can find at a discount on my Fullscript site. 
• According to recent research, legume sprouts are also thought to be high in DAO. 
• Eat your foods as fresh as possible. Studies have shown a significant increase in histamine concentration in spinach when stored in a refrigerator for 15 days. The fresher your food, the lower the histamine.
• Avoid alcohol if you’re going to eat other foods on this “high histamine” list. Alcohol can exacerbate the histamine intolerance reaction.
• Antihistamines may help but please note that some antihistamines can actually lower DAO activity, which could be counterproductive. 
• Stop or replace DAO-lowering medications and supplements (if possible). See Appendix 2. Note: if this applies to you and you choose to go this route, you must to do this in collaboration with your prescribing physician. Do not start/stop any prescription medications without your MD’s advice.

Can East Asian Medicine help with histamine intolerance?

I’d say so! Integrative East Asian modalities such as acupuncture, herbal formulas, and moxibustion can help to support the body’s natural histamine breakdown process. It can also help to reduce symptoms of a histamine tolerance flare. Schedule a session to learn more.  

Appendix 1

There are a number of “low histamine food” lists that do not agree on which foods are “high histamine” so it’s tough to know what to avoid. 

Additionally, not every food on the low histamine diet list actually has high histamine content. Researchers are still trying to determine why those foods sometimes cause a histamine intolerance response and/or why they’re on the lists.

Almost all low histamine diet lists agree to AVOID the following foods as it’s confirmed they often have high histamine content:

• Sauerkraut
• Spinach
• Eggplant

The foods below tend to have a range of histamine accumulation, so they could be low-medium-high depending on the actual individual item at that given point in time. This means you could eat one piece of cheese and the histamine is low but another piece from the same block might be high. You may want to avoid:

• Dry fermented sausages
• Cured, semi-cured, and grated cheese
• Wine
• Fish & fish derivatives (especially mackerel, tuna, sardines, and anchovies)
• Soy-fermented products

The foods on the below list have been identified as histamine-liberators so they may not necessarily have high histamine content themselves but can trigger the release of histamine already in your body. You may want to avoid:

• Citrus
• Seafood
• Papaya
• Tomato
• Nuts
• Pineapple
• Chocolate
• Strawberries

The foods on the below list are the remaining foods that tend to show up on many low histamine diet lists with about 20-60% regularity (i.e. researchers mostly agree these may sometimes have high histamine content, but not all the time). You may want to avoid:

• Fermented cabbage
• Beer
• Shellfish
• Eggs
• Avocado
• Banana
• Kiwi
• Plum
• Chocolate
• Milk
• Lentils
• Chickpeas
• Soybeans
• Mushrooms 

The jury is out on whether each item on the 20-60% lists must truly be avoided, so I say test to your level of comfort. 

One of the primary initiators of a histamine intolerance response is the histamine content of the food, which can vary within the food itself (even from strawberry to strawberry in a pack). So it’s important to understand that you may not have to strictly avoid all foods all the time but understand the risks and how your body responds to that food’s average histamine content. 

The concentration of histamine in a given food is based on the natural breakdown of the food. So, one way to reduce exposure to high histamine foods is to eat your foods as fresh as possible, including fish and meat. The longer something has been picked, packed, prepared – the longer microbes have had to start breaking it down and turning Histidine into Histamine (a buildup of which leads to the intolerance response).

Appendix 2

Medications that can lower DAO (low DAO can lead to histamine intolerance):

• Chloroquine (Antimalarial)
• Clavulanic acid (Antibiotic)
• Colistimethate (Antibiotic)
• Cefuroxime (Antibiotic)
• Verapamil (Antihypertensive)
• Clonidine (Antihypertensive)
• Dihydralazine (Antihypertensive)
• Pentamidine (Antiprotozoal)
• Isoniazid (Antituberculous)
• Metamizole (Analgesic)
• Diclofenac (Analgesic & anti-inflammatory)
• Acetylcysteine (Mucoactive)
• Amitriptyline (Antidepressant)
• Metoclopramide (Antiemetic)
• Suxamethonium (Muscle Relaxant)
• Cimetidine (Antihistamine – H2 Antagonist) [Antacid]
• Prometazina (Antihistamine – H1 Antagonist) [Antiemetic/Motion Sickness]
• Ascorbic Acid (Vitamin C)
• Thiamine (B1)

This information is intended to be informational, please work with your primary care physician if you suspect you may have histamine intolerance or food allergies.