Everything You Need To Know About Histamine Intolerance (2024)

Table of Contents
Evidence Based Causes of Histamine Intolerance and How to Overcome It What Is Histamine, and What Does It Do? Histamine Intolerance Symptoms Histamine Intolerance and Your Gut Dysbiosis & SIBO Low Levels of DAO Enzyme Hormone Fluctuations Over-Consuming Histamine Foods or DAO-Blockers How To Test for Histamine Intolerance Treating Histamine Intolerance: Diet, Probiotics, & Supplements Low-Histamine Diet Probiotics for Histamine Intolerance Other Supplements To Help Histamine Intolerance The Bottom Line

Articles

Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Written by Dr. Ruscio onNovember 21, 2020

Written by Dr. Ruscio on November 21, 2020 —Reviewed by Heidi Turner

Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.

Causes of Histamine Intolerance and How to Overcome It

  • What Is Histamine|
  • Symptoms|
  • |
  • Testing|
  • Treating Histamine Intolerance|
  • Low-Histamine Diet|
  • Probiotics|
  • Other Supplements|
  • The Bottom Line|

You probably know that histamine symptoms like hay fever, hives, and itching can be caused by seasonal or environmental allergies to things like pollen or animal dander. But you might not know that digestive and allergic symptoms can also be caused by histamine intolerance — a food intolerance triggered by histamine-rich food and drinks.

Histamine intoleranceaffects approximately 1% of Americans [1]. Women are more likely to develop histamine intolerancethan men[2, 3],and a surprising 30-55% of people with digestive symptomsor conditions like IBS, IBD, and Crohn’s disease have it[4].

Let’s discuss what histamine intoleranceis, what causes and triggers it, how it’s connected to gut health, and how to overcome it.

What Is Histamine, and What Does It Do?

Histamine is a naturally occurring organic chemical that is produced in your body. High amounts of histamine are also present in certain foods, such as red wine, fermented foods, and aged meats and cheeses.

When your body is exposed to an allergen, like pollen or dust, histamine is released from MAST cells,which are immune cells that travel the body looking for allergens. This release of histaminedirects your body to mobilize a white blood cellimmune responseto neutralize the threat.

When the immune system releases histamine in your tissues, you may experience allergy symptoms, such as itchy eyes, skin rashes, inflammation, or in extreme cases, life-threatening anaphylaxis.

Histamine is also a brain neurotransmitter and it’s also part of the complex series of biochemical reactions that release stomach acid [5], so a certain amount of histamine helps your body function normally.

Histamine intolerance is primarily an issue with excess histamine in the digestive tract, which can develop from gut imbalances.

Histamine Intolerance Symptoms

The common symptoms of histamine intoleranceare broad, affecting not just the digestive tract, but also the skin, brain, joints, and heart.You might be familiar with the itchy eyes, runny nose, nasal congestion, skin flushing, hives, or sneezingthat come with seasonal allergies, [6] and these symptoms can also happen with histamine intolerance. High levels of histamine can also trigger digestive symptoms like bloating [7],anddiarrhea [8], heart ratechanges or palpitations [9],low blood pressure[10], and headaches [11].

Everything You Need To Know About Histamine Intolerance (2)

Histamine Intolerance and Your Gut

​Histamine intoleranceresults from an excess of histamine in the digestive system where sensitivity to high histamine foodscauses both digestive and non-digestive symptoms.This sensitivity often results from poor gut health.

Histamine in the non-digestive tissues is cleared by the enzyme HNMT, but histamine in the digestive system — from bacteria, food, drinks, or an immune response to food allergens — is broken down by the DAO (diamine oxidase) enzyme[12]. If your levels of DAO enzymeare low, a build-up of histamine levelsin your digestive system can cause histamine symptoms.

There are several possible underlying causes for an increase of histamine in the digestive tract or a decrease of DAO enzymelevels.

Dysbiosis & SIBO

The digestive tract is full of histamine receptors, and the expression of these histamine receptorsis often altered in people with gastrointestinal diseases [13].

One study suggested that inflammation and intestinal permeability (leaky gut) caused by bacterial imbalance were likely involved in histamine intolerance[14]. Another study showed that 30%-55% of people with digestive symptoms also have histamine intolerance[15]. Bacteria produce histamine, so an overgrowth of bacteria contributes to histamine load.

SIBO (small intestinal bacterial overgrowth) is a specific type of dysbiosis that damages the lining of the small intestine and may trigger the loss of tolerance to dietary histamine [16].SIBO symptoms overlap significantly with histamine intolerance symptoms [17], indicating that at least some portion of histamine intolerance cases are related to SIBO.

Low Levels of DAO Enzyme

The DAO enzymeis responsible for breaking down histamine in the digestive tract. Low DAO activitycan lead to excess histamine and histamine intolerancesymptoms.Low DAO levelshave been associated with two Inflammatory Bowel Diseaseconditions — Crohn’s disease and ulcerative colitis [18, 19] — and histamine intoleranceis associated with leaky gut[20].

Genetics also play an important rolein levels of DAO enzyme.Some people have variations in the genes that affect DAO enzymefunction. If those gene variants are turned on, that person may be less efficient at breaking down dietary histamine due to a shortage of DAO enzyme[21].

Hormone Fluctuations

Some women notice that their histamine intolerancesymptoms are worse during certain parts of their menstrual cycle. This may be one reason why histamine intoleranceis more common for women than men [22, 23].Several studies suggest that estrogen fluctuations may decrease the amount of DAO enzymeavailable to help break down histamine[24, 25, 26].

Over-Consuming Histamine Foods or DAO-Blockers

If you eat lots of high-histamine foods, or foods the block DAO, such as alcohol [27], or black or green tea, your levels of histamine may exceed your ability to break down histamine.When levels of histamine build-up, either due to eating high-histamine foodsor reduced DAOaction in the gut, histamine symptoms occur.

In your unique situation, there is likely not one particular cause, but a perfect storm of causes and triggers that tips the balance toward histamine intolerance.

One way this can happen is when people shift to a healthier diet but include high amounts of high histamine foods, like spinach, avocados, sauerkraut, and kombucha. These are all perfectly healthy foods. But if you already have a brewing histamine problem close to the tipping point, suddenly increasing them could lead to histamine symptoms.

See Also
Diamine Oxidase (DAO): Benefits, Dosage, and Safety

How To Test for Histamine Intolerance

There’s no clear-cut test for histamine intolerance. Avoid getting pulled into the thinking that you need expensive testing to sort this problem out. That said, there are several options that provide at least partial answers.

The most accurate test would be a positive response to a low-histamine diet. If your symptoms resolve on a low-histamine dietand return with the reintroduction of high-histamine foods, this highly suggests your symptoms are caused by histamine intolerance.

Testing serum DAO levels may also help diagnose histamine intolerance. Research suggests serum DAO levels correlate with histamine intolerancesymptoms [28, 29, 30]. In one study, DAO levels below 10 U/ml were shown to increase the risk of histamine intolerance, especially in people who also showed digestive symptoms and responded to a low histamine diet[31].

Everything You Need To Know About Histamine Intolerance (3)

Similar to a histamine elimination diet, doing a trial with a DAO supplement may give you good information. If your symptoms subside when using DAO, that’s a sign that histamine intoleranceis the cause of your symptoms.

Allergy tests, like the skin prick testsoffered by allergists, check for IgE-mediated allergies to things like dust, pollen, or certain foods. Positive results on skin prick testsdo not indicate intolerance to histamine foods. People with histamine symptoms but negative results on a skin prick testmay still find relief from a low-histamine diet.

Everything You Need To Know About Histamine Intolerance (4)

Treating Histamine Intolerance: Diet, Probiotics, & Supplements

A low histamine diet, coupled with a DAO enzymeand gut health support is the best option available to help you reduce your histamine burden and resolve histamine intolerancesymptoms.

Eating a basic, anti-inflammatory diet to avoid common food sensitivities and additives is one of the first steps to take to repair your gut health. The paleo diet is a good, basic option.

Low-Histamine Diet

If you continue to have histamine symptoms on a basic healing diet, adapt that diet to the low-histamine diet. A low-histamine diet has been shown to reduce or eliminate histamine intolerance symptoms [32], and to increase levels of DAO enzyme [33]. Eliminate high histamine foodsfor 2-3 weeks and assess your symptoms. If they haven’t changed, chances are histamine isn’t the cause.

If you do experience relief on the low-histamine diet, you can slowly reintroduce histamine foods to try and discover your unique tolerance threshold.

High-Histamine Foods

Everything You Need To Know About Histamine Intolerance (5)

Histamine in food is produced by bacteria and yeast as they break the amino acid histidinedown into histamine. This means that fermented foods, or foods made with yeast, like alcohol or vinegar, are higher in histamine than other foods. Histamine liberators, like citrus fruitsor energy drinks, may also need to be avoided.

In addition to high-histamine foods, a key thing to avoid during a low-histamine dietis leftovers.Histamine levelsin protein-rich leftovers, like meat dishes, or raw meat and fish, increase the longer they are stored in the refrigerator. Store leftovers in the freezer, and cook or freeze raw meat quickly to avoid high histamine levels.

For your reference, here is a partial list of histamine-rich foodsto avoid on a low-histamine diet. For a more complete list, see our Histamine Diet mini eBook.

  • Alcoholic beverages of any kind (especially red wine)
  • Certain fruits and vegetables, including avocado, dried fruits, eggplant, spinach, and tomatoes, and ketchup
  • Fermented meat and dairy products, including aged cheeses, salami, sausages, and pepperoni
  • Fermented foods, including kombucha, water kefir, kimchi, sauerkraut, pickles, miso, natto, soy sauce, tamari, coconut aminos, liquid aminos, and vinegars
  • Fish and seafood, particularly tuna or mackerel, especially if left over, smoked, salted, or canned, or not gutted and frozen immediately after harvest [34]
  • Tea (black, green, white, or yerba mate tea)
  • Yeast products

Low-Histamine Foods

There are plenty of delicious foods to eat on a low-histamine diet. Build healthy, simple, and tasty menus centered around:

  • Fresh meat and lower histamine fish
  • Gluten-free grains like rice, quinoa, or millet
  • Fresh vegetables like lettuce, cucumbers, zucchini, kale, onions, green beans, peppers, or sweet potatoes
  • Fresh fruits like apples, blueberries, kiwis, or pears
  • Healthy fats like olive oil, butter, ghee, coconut oil, or coconut milk
  • Herbal teas

See How to Use a Low Histamine Dietfor Histamine Intolerancefor more detailed information.

Probiotics for Histamine Intolerance

The low-histamine diet, DAO enzymes, and antihistaminemedications can help reduce histamine intolerancesymptoms, but one study showed that once DAO supplementation was stopped, the symptoms returned [35]. Probiotics are one strategy for resolving the underlying dysbiosis that may be increasing inflammation, damaging the small intestinal lining, and reducing DAO levels.

There is some controversy about whether or not probiotics improve histamine intolerance. We don’t have direct research that shows probiotics improve histamine intolerance, but we do have evidence that probiotics benefit immune- and histamine-mediated conditions.

Research suggests that probiotics actually lower histamine levelsin the digestive tract[36].

Research clearly shows that probiotics reduce gut inflammation and help resolve infections that increase histamine intolerance, such as SIBO [37, 38, 39], as well as bacterial and parasitic infections [40, 41, 42, 43]. Probiotics have also been shown to benefit histamine-mediated conditions, such as seasonal allergies [44, 45], non-allergic rhinitis [46], and eczema and asthma [47, 48, 49]. Though the specific mechanism has not been demonstrated in studies, these data suggest that probiotics can help mediate histamine symptoms.

Some suggest the need to take special, “low-histamine” probiotics. This isn’t necessarybecause probiotics appear to be net-antihistamine. Including a quality probioticfrom each of the three main categories — Lactobacillus and Bifidobacteria blends, Saccharomyces boulardii, and soil-based probiotics — is an effective strategy to improve histamine intolerance. For more on how to use probiotics, see our Probiotics Starter Guide.

Other Supplements To Help Histamine Intolerance

Vitamin B6is an important cofactor for the efficient function of the DAO enzyme. Several studies demonstrated that vitamin B6 supplementation helps reduce symptoms of histamine intolerance, suggesting that B6 deficiency may reduce levels of DAO enzyme[50, 51, 52].

Quercetinis a plant flavonoid that has demonstrated an antihistamine and anti-inflammatory effect and may help reduce histamine intolerance symptoms [53, 54, 55].

Vitamin Chas been shown to reduce serum histamine levels [56], and is known to have antihistamine properties [57]. Supplemental vitamin C may help you manage your symptoms of histamine intolerance while you work on the underlying causes.

The Bottom Line

Digestive, allergic, and neurological symptoms may be caused by histamine intolerance, which is a loss of your body’s ability to properly break down dietary histamine. Testing your response to a low-histamine dietor a DAO supplement can help you determine if histamine intoleranceis the cause of these symptoms. Probiotics can improve the gut dysbiosis and inflammation that is likely causing your histamine intolerance.

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