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Histamine is a chemical naturally produced by your body’s immune system.
While necessary for controlling inflammation, too much histamine can cause various symptoms that mimic an allergic reaction or food intolerance.
Because many foods contain histamine or trigger your body’s production of the chemical, consuming a low-histamine diet may help prevent or reduce these symptoms.
This article explains how a low-histamine diet works and provides a list of low-histamine foods as well as a sample menu.
What is histamine intolerance?
Histamine intolerance occurs when more histamine accumulates in the body — typically from food — than what it can handle (1).
Histamine plays a variety of important bodily functions, but it’s best known for its role in triggering your body’s inflammatory response to a toxin or an invading pathogen like a virus, bacteria, or allergen (2).
Diamine oxidase (DAO) is the main enzyme responsible for breaking down histamine.
People with histamine intolerance typically have low or no DAO activity, resulting in increased histamine concentrations that trigger various symptoms.
Symptoms of histamine intolerance include (3):
- stomach pain
- heart palpitations
- skin flushing or itching
A deficiency in the DAO enzyme may be due to genetics or the presence of another disease that affects the digestive system, such as inflammatory bowel disease.
Many classes of medications like antibiotics, antidepressants, and NSAIDs can also block the action of the DAO enzyme, causing histamine intolerance (3).
Approximately 1% of the population is estimated to have histamine intolerance, though the prevalence is likely much higher since it’s thought to be underdiagnosed (1).
While there are a variety of diagnostic tests used to diagnose histamine intolerance, there remains no gold standard (3).
Currently, the most recommended strategy to prevent or reduce the symptoms associated with histamine intolerance is to follow a low-histamine diet (4).
Low-histamine diet foods
A low-histamine diet is a type of elimination diet that limits foods high in histamine.
The diet also limits foods that may interfere with histamine metabolism or that trigger the body’s production of histamine.
A low-histamine diet can be very strict, so it’s best to receive guidance from a registered dietitian so you can ensure you’re getting adequate nutrition.
Foods to avoid
Here is a list of high-histamine foods to avoid (4):
- Vegetables: eggplant, spinach, tomato
- Fermented foods and beverages: beer, cider, cheese (especially aged), kefir, kombucha, kimchi, yogurt, sauerkraut, and soy-fermented products like tempeh, miso, and natto
- Seafood: preserved or processed fish, especially anchovy, mackerel, tuna, and sardines
- Cured meats: bacon, corned beef, ham, pastrami, pepperoni, sausages, etc.
Of these, fermented foods and beverages tend to contain the highest amounts of histamine.
This is because the fermentation process converts the amino acid l-histidine to histamine.
Still, the histamine content of foods can vary depending on how its processed, stored, and whether it contains any additives.
Other foods don’t contain high levels of histamine but they contain chemicals that can block the DAO enzyme or trigger your cells to release histamine, causing symptoms in some people.
- citrus fruits
- nuts and nut butters
Since these foods don’t provoke symptoms in everyone, it’s best to eliminate them from your diet for 10–14 days and then reintroduce them, one at a time, to see if they cause a reaction (3).
Foods to eat
- Fruits: apples, apricots, blueberries, cherries, pears, peaches, and watermelon
- Vegetables: artichoke, asparagus, broccoli, carrots, cauliflower, cucumbers, and potatoes
- Grains and grain products: breads, cereals, oats, pastas, popcorn, and rice
- Fresh meats: fresh beef, lamb, pork, and poultry
- Fresh poultry: chicken, duck, goose, turkey, and eggs
- Fresh seafood: fresh fish like tilapia, herring, tuna, and salmon
- Dairy: buttercream, butter, cottage cheese, and milk
- Spices and herbs
- Oils: canola and extra-virgin olive oil
- Beverages: coffee, cow milk and milk alternatives, tea, and water
Sample low-histamine diet menu
Here’s a one-day sample low-histamine diet menu:
- Breakfast: quick oats cooked with milk and topped with blueberries and a dash of cinnamon
- Snack: cottage cheese with peaches
- Lunch: grilled chicken, whole-grain pasta, and broccoli
- Snack: apple slices
- Dinner: fresh salmon, steamed potato, and sauteed asparagus
Who may benefit from a low-histamine diet?
In addition to relieving symptoms in people with histamine intolerance, a low-histamine diet may be beneficial for people with certain allergic conditions (8).
Chronic spontaneous urticaria (CSU)
CSU is a skin condition that causes reoccurring urticaria — or hives — and areas of swelling.
While the exact cause of CSU remains unknown, some people with the condition have reported improvements in symptoms after following a low-histamine diet (10).
In one study, 75% of patients with CSU who followed a low-histamine diet for at least three weeks reported a significant improvement in skin itching and hive severity (7).
The patients in the study were also able to decrease their reliance on antihistamines for symptom relief.
A much larger study found similar — but less impressive — results demonstrating that a low-histamine diet eliminated symptoms completely in 12% of patients and improved symptoms in 44% of patients with CSU (11).
Atopic dermatitis (eczema)
Atopic dermatitis is a chronic inflammatory skin condition that causes it to become itchy, dry, and cracked.
Like CSU, the exact cause of atopic dermatitis remains largely unknown but people with the condition may have less DAO enzyme activity and therefore benefit from a low-histamine diet for symptom relief (12).
Coronavirus disease (COVID-19) is caused by SARS-CoV-2, the cornovirus that emerged in 2019.
Many of the symptoms associated with histamine intolerance are similar to those in people with long COVID or long-haulers.
A COVID long-hauler is someone who experiences COVID signs and symptoms for more than three months after the initial infection (15).
It has been suggested that the aggressive inflammatory response of COVID is caused by a dysfunction in the cells that release histamine and other inflammatory proteins and that a low-histamine diet could improve COVID symptoms.
Supplements for histamine intolerance
A few supplements may be helpful for alleviating histamine intolerance symptoms but with mixed results.
Quercetin is a beneficial plant compound with potent antioxidant properties.
The compound has been shown to block histamine from binding to its receptors, thereby preventing histamine from exerting its effects that can lead to allergy-related symptoms (18).
Quercetin has also been shown to inhibit histamine production by turning off the gene involved in its expression (19).
As such, supplementing with quercetin has been suggested to provide symptom relief in people with histamine intolerance and other allergic conditions, such as asthma, hay fever, and eczema (20).
Still, research on the effectiveness of quercetin and optimal dosing strategies is limited.
Most quercetin supplements contain 500–1,000 mg per capsule, so it may be best to start with one capsule per day with a meal and increase to 2–3 capsules if necessary.
Find quercetin supplements online.
There’s some evidence to support the use of DAO enzymes for relieving symptoms of histamine intolerance.
By increasing the availability of DAO, your body can break down more histamine, preventing it from building up and triggering symptoms. This could allow for a less restrictive diet.
Most DAO supplements contain an extract from pig kidney or legume sprouts.
However, one study suggested that a popular DAO enzyme supplement extracted from pig kidneys did not significantly reduce histamine levels since the acidity of the stomach inactivated some of the DAO enzymes, rendering it ineffective (21).
The bottom line
A low-histamine diet limits foods high in histamine, foods that may interfere with histamine metabolism, and foods that may increase the release of histamine from your cells.
The diet can provide symptom relief in people with histamine intolerance and may also benefit people with certain allergic conditions like CSU and atopic dermatitis. It’s unknown whether a low-histamine diet can consistently improve symptoms in COVID long haulers.
Taking a quercetin or DAO enzyme supplement with meals can inhibit histamine production or increase your body’s ability to break down histamine, helping to relieve symptoms of histamine intolerance. But more research is needed on these supplements.