What Is Histamine?
Histamine is a naturally occurring chemical, serves a number of vital functions in your body, it serves mainly as a signalling molecule released by the immune system in order to facilitate cell-to-cell communication.
It participates in several physiological processes, such as controlling the amount of stomach acid produced, functioning as a neurotransmitter in the brain, and mediating several immune responses, but its primary recognition stems from its involvement in the development of allergic and anaphylactic responses.
Histamine Reaction
Histamine intolerance happens when your body can’t break down histamine quickly enough, causing a buildup. This can be due to factors like genetics, alcohol, or a lack of certain nutrients (Jochum 2024).
Histamine intolerance symptoms aren’t limited to just your digestive system—they can affect your entire body, often showing up unexpectedly and in different ways as we will learn.
Histamine Intolerance Affects 1-3% of Population
One leading histamine researcher calls histamine reactions “pseudo-allergic reactions”, commonly affecting between 3 to 6% of all children. (Zhao 2022)
When the body has trouble metabolising histamine or when there is a build-up of too much histamine in our body, histamine intolerance (HIT) develops. Histmine intolerance is also known as histamine sensitivity. HIT affects between 1-3% of the population.(Comas-Basté 2020)
Histamine plays a critical role in the body’s inflammatory and allergic response, and it’s a major mediator of itching . So, if you’ve been struggling with unexplained symptoms, particularly involving your sinus or respiratory system, your digestive system or skin, histamine intolerance might be the underlying issue.
Could You Be Histamine Intolerant?
Did you know that one or more of your favourite foods or drinks could be sparking an allergic reaction in your gut? I’ve encountered many patients in my clinic who, unaware of the issue, suffered from symptoms like persistent gut pain or a chronically stuffy nose.
Often, after eliminating a high histamine-containing food or beverage, their symptoms significantly improved. In most cases, patients had no idea their everyday choices were contributing to their discomfort. Histamine intolerance (HIT) is more common than many realise, which is why it’s important to explore this topic further.
I often heard patients with unresolved symptoms ask questions like:
When I hear questions like these, I suspect histamine intolerance—or, in some cases, different kinds of food reactions we will discuss soon.
Histamine Intolerance Test
A histamine skin prick test may not be effective in diagnosing histamine intolerance when there is a DAO deficiency, particularly in cases of intestinal disease. In these situations, an oral histamine challenge test is more appropriate, along with examining urinary histamine metabolites.
However, this test can carry the risk of serious side effects and should only be conducted in a hospital setting. Additionally, there is no standardised protocol for the oral histamine challenge. (Comas-Basté et al., 2020).
Histamine Intolerance Symptoms
A wide range of symptoms that may resemble those of allergies or other gastrointestinal conditions can result from this. When I think of a histamine response, I immediately think of cramp or pain in the gut, itching skin, and headaches as being three key areas, but there are many more.
Histamine intolerance symptoms frequently include:
Symptoms Can Be Delayed or Rapid
Histamine reactions can vary. Some people experience a rapid onset of symptoms, while others may notice a delayed response that builds over several hours, like the slow onset of a migraine (Ferretti et al., 2023).
Histamine-rich foods are sometimes linked to migraine headaches, which many people experience as intense, throbbing pain. Other key symptoms of histamine intolerance include gut cramps, abdominal pain, and itchy skin.
Most Common Symptoms
Gut-related symptoms tend to be the most prominent and severe among many. Common symptoms include abdominal pain, bloating, cramps, diarrhoea, constipation, nausea, vomiting, and a sensation of fullness after meals. Other people may only experience headaches and not any gut symptoms.
Symptoms Confused With Another Condition
Histamine intolerance’s symptoms can be confused with those of other conditions, even a Candida gut overgrowth, making a diagnosis difficult. Please remember that each person will experience symptoms differently, both in terms of their severity and combination.
The symptom list sounds like some of the symptoms someone with Candida overgrowth, IBS, or SIBO may experience, making it difficult at times to distinguish between the two. One study suggest that gut Candida colonisation promotes sensitisation against certain foods, partly due to hyper-permeability in the gut caused by too much histamine. (Yamaguchi 2006)
Therefore, if you are confused and believe you may have histamine intolerance, in order to receive a proper evaluation and diagnosis, it is in your best interest to visit your health-care professional, such as your medical doctor, your gastroenterologist, or naturopathic doctor.
Gluten Intolerant or Histamine Intolerant?
An increasing number of people are removing gluten from their diets, often influenced by discussions of various food-related disorders in the media. One emerging condition is “non-celiac gluten sensitivity” (NCGS), which has led around 20% of the population to avoid gluten, even without a formal medical diagnosis.
This group is also referred to as “people without celiac disease avoiding gluten” (Choung 2016).
While many believe that a gluten-free (GF) diet has health benefits, these claims remain largely unproven by scientific studies.
Interestingly, some experts suggest that histamine intolerance may actually be a contributing factor for those who believe they are gluten-sensitive. A study found that the symptoms of NCGS closely resemble those of histamine intolerance, particularly regarding gut and systemic reactions (Schnedl 2018).
From my own experience, I’ve observed that people often self-diagnose gluten intolerance by adopting a gluten-free diet, leading them to believe gluten was the issue. More recently, the term “non-celiac wheat sensitivity” has been proposed to better define this condition (Zevallos 2017).
One fascinating link between gluten and histamine lies in food processing. Many gluten-containing foods, like beer and baked goods, use histamine-producing yeast. Additionally, common accompaniments to gluten-rich meals, such as histamine-laden tomatoes and seasonings in pizza or pasta, can contribute to the overall histamine load. Reducing gluten in the diet inadvertently lowers histamine intake, which might help explain the widespread popularity of gluten-free products—many of which are naturally low in histamine.
Histamine Intolerance and Food Reactions
It can often be challenging to distinguish between food allergies, intolerances, and sensitivities. However, whether it’s an allergy or intolerance, the key to managing symptoms lies in the careful elimination and reintroduction of potential trigger foods. This systematic approach helps identify which specific food groups are causing issues. Here’s a list of all the most common reactive foods: The High Reactive Food List
Patience is crucial—removing one food or food group at a time is the most effective way to avoid confusion and accurately pinpoint the culprit. Occasionally, foods within the same group share similar proteins or sugars, leading to subtle, overlapping reactions. Many people don’t realise the connection until they eliminate an entire food group. This is especially important for those who have already tried various doctors, supplements, or treatments without success.
Good Tip:
When eliminating a food group, I recommend avoiding it for at least 3 to 6 months. A short 2 to 3 week elimination may not yield clear results. In my experience, longer eliminations are far more effective at uncovering the true source of persistent “mystery” symptoms than brief exclusions.
Key Food Reaction Groups
Here are some common categories of food reactions:
The most reactive foods vary depending on the individual, but many elimination diets tend to highlight certain culprits that trigger responses in people with food sensitivities.
The elimination diet helps isolate these triggers through the systematic removal and reintroduction of these foods. You may like to read The Low-Reactive Diet page.
High Histamine Foods
Free Download: The High Histamine Food List
The key to managing histamine intolerance is following a low-histamine diet. While there aren’t official guidelines, it’s generally advised to avoid foods like hard and semi-hard cheeses, oily fish, shellfish, fermented meats, pickled vegetables, fermented soy, wine, beer, eggs, chocolate, and mushrooms.
Meat and fish should only be eaten when fresh. Additionally, certain fruits and vegetables that trigger histamine release, like spinach, tomatoes, citrus fruits, strawberries, eggplant, avocado, bananas, kiwi, pineapples, and plums, should also be avoided.
Foods listed in bold have highest histamine values. Any foods listed in plain font can be introduced after two weeks, but foods listed in bold font are best kept from the diet for a further 12 to 16 weeks to allow your microbiota to recover. At this point they can be re-introduced slowly one by one to observe for any new reactions.
Histamine Food reference: (Zhao 2022)
Low Histamine Foods
These foods are low in histamine:
Histamine Releasing Foods
Some foods are called histamine releasers, they may not necessarily be high in histamine themselves, but are known to trigger the release of histamine in your body.
Citrus foods are an example of histamine-triggering foods. Other foods have been found to be DAO blockers, they block the enzyme responsible for breaking histamine down, the diamine oxidase enzyme (DAO).
I’ve listed them all in The High Histamine Food List
High Histamine Foods – Key Tips to Manage and Avoid Triggers
Some foods naturally contain high levels of histamine, while others have lower amounts. It’s helpful to become familiar with these foods and assess if any might be triggering your symptoms.
Are there foods or beverages you frequently consume from the high-histamine list? Particularly, those with histamine intolerance often find themselves reacting to alcohol, especially red wine.
Recognising High-Histamine Foods
Certain foods are naturally high in histamine, including:
Histamine is also produced by bacteria in spoiled foods, especially fish, which can cause poisoning. Fermented foods and drinks, like wine and sake, contain histamine due to the fermentation process. For example, wine can contain between 2-10 mg of histamine per litre, while sake has 20-40 mg per litre.
Freshness Matters
Histamine levels increase in aged or overripe foods. A study found that plant-based foods can contain histamines if they aren’t fresh. (Shulpekova et al., 2021).
Therefore, freshness is key when aiming to reduce histamine intake. Plant-based foods like eggplant, spinach, tomato, and avocado show variability in histamine content but can still be problematic for some.
Histamine Releasers and DAO Blockers
Some foods are not high in histamine themselves but can trigger its release in your body. Alcohol and citrus fruits are an example of histamine-releasing foods. Additionally, certain foods act as DAO blockers, meaning they inhibit the enzyme that breaks down histamine in your body (Diamine Oxidase, or DAO).
Guidelines for a Low-Histamine Diet
If you’ve been advised to follow a low-reactive diet, these are some general guidelines to help:
Pro Tips for Managing Histamine Intolerance
By following these tips and understanding how different foods impact histamine levels, you can take control of your diet and reduce symptoms.
Eric Bakker N.D.
Greetings! I am a naturopathic physician from New Zealand. Although I’ve retired from clinical practice since 2019, I remain passionate about helping people improve their lives. You’ll find I’m active online with a focus on natural health and wellbeing education through my Facebook page and YouTube channel, including this website.
