Histamine Intolerance: Causes, Symptoms, And Diagnosis - Healthline

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- Histamine Intolerance

Understanding Histamine Intolerance

Medically reviewed by Megan Soliman, MD — Written by Kiara Anthony — Updated on November 22, 2024

What it is
Symptoms
Causes
Diet
Treatment
Diagnosis
FAQ
Outlook

Histamine intolerance means you have high histamine levels in your body. It can happen if your body cannot break down histamine. It can affect multiple systems in your body, but gastrointestinal symptoms are most common.

Histamine intolerance is not a sensitivity to histamine but an indication that you’ve developed too much of it. You can be born with this condition or develop it as a result of your genetics, diet, or medications you take.

Learn more about histamine intolerance and what you can to if you have it.

What is histamine intolerance?

Histamine intolerance is an indication that you have too much histamine in your body. Histamine is a chemical responsible for a few major functions, including:

sending messages to your brain
triggering the release of stomach acid to help digestion
releasing after injury or allergic reaction as part of your immune response

When there’s too much histamine, your body develops histamine intolerance and cannot break it down properly. It can affect many of your typical bodily functions.

What are the symptoms of a histamine intolerance?

Because you have histamine receptors throughout your body, histamine intolerance can affect several body systems. In a small 2019 study, participants experienced an average of 11 symptoms, with 96.8% experiencing more than 3 symptoms.

Histamine intolerance symptoms are nonspecific. That means they can appear like symptoms of other conditions. This can often make it challenging for doctors to diagnose.

Gastrointestinal (GI) symptoms are the most common and include:

digestive issues
abdominal pain
bloating
diarrhea
constipation
flatulence
nausea
vomiting

While they may vary, other common reactions associated with this intolerance include:

headaches or migraine
nasal congestion or sinus issues
fatigue
itchy skin
hives
irregular menstrual cycle

In more severe cases of histamine intolerance, you may experience:

abdominal cramping
tissue swelling
high blood pressure
irregular heart rate
anxiety
difficulty regulating body temperature
dizziness

What causes histamine intolerance?

You naturally produce histamine along with the enzyme diamine oxidase (DAO). DAO is responsible for breaking down histamine that you take in from foods.

If you develop a DAO deficiency and cannot break down histamine, you could develop histamine intolerance.

Things that can affect your DAO enzyme or histamine levels include:

Genetics: You may have a gene mutation that causes your body to produce either less DAO or dysfunctional DAO.
Medications: Some medications can temporarily block DAO functions or prevent production, including:
- phlegm reducers, such as acetylcysteine
- antiemetics, such as metoclopramide
- antiarrhythmics, such as propafenone
- blood pressure medications, such as dihyrdalazine
- antidepressants, such as amitriptyline
Gastrointestinal (GI) disorders: GI disorders like inflammatory bowel disease (IBD) can cause DAO deficiency.
Diet: Histamine-rich foods can cause DAO enzymes to function improperly. Some foods can block DAO enzymes or trigger histamine release.
Bacterial overgrowth: When your body is unable to digest food properly, bacteria grow, causing you to produce too much histamine. Typical DAO enzyme levels cannot break down the increased histamine in your body, causing a reaction.

What diseases cause histamine intolerance?

Histamine intolerance usually stems from an intestinal issue. You may be more likely to develop histamine intolerance if you have a gastrointestinal disorder, such as:

colon polyps
malabsorption
food allergies
celiac disease
IBD, such as Crohn’s disease or ulcerative colitis
irritable bowel syndrome (IBS)
functional dyspepsia
small intestinal bacterial overgrowth

How do you manage histamine levels with diet?

Foods to consider limiting

A health-promoting diet contains moderate levels of histamine. However, some foods high in histamine can trigger inflammatory reactions and other negative health events.

The benefits of a histamine-limiting diet are still an uncertain field of study. More research is needed. Limiting these foods may help some but not others.

Histamine-rich foods include:

alcohol and other fermented beverages
fermented foods and dairy products, such as yogurt and sauerkraut
dried fruits
avocados
eggplant
spinach
processed or smoked meats
preserved fish and shellfish
aged cheese

Several foods can also trigger histamine release in your body, such as:

alcohol
bananas
tomatoes
wheat germ
beans
papaya
chocolate
citrus fruits
nuts, specifically walnuts, cashews, and peanuts
food dyes and other additives
fish
pork

Drinks that block DAO production include:

alcohol
black tea
mate tea
energy drinks

In a systematic review from 2021, many of the foods typically listed as high-histamine or histamine-triggering may not actually have this effect depending on the person.

For instance, based on this systematic review, citrus fruits and fish were very low in histamine. Research results also showed that various studies focusing on a low-histamine diet really differed in their approach, and the list of foods to avoid or to consume was significantly different.

The best strategy may be to try eliminating foods you suspect that are adversely contributing to your health events to see if doing so helps or changes your symptoms.

Foods to eat

If you have histamine intolerance, incorporating low-histamine foods into your eating pattern can help reduce symptoms. There are several variations of low-histamine eating plans. It’s important that you consult a healthcare professional such as a dietician before you eliminate foods from your eating plan.

Some foods low in histamine include:

fresh meat and freshly caught fish

non-citrus fruits
eggs
gluten-free grains, such as quinoa and rice
dairy substitutes, such as coconut milk and almond milk
fresh vegetables except for tomatoes, avocados, spinach, and eggplant
cooking oils, such as olive oil

What’s the treatment for histamine intolerance?

Other than making changes to your eating pattern, there’s not much you can do to fix histamine intolerance.

Antihistamines may help reduce symptoms in the short term.

A 2020 research review notes that DAO supplements may also help, but more research is needed to confirm how well they work.

How do doctors test for histamine intolerance?

Before reaching a diagnosis, a doctor will eliminate other possible disorders or allergies that cause similar symptoms.

They may also suggest following an elimination diet for 14–30 days. This diet requires you to remove foods high in histamine or histamine triggers before slowly reintroducing them to watch for new reactions.

A doctor might also request a blood sample to analyze whether you have a DAO deficiency.

Another way to diagnose histamine intolerance is through a prick test. A typical prick test checks for allergic reactions within 20 minutes. But a prick test for histamine intolerance will typically require a 50-minute wait to get results.

Frequently asked questions

How do you fix histamine intolerance?

Making changes to your eating pattern is the main way you may be able to fix histamine intolerance. Taking antihistamines may help reduce short-term symptoms. Some research suggests that taking DAO supplements may help, but more research is needed.

What triggers histamine intolerance?

Your body produces histamine. It also produces an enzyme, DAO, that breaks down histamine. If your body has a problem producing DAO, you may develop histamine intolerance. There are many things that may affect DAO production, such as eating too many foods that contain histamines or foods that block DAO, having a genetic mutation, taking certain medications (like acetylcysteine, metoclopramide, propafenone, dihyrdalazine, or amitriptyline), or having IBS.

What’s the outlook for people with histamine intolerance?

Histamine intolerance can cause uncomfortable symptoms, but a low-histamine eating plan may help ease symptoms.

Diagnosing histamine intolerance can be challenging as symptoms are similar to other allergens, disorders, or infections. During the diagnosis process, a doctor will need to eliminate similar medical conditions.

If you think you might have an intolerance or are experiencing irregular symptoms, talk with a doctor.

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Comas-Basté O, et al. (2020). Histamine intolerance: The current state of the art. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463562/
First steps: Things to discuss with your doctor and what to consider before you start a low-histamine diet. (n.d.). https://www.histamineintolerance.org.uk/about/first-steps/
Hrubisko M, et al. (2021). Histamine intolerance — the more we know the less we know. A review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308327/
Sánchez-Pérez S, et al. (2021). Low-histamine diets: Is the exclusion of foods justified by their histamine content? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143338/
Schnedl WJ, et al. (2019). Evaluation of symptoms and symptom combinations in histamine intolerance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667364/
Schnedl WJ, et al. (2021). Histamine intolerance originates in the gut. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069563/
Tuck CJ, et al. (2019). Food intolerances. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682924/
Wagner A, et al. (2019). Impaired resolution of wheals in the skin prick test and low diamine oxidase blood level in allergic patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906969/
Zhao Y, et al. (2022). Histamine intolerance — a kind of pseudoallergic reaction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8945898/

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Medically reviewed by Megan Soliman, MD — Written by Kiara Anthony — Updated on November 22, 2024

Related Topics

Types

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Causes & Risk Factors

Related Articles

Symptoms

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Diagnosis

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Treatment

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Home Remedies

Related Articles

Prevention

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Management

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Complications

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Related Conditions

Related Articles

What is histamine intolerance?

What are the symptoms of a histamine intolerance?

What causes histamine intolerance?

What diseases cause histamine intolerance?

How do you manage histamine levels with diet?

Foods to consider limiting

Foods to eat

What’s the treatment for histamine intolerance?

How do doctors test for histamine intolerance?

Frequently asked questions

How do you fix histamine intolerance?

What triggers histamine intolerance?

What’s the outlook for people with histamine intolerance?

How we reviewed this article:

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