Understanding Histamine Intolerance

Each person's level of tolerance to histamine is unique and ever changing, so the approach to reduce dietary sources of histamine needs to be individualized for patients or clients with a suspected intolerance. This process can aid in its diagnosis, after other conditions and food allergies have been ruled out by a physician. At this time, no diagnostic criteria or validated tests exist. Rotation diets have been considered helpful for intolerances that are dose-dependent, but research in support of them is lacking. The focus of more recent research has been a short-term dietary restriction of foods high in histamine.

Dietary sources which are typically high in histamine include many aged and fermented foods and beverages (i.e., cheeses, yogurt, processed meats, alcoholic beverages, sauerkraut, soy, etc.), some fish, especially frozen, smoked, and canned varieties, fruits such as strawberries and cherries, vegetables including spinach, tomatoes, eggplant and seasonings, such as chili powder, cinnamon, cloves, and vinegar.

The list is not exhaustive, and the amount of histamine from dietary sources can vary. Foods that are minimally processed are encouraged, since even the removal of skins or peels on produce can increase their histamine content.

Certain foods, beverages, additives, and drugs are also thought to either aid in the release of histamine or inhibit the enzymes needed to break it down. A few examples of these include citrus fruits, nuts, alcoholic beverages, teas, egg whites, food additives, some preservatives, and medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

In addition, bacteria that inhabit the large intestine of humans are able to convert the amino acid histidine that is found in protein foods into histamine, therefore contributing to internal levels. Similar microorganisms exist in other sources, and that is why higher amounts of histamine are found in some spoiled foods, especially fish.

Because exposure to histamine exists beyond diet, total avoidance of histamines is not attainable. In some cases, antihistamine medications may be prescribed to help minimize symptoms or a diamine oxidase (DAO) supplement. A registered dietitian nutritionist (RDN) can assist with a trial of a histamine-restricted diet, while ensuring the patient' s eating pattern remains adequate in all nutrients.

References:

• Joneja JV. Chapter 31: Histamine Sensitivity. In: The Health Professional's Guide to Food Allergies and Intolerances. Chicago, IL: Academy of Nutrition and Dietetics; 2013.
• Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007;85:1185-96.
• Zopf Y, Baenkler HW, Silbermann A, Hahn EG, Raithel M. The Differential Diagnosis of Food Intolerance. Dtsch Arztebl Int. 2009;106(21):359-70.
• Hrubisko M, Danis R, Huorka M, Wawruch M. Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients. 2021;13(7):2228. Published 2021 Jun 29. doi:10.3390/nu13072228