The Symptoms, Diagnosis, and Treatment of Histamine Intolerance

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If your body reacts to a diverse group of foods—including spinach, tomatoes, wine, and sauerkraut—with symptoms that can include a stuffy nose or migraine headaches, you may not be allergic to those foods. Instead, you may have what's called histamine intolerance, since all those foods have high levels of histamine in them.

A man pouring a glass of red wine
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Histamine is a chemical that our bodies produce naturally, and it's also found in certain foods. In situations involving "true" allergies, your body releases histamine, which provokes the response we think of as an allergic reaction.

Histamine intolerance isn't a true allergic reaction. Instead, it refers to a reaction some people experience to foods that have high levels of naturally occurring histamine.


The most common symptoms of histamine intolerance are migraine headaches, digestive symptoms such as diarrhea, flushing, hives, worsening eczema, congested, runny or itchy nose, and red itchy watery eyes.

Histamine intolerance can also cause more severe symptoms, as well. It can trigger asthma attacks or anaphylactic shock, it can cause your heart to beat erratically, and it may be associated with serious chronic conditions like Crohn's disease.


People with histamine intolerance often have low levels of either of two very specific enzymes—diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT) — that process histamine in your body. Without enough of those enzymes, histamine can build up and cause symptoms throughout the body.


If you think you might be repeatedly experiencing symptoms after eating high-histamine foods, keeping a food log can help you and your medical professional track the pattern of foods that are causing you to have symptoms.

The diagnosis of histamine intolerance can be challenging. Eating a high-histamine food (or more than one at the same time) may be enough to "push you over the edge" into symptoms one day, but may not be enough to do so on a different day.

If you stay away from high histamine foods, you may be able to reduce your build-up of histamine, which can reduce or eliminate your symptoms.

Traditional allergy tests—skin prick tests and ELISA IgE antibody blood tests—can't diagnose histamine intolerance. The only way you can find out if you have the condition is by trying a histamine-free diet, followed by a double-blind food challenge.


Treatment hinges on avoidance through a histamine-free diet. There are medications and other tactics you can use in coordination with diet modifications.

You should also let your healthcare provider know about any medications, prescription or non-prescription, you're taking. Some medications can affect the action of your histamine-processing enzymes.

If you are taking such a medication, your healthcare provider may adjust your dosage, switch you to a similar medication that doesn't affect histamine, or, if possible, take you off the medicine entirely.

Histamine-Free Diet

Maintaining a strict histamine-free diet is the key to relief from histamine intolerance symptoms. Your healthcare provider will discuss which foods you should avoid, but in general, fermented and aged foods, along with certain high-histamine vegetables, are most likely to cause problems.

Most foods that are high in histamine are highly processed or fermented. These include wine (especially red wine), aged cheese such as parmesan cheese, yeast-containing foods, and sauerkraut. Spinach and tomatoes also are high in histamine.

In addition, while citrus fruits are not considered high in histamine, they can trigger your body to release stored histamine. Therefore, people on a strict histamine-free diet are generally advised to avoid oranges, grapefruit, and other citrus.

"Red wine migraines" are often histamine intolerance headaches, and red wine is indeed high in histamine.

All alcoholic beverages can be problematic for people who have histamine intolerance because alcohol can make DAO less effective. Therefore, giving up alcohol is part of a histamine-free diet strategy.


While a histamine-free diet is the only long-term treatment for histamine intolerance, there are a couple of other treatments that may be useful. Benadryl (an over-the-counter antihistamine) may be useful if you accidentally eat a histamine-containing food or have to take a drug that can block histamine-processing enzyme activity.


There are also supplements that some healthcare providers recommend for people who have histamine intolerance. They include high doses of vitamin C and vitamin B6 (which can stimulate the activity of those histamine-processing enzymes in your body).

Capsules of the DAO enzyme can supplement the body's natural supply. Diem Labs, LLC, is the only manufacturer that sells DAO enzyme in the U.S.; look for the brand name Umbrellux DAO.

While these treatments can help, they're not a substitute for a histamine-free diet. Talk to your healthcare provider if you're interested in trying these supplements to see whether they could improve your symptoms.

Frequently Asked Questions

How long does it take to get relief from histamine intolerance symptoms?

It may take three to four weeks. One review study found that 90% of histamine intolerance patients who followed a low-histamine diet for four weeks had a reduction of headache symptoms.

What healthcare provider can diagnose a histamine intolerance?

Your primary care physician can help you determine whether you need to see a specialist. They might recommend an allergist to determine if your symptoms are coming from a food allergy or a histamine intolerance.

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