The Symptoms, Diagnosis, and Treatment of Histamine Intolerance

A man pouring a glass of red wine

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If you find your body reacts to a diverse group of foods—say, spinach, tomatoes, wine, and sauerkraut—with symptoms that range from a stuffy nose to 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.

Histamine is a chemical our bodies produce naturally, and it's also found in certain foods. In situations involving "true" allergies, your body releases histamine, and that histamine, in turn, 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, eczema, and allergic rhinitis (the medical term for hay fever, although in this case it obviously doesn't involve any hay).

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 to process the histamine, it can build up over time and cause symptoms throughout the body.


If you have symptoms regularly after eating high-histamine foods, that may lead you or your doctor to suspect a histamine intolerance. You may find that keeping a food log helps you and your doctor to figure out the problem.

In histamine intolerance, the histamine can build up over time, which can make diagnosing this condition 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 doctor 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 on such a medication, your doctor may want to 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 doctor 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 themselves 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 with histamine intolerance because alcohol can make DAO, one of the enzymes your body uses to process histamine, less effective. Therefore, to follow a true histamine-free diet, you need to give up alcohol.


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 doctors recommend for people with 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.

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

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