Allergies Food Allergies Treatment & Diagnosis What Is a Low-Histamine Diet? By Barbie Cervoni MS, RD, CDCES, CDN facebook twitter linkedin instagram Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist. Learn about our editorial process Barbie Cervoni MS, RD, CDCES, CDN Medically reviewed by Medically reviewed by Daniel More, MD on November 07, 2019 Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California. Learn about our Medical Review Board Daniel More, MD on November 07, 2019 Print Verywell / Zorica Lakonic Table of Contents View All The Benefits How It Works Considerations Low-Histamine Diet vs. Other Diets A low-histamine diet can be suggested for people who have histamine intolerance. Histamine is a chemical released by mast cells in the immune system when the body encounters an allergen, which causes an allergic reaction. Histamine intolerance, otherwise referred to as enteral histaminosis, is a very rare condition that is estimated to affect about 1% of the population. It is very hard to diagnose and is often characterized by symptoms such as itching, hives, sneezing, watery eyes, asthma, headaches, abdominal pain, diarrhea, tachycardia, and hypotension. Ingesting a large quantity of foods high in histamine can trigger this response, but figuring out which foods triggered a response can be complicated. Once food allergies have been ruled out, people can try a low-histamine diet. This type of diet is very restrictive and should not be followed for long-term. In addition, people following a low-histamine diet should be seen by a registered dietitian or nutrition professional to make sure they are receiving adequate nutrition. The Benefits There aren’t many studies examining the benefits of a low-histamine diet, likely due to the difficulty of following a low-histamine diet and the complexity of diagnosing histamine intolerance. A small study conducted in Italy found that, when people restricted their intake of histamine provoking foods, their symptoms improved. These people did not have food allergies or other gastrointestinal diseases. There are many limitations in examining the role of histamine in the diet, and most of the time, individual cases need to be examined. Part of the reason for this is because it’s not possible to avoid histamine altogether—exposure to histamine goes beyond diet. Additionally, because some people are more sensitive to histamine, a dose-dependent response is plausible. This makes following a rotation diet, where certain foods are avoided and then added back in at specific times is important. Keeping a food journal for a few weeks and tracking symptoms is also important in discovering the trigger foods. Histamine Intolerance vs. Histamine Toxicity Histamine toxicity, also referred to as scombrotoxic fish poisoning, is a result of ingesting spoiled finfish, such as tuna or mackerel. It is not considered to be an allergy or intolerance and usually needs to be treated with antihistamines and supportive care. How It Works If food allergies and other gastrointestinal diseases such as celiac disease have been ruled out, your physician may try to determine if you are histamine intolerant. To do so, they may ask you to take a skin prick test (which can often be unreliable) or measure your blood to test your diamine oxidase activity (DOA), the main enzyme involved in the metabolism of histamine. Oftentimes, people with histamine intolerance have an imbalance of histamine due to a combination of too much histamine and lack of DOA. If you are histamine intolerant, you may be told to follow a low-histamine diet. Because everyone responds to histamine differently, an individualized meal plan should be created. Most of the time, you will start slowly by taking out high-histamine foods and logging symptoms. If you find that your symptoms have improved after removing a trigger food, you can omit that food temporarily and attempt to add it back into your diet in a about a month. There is no specific scientific protocol for elimination diets, therefore, it will be important to work with a registered dietitian to make sure you are receiving adequate nutrition and are getting all your vitamins and minerals. The rate at which you eliminate and add foods back in will be determined by your tolerance and symptoms. Sometimes you will need to incorporate certain supplements and in some cases medications, such as an antihistamine, to improve symptoms. This will be discussed with your medical professionals. Some people will also need to supplement with B vitamins, calcium, copper, zinc, and other micronutrients. Researchers suggest, “A histamine-free diet, if necessary, supported by antihistamines or the substitution of DOA, leads to an improvement of symptoms.” Eating a diet rich in whole, non-processed foods will be important. Foods that are very ripe, aged, fermented or soured, also should be avoided. Certain fruits and vegetables can induce a histamine response, too. What To Eat Compliant Foods Fresh fruit: Apples, pomegranates, grapes, cherries, pears, plums, peaches (any fruit except citrus fruits, strawberries, avocado) Fresh vegetables: Arugula, artichokes, broccoli, carrots, onions, peppers, cucumbers, spaghetti squash, etc. (any vegetables except those on the do not eat list) Fresh herbs: Basil, parsley, oregano, rosemary, cilantro, thyme, turmeric Gluten-free grains: Quinoa, brown rice Dried legumes: Chickpeas, black beans, kidney beans Starchy vegetables: Sweet potato, yam, butternut squash, winter squash Fresh meat and fish: Chicken, turkey, salmon, lean ground beef, lamb Carob (an alternative to chocolate) Nut based milk: Almond, cashew, hemp Hemp, flax, chia seeds Olive oil, coconut oil Egg yolks Non-Compliant Foods Aged cheeses: Parmesan, cheddar, Gouda, Camembert, Swiss Fermented foods and beverages: Sauerkraut, pickles, pickled vegetables, kefir, kombucha Yogurt, sour cream, and buttermilk Processed meats: Cold cuts, bacon, sausage, salami, ham, chorizo, pepperoni Alcoholic beverages Egg whites Tea Soy Peanuts Frozen and smoked fish Shellfish: Clams, mussels, shrimp Canned fish: Salmon and tuna Certain vegetables: Spinach, tomatoes, eggplant Certain fruits: Strawberries, cherries, citrus fruits (papaya, orange, lemon, pineapple) Spices and condiments: Ketchup, chili powder, cinnamon, cloves, vinegar Packaged and processed foods: Snacks, ready-made grains, cookies, sweets Food additives, preservatives, and food coloring Licorice and chocolate Yeast Fresh meat and fish: The longer a food is left out (never eat spoiled foods) or the more it is processed, the more histamine will be produced. Plan to cook your meat or fish right away and purchase wild or organic, pasture-raised when possible. Starchy vegetables: Starchy vegetable such as sweet potatoes, yams, and butternut squash are rich in vitamin A, C, and other antioxidants. They are wholesome, fiber-rich, healthy food choices that can keep you full and replace processed grains. Carob: Carob is packed with antioxidants and is a caffeine-free alternative to chocolate. It is also gluten-free and contains bioactive compounds such as dietary fiber, polyphenols, flavonoids, cyclitols, (like d-pinitol) and tannins. These compounds have been associated with a variety of health benefits including glycemic (blood sugar) control, cholesterol reduction, anticancer effects, and many more. It can be used in homemade baked goods and smoothies. The Health Benefits of Carob Fresh herbs: Fresh herbs can add flavor and nutrition to any meal without added calories and fat. They can spice up any boring protein, vegetable, or salad and are a wonderful and colorful addition to any meal plan. You can buy a potted herb plant and keep them at home if you prefer not to waste fresh herbs. Nut-based milk: Fortified with calcium and vitamin D, nut-based milks are lower in calories and saturated fat than some cow's milk varieties and can serve for a dairy substitute for those people following a vegan or vegetarian meal plan. A low-histamine diet can be very restrictive because dietary sources of histamine are found in a wide range of food items. Aged foods, fermented, processed, and overly ripe foods should be avoided. Recommended Timing There is no set schedule or timing of meals that you need to stick to unless you are taking certain medications, in which you should discuss with your physician. Timing will be of the essence when you eliminate and add foods into your diet. When doing this, it is recommended that you consult with a professional, such as a registered dietitian. For example, eliminating too many foods at once or reintroducing foods too quickly can reduce the quality of your diet and skew results. Working with a professional will help you to balance out your nutrient intake and reduce stress. Cooking Tips Cook fresh foods as often as you can. Focus on simple meal prep and cooking methods to ease the burden of meal planning. Baking, broiling, grilling, sautéing, and steaming foods are simple cooking techniques that you can use to prepare your meals. Modifications Modifications can be made based on histamine tolerance and sensitivity. For example, while some people may need to avoid strawberries altogether, others may be able to tolerate small amounts. Keeping a detailed food log that describes symptoms after food ingestion will be important. Considerations While limited data have suggested that following a low-histamine diet can reduce the symptoms of histamine intolerance, more research needs to be done in this area. Keep in mind that because this diet is somewhat restrictive, it is not meant for everyone. Discovering trigger foods and identifying tolerable foods can help you to reduce cost and improve symptoms. You must also keep in mind, the following: General Nutrition Overall, if done right, this diet can be a healthy one. But one must make sure that they are eating a variety of fruit, vegetables, healthy fats, and protein. Because one of the main focuses is on eliminating foods, people can fall into the trap of focusing on that and eating the same things daily. To ensure adequate nutrition, it’s important to meet with a registered dietitian. Some people may need additional supplements, too. Sustainability and Practicality This diet is hard to sustain as you really cannot eat anything processed, packaged, canned, or pre-prepared. Most of the time, this diet is used temporarily until symptoms are managed and trigger foods are slowly added back in. Safety Including a wide variety of nutrient-dense whole foods is safe when done properly. Guidance is always recommended as meal plans should be individualized. As previously mentioned, it is advised to meet with a registered dietitian to ensure all your nutrition needs are being met. Flexibility For those people who like to cook and prepare foods at home, this diet may not seem too difficult. On the other hand, if you eat on-the-go regularly this diet can be particularly challenging due to its lack of flexibility, especially during the elimination phase. Cost Whole foods, such as fruits and vegetables, fresh meat and fish, can be expensive. Try to buy local and seasonal when possible to reduce cost. Low-Histamine Diet vs. Other Diets A study found that a low-FODMAP diet reduced the histamine produced by the microbiome, which also may contribute to the reduction in pain experienced by irritable bowel syndrome (IBS) patients. A low-FODMAP diet eliminates or reduces certain types of short-chain carbohydrates found naturally in many foods that we eat. These types of carbohydrates may be poorly absorbed in the intestine, draw extra water into the intestine, and are rapidly fermented by bacteria in the gut. This type of eating plan also depends on an individual’s tolerance and the quantity of food that is consumed. FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. A Word From Verywell A low-histamine diet has been shown to help improve symptoms of histamine intolerance, which can produce allergy-related symptoms such as sneezing, headaches, itchy skin, etc. Understanding histamine intolerance and diet is complex, as many individuals have differing levels of histamine intolerance. It’s important for anyone looking to follow this type of eating plan to meet with a registered dietitian to ensure adequate nutrition: both macro and micronutrients. Because the focus is on eliminating offending foods, understanding which types of foods you need to eat to avoid nutrient deficiencies will be important. Sometimes people with histamine intolerance will also need additional supplements, and/or medications to relieve symptoms. More research needs to be done in this area to better understand histamine intolerance and how diet plays a role in reducing symptoms. Was this page helpful? Thanks for your feedback! Get one simple hack every day to make your life healthier. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Kohn JB. Is there a diet for histamine intolerance? J Am Diet Assoc. 2014 Nov;114(11):1860. doi:10.1016/j.jand.2014.09.009 Manzotti G, Breda D, Di gioacchino M, Burastero SE. Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol. 2016 Mar;29(1):105-11. doi:10.1177/0394632015617170 Harvie R, Chanyi RM, Burton JP, Schultz M. Using the human gastrointestinal microbiome to personalize nutrition advice: are registered dietitian nutritionists ready for the opportunities and challenges?. J Acad Nutr Diet. 2017;117(12):1865-1869. doi:10.1016/j.jand.2016.10.02 Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007;85(5):1185-96. doi:10.1093/ajcn/85.5.1185 Smolinska S, Jutel M, Crameri R, O'mahony L. Histamine and gut mucosal immune regulation. Eur J Allergy Clin Immunol. 2014 March;69(3): 273-281. doi:10.1111/all.12330 Additional Reading King, Kristy. What Is the Low FODMAP Diet? Eat Right. Academy of Nutrition and Dietetics. Published August 2, 2019. Maintz, L. and Novak, N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5): 1185–1196. doi:10.1093/ajcn/85.5.1185 Stratta, P. Scombroid poisoning. CMAJ. 2012 Apr 3;184(6): 674. doi:10.1503/cmaj.111031