The multiple symptoms of histamine intolerance

Overabundance of histamine can lead to allergy like symptoms like itching and hives, headaches, nausea and tummy troubles – but the wide ranging roles of histamine throughout the body means that too much of this biogenic amine could also trigger complaints as wide ranging as low blood pressure, palpitations, changes in body temperature, pain, fatigue, shortness of breath, tingling or hormone imbalances (1).

An intolerance to histamine arises when you have more histamine coming into the system than you can clear effectively. Think of a boat with a hole: if you can’t bail the water out fast enough, eventually you’ll sink.

Where does this histamine come from?

One source is immune cells. As well as being released by mast cells during an allergic reaction, histamine plays a role in the acute inflammatory response. Its role is to dilate blood vessels and increase blood vessel permeability to allow immune cells to reach the site of injury/infection – this is what causes the local redness and swelling (2). Though less is known about what happens when inflammation is not resolved, it is possible that histamine continues to be produced in chronic inflammation (3).

A lot of histamine comes from the diet. Histamine is created by bacteria from the amino acid histidine, so any old or spoiled food can contain high levels, as well as:

~ aged and fermented food and drinks (cheeses, wine, yogurt, sauerkraut, kimchi, soy sauce, vinegar, yeasted breads)

~ fish (though very fresh and frozen fish has lower levels)

~ processed meats

~some fruit and vegetables including spinach, strawberries and aubergine

Other foods can trigger histamine release, including citrus, nuts, egg whites, wheat germ and some food additives and preservatives.

As bacteria can produce histamine, an overgrowth of certain bacteria within the digestive tract can also lead to an increased histamine load.

How do you get rid of excess histamine?

Two enzymes – diamine oxidase (DAO), found primarily in the gut, and histamine N-methyltransferase (HNMT), which works throughout the rest of the body – are charged with degrading histamine. If you have inherited particular variants of the genes for these enzymes, you are likely at a disadvantage for histamine clearance from the start – though this does not mean that you can’t do things to support your system.

How can nutritional therapy help?

Avoiding all high histamine foods and histamine releasing foods is highly impractical long-term, though a short-term low histamine diet may be warranted while investigations into why histamine load is so high are going on, or as part of an elimination/challenge test to confirm that histamine is the issue. There may be particular foods that are triggering histamine in you though, or it may be a case of being aware of which foods may be a problem, and making sure that you don’t have too many in one go. A food and symptom diary might be a useful tool.

Long term, ensuring that your histamine-degrading enzymes can work to the best of their capabilities is a wise move. As their function depends on a wide range of nutrients – including copper, vitamin C, magnesium and B-vitamins – make sure you are getting enough of these nutrients (and that you can absorb them) (4,5). Taking things out of your diet that block these enzymes’ function can also help: black and green tea and alcohol are the most commonly cited offenders (1).

A parallel approach is to add in to your diet those things that can support the breakdown of histamine or reduce its activity. Quercetin is a natural anti-histamine compound found in a range of foods. Onions especially, red onion, apple (including the peel), American cranberries, brassicas, nettles, asparagus, capers, watercress and red grapes are all good sources of this flavonoid (6).

As histamine is released as part of the inflammatory process, addressing any underlying inflammation may also be helpful. This could be coming from chronic infections or injuries, or from high circulating sugar levels in those with underlying insulin resistance (7). Vitamin D deficiencies are also associated with increased inflammation (8) It is also worth bearing in mind how well your diet matches up to the ‘dietary inflammatory index’. The Mediterranean diet, with extra-virgin olive oil and nuts has been shown to reduce inflammation, for example (9).

It is also worth noting that as DAO is located within the small intestine, any gut inflammation could lead to reduced functioning of this enzyme. Given that an overgrowth of particular subtypes of bacteria could also increase your histamine load, using a functional stool test to check what is going on inside your digestive tract (inflammation, digestive function and bacterial profile) is usually warranted if histamine intolerance is suspected.

If you think that high histamine may be contributing to your symptoms, and would like to find out more about how nutritional therapy could help. Contact me to arrange a 15 minute discovery call today.



  1. Reese, I (2018) ‘Nutrition therapy for adverse reactions to histamine in food and beverages’, Allergologie Select 2(1): pp.56-61. Available at:
  2. Branco, et al., (2018) ‘Role of histamine in modulating the immune response and inflammation’, Mediators Inflamm. 2018: 9524075
  3. Hirasawa, N (2019) ‘Expression of histidine decarboxylase and its roles in inflammation’ Int J Mol Sci 20(2): 376
  4. Mahmoud, A.M.m and Ali, M.M (2019) ‘Methyl donor micronutrients that modify DNA methylation and cancer outcome’ Nutrients 11(3) 608
  5. McGrath, A. P. et al., (2009) ‘The structure and inhibition of human diamine oxidase’ Biochemistry 48(41) pp. 9810-9822
  6. Li, Y., et al., (2016) ‘Quercetin, inflammation and immunity’, Nutrients, 8(3), 167
  7. Nowotny, K. et al., (2015) ‘Advanced glycation end products and oxidative stress in type 2 diabetes mellitus’, Biomolecules 5(1), pp.194-222
  8. Sassi, F., Tamone, C., and D’Amelio, P.D. (2018) ‘Vitamin D: Nutrient, hormone and immunomodulator’, Nutrients 10(11): 1656
  9. Ros, E. et al., (2014) ‘Mediterranean diet and cardiovascular health: Teachings of the PREDIMED study’ Adv Nutr 5(3), pp. 330S-336S

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