Histamine Intolerance - What is it?
- 3 days ago
- 5 min read
Written by Claudia Knight and Dietetic Intern, Hannah Swope
What are Histamines?
Histamine is a natural compound found in foods that acts as a signaling molecule in the body (1). Histamine is important for a number of regulating and protective processes, including modulating the inflammatory response in allergic reactions (2). As long as you are consuming histamines in moderation (extremely high intake could lead to toxicity), there is no downside, unless you are not able to tolerate them. Signs of histamine intolerance include various gastrointestinal, topical, respiratory, and/or circulatory symptoms.
What is Histamine Intolerance?
Having “histamine intolerance” is when a person has a sensitivity to histamines. This is caused by the reduced production of an enzyme called DAO in the intestinal lining (2). DAO is our body's first line of defense against ingested histamine (1). Without DAO, histamine can build up in the body and it can cause symptoms (examples below).
Symptoms of Histamine Intolerance
Table 1. List of common symptoms experienced by people with histamine intolerance in order of biologic system frequency. Derived from article Histamine Intolerance Originates in the Gut (3):
Gastrointestinal | Nervous System | Skin | Respiratory | Circulatory |
Bloating Abdominal pain Diarrhea Constipation Gas Nausea Vomiting Postprandial fullness Burping Cramps | Headache Dizziness | Hives Itchiness Flush Eczema Swelling of eyelids | Runny nose Congestion Inflamed sinuses Sneezing Difficulty breathing | Low blood pressure Irregular heart beat |
Diagnosis of Histamine Intolerance:
Symptoms of histamine intolerance can vary greatly. In a study performed by Wolfgang J. Schnedl and colleagues, histamine intolerance resulted in participants experiencing at least 3 of the symptoms from the chart above (3). On average, they found that people with histamine intolerance will experience eleven of the listed symptoms above at varying levels of severity. The most common way to treat histamine intolerance is to consume a low-histamine diet. Other options that can be discussed with a doctor are to take antihistamine medications, or supplemental DAO (4).
Some foods are naturally high in histamine, others go through processes that increase their histamine content (1,2). Foods that are considered low- or no-histamine can become high-histamine foods through microbial action. This is why fermented and aged foods (cheese and sauerkraut) and beverages (beer and wine) are considered high in histamine (2). Leftovers and raw ingredients left in the refrigerator can experience increased histamine levels as time passes and microbial action increases on these foods.
Putting Histamine Amounts in Perspective - What foods are High and Low in Histamines?
High-histamine is anything over 25 mg for a person with normal functioning DAO according to the European Food Safety Authority. A person with histamine intolerance can be reactive to as little as 1-4 mg of histamine (4).
Table 2. List of foods that have a histamine content of 4 mg/kg or more.
High-Histamine Foods | |||
Food | Histamine Content (mg/kg) | Food | Histamine Content (mg/kg) |
Red wine | 2.91 - 8.76 mg/L (8) | Bananas (fresh) | 17.99 (12) |
European Beer | <0.3 - 21.6 mg/L (13) | Processed meats (Finish sausage) | 54 (8) |
Avocado | 23 (9) | Aged cheeses (Parmesan) | 40.64 (8) |
Eggplant | 4.17 - 100.6 (9) | Fermented soybean paste | 26.79 (8) |
Tomatoes | 2.51 - 17.07 (9) | Fermented foods (sauerkraut) | 37.01 (8) |
Chocolate | 8.1 - 12.8 (11) | Pacific saury (fish) | 9.13 (8) |
Condiments and pickled foods (ketchup) | 22 (9) | Spinach | 9.46 - 69.71 (9) |
Table 3. List of foods that contain less than 4 mg/kg of histamine.
Low-Histamine Foods | |||
Food | Histamine Content (mg/kg) | Food | Histamine Content (mg/kg) |
White wine | 0.18 mg/L (8) | Asparagus | 1.42 (9) |
Leerdamer cheese | 0.02 Doeun | Chard | 1.33 (9) |
Pacific mackerel | 2.7 Doeun | Pumpkin | 1.90 (9) |
Orange juice | 0.46 - 1.32 mg/L (9) | Fresh meat (beef, pork, chicken) | <0.5 (10) |
Grapefruit juice | 0.31 - 1.74 mg/L (9) | Brazilian beer | <0.2 - 1.5 (13) |
Canned tuna | 0.33 (8) | Chocolate | 0.26 (8) |
Histamine can build up in foods based on preparation methods and age. This is why chocolate is present in both tables and some people find that they can react to foods that are typically considered low.
Conclusion
People with histamine intolerance often find that their symptoms are relieved on an individualized low-histamine diet determined through collaboration with a registered dietitian nutritionist (11). It is often recommended to keep a food-symptom journal when experimenting with low-histamine diets so that exposure to sensitivities can be reduced and safe foods are not avoided (5). Some people find that they have safe foods that are generally recognized as high in histamine and react to some that are considered low. The variation of symptoms and individuality can make identifying histamine intolerance difficult. Many practitioners may not be aware of this condition as it is relatively new in the literature, but research is increasing and awareness in the research and clinical sectors will help with treatment and identification of histamine intolerance (1).
Resources
Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MdC. Histamine Intolerance: The Current State of the Art. Biomolecules. 2020; 10(8):1181. https://doi.org/10.3390/biom10081181
Maintz, et. al. Histamine and histamine intolerance. 2, The American Journal of Clinical Nutrition, Volume 85, Issue 5, 2007, Pages 1185-1196, ISSN 0002-9165, https://doi.org/10.1093/ajcn/85.5.1185.
Wolfgang J. Schnedl (et. al.) Histamine Intolerance Originates in the Gut. Nutrients. 2021 Apr 12;13(4):1262. doi: 10.3390/nu13041262
Hrubisko M, Danis R, Huorka M, Wawruch M. Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients. 2021 Jun 29;13(7):2228. doi: 10.3390/nu13072228. PMID: 34209583; PMCID: PMC8308327.
Rowe : https://www.hopkinsmedicine.org/-/media/johns-hopkins-childrens-center/documents/specialties/adolescent-medicine/cfs-low-histamine-diet.pdf
DOI: 10.3390/nu13072228
EFSA Panel on Biological Hazards (BIOHAZ). Scientific Opinion on risk based control of biogenic amine formation in fermented foods. EFSA J. 2011, 9, 1–93
Doeun, D., Davaatseren, M. & Chung, MS. Biogenic amines in foods. Food Sci Biotechnol 26, 1463–1474 (2017). https://doi.org/10.1007/s10068-017-0239-3
Sánchez-Pérez S, Comas-Basté O, Rabell-González J, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Biogenic Amines in Plant-Origin Foods: Are they Frequently Underestimated in Low-Histamine Diets? Foods. 2018; 7(12):205. https://doi.org/10.3390/foods7120205
Schirone M, Esposito L, D’Onofrio F, Visciano P, Martuscelli M, Mastrocola D, Paparella A. Biogenic Amines in Meat and Meat Products: A Review of the Science and Future Perspectives. Foods. 2022; 11(6):788. https://doi.org/10.3390/foods11060788
Spizzirri UG, Ieri F, Campo M, Paolino D, Restuccia D, Romani A. Biogenic Amines, Phenolic, and Aroma-Related Compounds of Unroasted and Roasted Cocoa Beans with Different Origin. Foods. 2019; 8(8):306. https://doi.org/10.3390/foods8080306
Tanasa V, Moise D, Stanca M. (2016). Separation and Quantification of Biogenic Amines in Bananas by High Performance Liquid Chromatography. Food and Environment Safety Journal, 14(3). Retrieved from http://fens.usv.ro/index.php/FENS/article/view/42
Eat Right. https://www.eatrightpro.org/news-center/practice-trends/histamine-intolerance
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