How to follow a low-histamine diet

From headaches to itchy skin and nausea, histamine intolerance can make life uncomfortable. A low-histamine diet can help.

Histamine plays a role in our immune and digestive systems, and helps our neurological function.

Our body naturally produces this chemical, but it can also be found in food.

Some people are less tolerant of histamine – they have too much of it in their system.

Dietitian Nicole Dynan says this may be because they lack an enzyme called diamine oxidase (DAO), which breaks down histamine in the body.

“People may lack DAO due to interference by medications or if they have a gut disorder. Some foods also block the release of DAO,” says Nicole, of Dietitians Association of Australia.

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Is histamine intolerance becoming more common?

A 2020 review noted some researchers estimate histamine intolerance affects 1 to 3 per cent of the population.

However given research into this area is still relatively new, the incidence may increase as more is understood about the issue and diagnostic tools improve.

How do you know if you are sensitive to histamine?

There are no standard blood tests to identify intolerance, so an elimination diet is the “gold standard” to identify a problem.

This involves removing high-histamine foods from your diet and slowly adding them back in, one at a time. This should be done with a dietitian who specialises in food intolerances.

“You may be able to tolerate a certain amount of histamine and when you get beyond a threshold, you get symptoms,” dietitian Aloysa Hourigan says.

“You might be fine having avocado on toast in the morning, but if you then have aged cheese at lunchtime or chocolate after dinner – all foods that contain higher levels of histamine – you may release or consume too much histamine and get a headache.”

Signs of histamine intolerance

Symptoms include:

  • Headaches
  • Skin irritations
  • Diarrhoea
  • Sinus problems
  • Fatigue
  • Hives
  • Digestive problems
  • Nausea or vomiting
  • Dizziness.

How do you treat histamine intolerance?

2019 study found an improvement in symptoms when patients took a DAO supplement.

The study assessed 28 patients with histamine intolerance over four weeks. They were given a DAO capsule before meals, followed by a period where they did not take a capsule.

Researchers observed a significant reduction in symptoms while patients were taking the supplement.

But largely, people with histamine intolerance are advised to avoid or reduce foods with higher levels of the chemical to manage their symptoms.

High-histamine foods: which foods should you avoid?

Foods to avoid include:

  • Fermented dairy products such as cheese – particularly aged cheese, yoghurt, sour cream and kefir
  • Fermented vegetables like sauerkraut, kimchi and pickles
  • Cured or fermented meats – sausages, salami, fermented ham
  • Wine, beer and champagne (which can also harm your immune system)
  • Fermented soy products – tempeh, miso, soy sauce
  • Sourdough bread
  • Tomatoes, eggplant and spinach

Some foods don’t contain high levels of histamine, but they are “histamine liberators” that promote the release of the chemical in our body.

These include:

  • Pineapples
  • Bananas
  • Citrus fruits
  • Strawberries
  • Nuts
  • Spices
  • Legumes
  • Seafood
  • Egg whites

low histamine diet

What are low-histamine foods?

These include:

  • Fresh meat, chicken and fish
  • Eggs
  • Gluten-free grains
  • Apples and just ripe bananas
  • Potatoes and sweet potato
  • Pumpkin
  • Zucchini
  • Carrot
  • Cucumber
  • Celery
  • Shallots

“If you cut out certain foods, you need to make sure you still have nutritional balance in your diet. Otherwise you miss out on some vitamins and minerals,” Aloysa advises.

“For example, if you follow a low-histamine diet you may not have as much citrus fruit, which is a great source of vitamin C.

“So, you need to add fruits and vegetables that contribute to vitamin C like blueberries, guava and melon.”

A low-histamine day on a plate diet plan

Breakfast: Eggs on gluten-free toast

Lunch: Salad sandwich with gluten-free breads but without tomatoes, avocado and spinach

Dinner: Fresh fish, potatoes, zucchini and carrot

Snacks: Coconut yoghurt, tinned or peeled pear or grated apple, a plain gluten-free biscuit.

Source: Nicole Dynan, DAA

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Written by Jenna Meade. Updated June 2024.