Written by Julie Woon, MSJ
What Is Histamine?
Histamine is a chemical the your immune system releases in the process of sending messages between different cells. While it is well known for causing allergy symptoms, it plays many other roles in the body. In particular, it plays a key role in the body’s inflammatory response.
What Happens When You Cannot Tolerate Histamine?
When you have a high level of histamine in your body, and it cannot properly break it down, you have histamine intolerance. In many cases, the symptoms of Postural Orthostatic Tachycardia Syndrome (POTS). High levels of histamine can cause blood vessels to dilate, worsening blood flow, which makes it difficult for the body’s of patients living with POTS to adjust to changes in posture. This leads to symptoms of dizziness and palpitations.
Certain foods can increase the histamine levels in your body. Therefore, we have added this guide dedicated to highlighting these foods to help support the many patients living with POTS and Mast Cell Activation Syndrome (MCAS) within our community, as well as educate those unfamiliar with the impact of diet on these two challenging chronic conditions.
About This Histamine Intolerance Guide
This guide is adapted from the Swiss Interest Group Histamine Intolerance (SIGHI) and is intended to help people with a DAO degradation disorder identify foods that may need to be limited or avoided due to histamine, other biogenic amines, or substances that inhibit DAO (diamine oxidase).
This list is not a complete treatment guide. For more information about managing histamine intolerance through dietary changes, please consult SIGHI’s therapy and dietary guidance, including its related pages.
Important Considerations
This guide may not be sufficient for people with mast cell activation disorders (MCAD). MCAD can be mistaken for histamine intolerance, and dietary needs may differ. If you do not achieve and maintain symptom relief with this approach, SIGHI recommends consulting its more detailed food list, which also considers histamine liberators: Mastzellaktivierung.info.
Food tolerance varies considerably from person to person and depends on several factors, including the amount consumed, food freshness, stress, hormones, and individual sensitivity. At the beginning of an elimination diet, following the list consistently may help you identify potential triggers. Over time, your own experience should guide your food choices rather than relying solely on a list.
Always check ingredient labels. Prepared foods and packaged products may contain ingredients that are not compatible with your individual dietary needs.
This guide is for informational purposes only and is not a substitute for individualized medical advice. If you are considering an elimination diet or continue to experience symptoms, consult a qualified healthcare professional or registered dietitian for guidance.
Histamine Intolerance Food List
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To Avoid
Fermented or microbially ripened products, including alcoholic products, vinegar, and products involving yeast or bacteria.
Perishable foods with uncertain freshness or an interrupted refrigeration chain.
Canned, prepared, or partially prepared products.
Foods kept warm or reheated, especially fish, meat, and mushroom dishes, as well as foods stored for long periods.
Risky
Restaurant, canteen, and snack-bar meals, which may be poorly tolerated for various reasons.
Well-tolerated
Fresh, unprocessed, or minimally processed foods.
Properly refrigerated perishable foods.
Leftovers cooled briefly, frozen, then thawed quickly and consumed immediately.
Food prepared using methods that preserve vitamins.
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To Avoid
Canned, cured, dried, marinated, smoked, or otherwise preserved meats, including bacon and dry-cured ham.
Dry-aged or long-hung meats.
Finely chopped or pureed meats, such as meatloaf, spreads, and cold cuts.
Most sausages, including salami and liverwurst.
Organ meats, especially liver.
Risky
Fresh meat sold over the counter without a date.
Prepackaged minced meat.
Precooked sausages.
Venison and other game meats.
Well-tolerated
Fresh, dated, packaged meats, including poultry, pork, beef, lamb, and goat.
Frozen meat thawed rapidly.
Sliced cooked ham without yeast extract or glutamate.
Eggs, including chicken and quail eggs.
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To Avoid
Canned, marinated, salted, dried, smoked, or pickled fish and seafood.
Tuna, mackerel, herring, sardines, anchovies, and mahi-mahi.
Fish sauces.
Shellfish and crustaceans, including mussels, lobster, crab, shrimp, and prawns.
Risky
Fish sold as fresh at shops, fish markets, or restaurants.
Seafood of uncertain freshness.
Well-tolerated
Very freshly caught fish.
Frozen fish that has not been stored for long periods, thawed quickly, and used immediately.
Examples include pollock, cod, trout, whitefish, perch, and organic pangasius.
-
To Avoid
Matured cheeses, including hard, semi-hard, and soft cheeses; processed cheese; blue cheese; mold-ripened cheese; fondue; and aged Gouda.
Risky
Yogurt, kefir, sour milk products, acidified buttermilk, sour cream, and crème fraîche.
Feta cheese.
Well-tolerated
Fresh dairy products, including pasteurized milk, UHT milk, butter, cream, and whey.
Cream cheese varieties, including mozzarella, cottage cheese, mascarpone, ricotta, and goat cream cheese.
Young Gouda, Butterkäse, and Schichtkäse.
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To Avoid
Some yeast-based and sourdough bakery products, particularly those made with very long proving times.
Possibly very fresh pastries that are still almost warm.
Risky
Canned corn.
Unpeeled buckwheat.
Well-tolerated
Potatoes, corn, rice, and other grains.
Grain products in various forms, including flakes, flour, semolina, pasta, and bakery products.
Sauces and other foods made from these ingredients.
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To Avoid
Sauerkraut, spinach, tomatoes, ketchup, tomato juice, eggplant, avocado, and olives.
Legumes, including lentils, beans, soy, and soy products such as tofu.
Pickled vegetables.
Ceps, morels, and Agaricus mushrooms.
Risky
Green bush beans.
Peas.
Unfermented olives.
Mushrooms.
Well-tolerated
Fresh or frozen vegetables not listed under “To Avoid.”
-
To Avoid
Strawberries, raspberries, lemons, oranges, and other citrus fruits.
Bananas, pineapple, kiwi, pears, papaya, and guava.
Nuts, especially walnuts, cashews, and peanuts.
Risky
Overripe fruits and rotten portions of fruit.
Well-tolerated
Fruits not listed under “To Avoid,” including apples, peaches, apricots, melons, mangoes, persimmons, lychees, cherries, blackberries, blueberries, cranberries, currants, cassis, and jostaberries.
Coconut, coconut milk, coconut water, macadamias, and chestnuts.
Acceptable fruits may be fresh, frozen, or canned.
-
To Avoid
No specific foods are listed in this category.
Risky
Walnut oil.
Well-tolerated
Vegetable oils and fats.
Animal fats.
Fish oil.
-
To Avoid
Vinegar, especially wine vinegar and balsamic vinegar.
Yeast extract and flavor enhancers such as glutamate and sodium glutamate.
Bouillon and broth.
Soy sauce and hot spices.
Risky
No specific foods are listed in this category.
Well-tolerated
Table salt, fresh or powdered garlic, culinary herbs, and mild spices.
Distilled white vinegar and apple cider vinegar.
Fresh or dried culinary herbs.
Starches used as binders, including cornstarch and potato starch.
-
To Avoid
Cocoa, cocoa mass, brown and dark chocolate, and carob.
Risky
White chocolate.
Well-tolerated
Sugar, agave syrup, honey, and stevia.
Jams made from fruits listed as acceptable in the guide.
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To Avoid
Alcoholic beverages.
Soy milk.
Energy drinks containing theobromine.
Juices and sodas containing incompatible ingredients.
Nettle tea.
Risky
Rice milk and oat milk.
Clear spirits.
Black tea, coffee, green tea, and espresso.
Well-tolerated
Water.
Herbal teas and plain rooibos tea.
Juices and sodas made with acceptable ingredients.
Almond milk.
-
To Avoid
No specific items are listed in this category.
Risky
Certain additives; consult the detailed information referenced by SIGHI at mastzellaktivierung.info.
Well-tolerated
No specific items are listed in this category.
Modes of action to the histamine metabolism of foods and additives
It is important to understand what foods affect the histamine levels in which way. Besides food containing histamine directly, there are also those that indirectly influence the histamine levels (histamine liberators, diamine oxidase inhibitors, other biogenic amines and substances that affect the intestinal permeability).
A histamine intolerance can have various causes with different underlying pathogenetic mechanisms. This may be one of the reasons why not all those affected react equally to the same foods or categories of triggers respectively. This knowledge is also relevant for medical support therapy, because not every drug is appropriate in all the below mentioned groups.
Histamine-containing foods
Histamine is formed as a deterioration product in perishable food, in microbial fermentation and maturation processes and in the ripening of fruit. Even some vegetables are naturally histamine containing, although very fresh.
Medication: DAOSIN (works best if ingested 15-30 min before meal), H1 antihistamines, possibly H2 antihistamines.
Fish, if not freshly caught or frozen
Meat, if no longer fresh, sausages, dry-cured meats
Matured cheese, processed cheese (histamine increases with maturity)
Any fermented food, e.g. Sauerkraut
Tomatoes, spinach, eggplant, avocado
Alcoholic drinks, fermented fruit juices
Vinegar, pickled vegetables
Soy sauce, Worcestershire sauce
Yeast extract
Other biogenic amines
Besides histamine, there are numerous other biogenic amines. Several amines share the same main degradation pathway with histamine: They are competing substrates, degraded by the same enzyme diamine oxidase (DAO). The DAO prefers other amines before it degrades histamine. While the DAO is busy with the breakdown of other biogenic amines, the breakdown of histamine is temporarily decreased or blocked. Some of these biogenic amines have properties similar to those of histamine and can cause histamine-like symptoms directly.
Medication: H1 antihistamines, DAOSIN.
Pineapple
Banana
Pears
Peanuts
Grapefruit
Raspberries
Legumes (lentils, beans, soy products)
Kiwi
Oranges
Papaya
Wheat germ
Histamine liberators
The foods and additives listed on the right have the property of releasing endogenous histamine from certain cell types (mainly from mast cells). This
mechanism is independent from a lack of diamine oxidase (DAO). Histamine release is enhanced in persons with mast cell activation disease (MCAD) and to a lesser extent maybe also when the enzyme activity of histamine-N-methyltransferase (HNMT) is reduced. HNMT is an intracellular histamine degradation pathway. Even healthy people can react to liberators if the dose is strong enough.
Medication: H1 antihistamines, cromoglicic acid (or its salt sodium cromoglicate or cromolyn sodium), ibuprofen.
DAOSIN has no direct effect against histamine liberators.
Alcohol (ethanol) and its degradation product acetaldehyde
Strawberries
Nuts (walnut, cashews)
Seafood, shellfish, crustaceans (e.g. mussels, crayfish, crabs)
Chocolate, cocoa
Tomatoes, ketchup, tomato juice
Citrus fruits
Certain active substances and additives in medicaments
Diamine oxidase inhibitors
The diamine oxidase is a sensitive molecule that can be inhibited in its activity by chemical influences. The foods and additives on below are or contain DAO inhibitors that can block the breakdown of histamine by the DAO. The activity of histamine N-methyltransferase (HNMT) can also be inhibited by chemicals, but little is known about which substances are inhibitors.
Medication: H1 antihistamines. DAOSIN just supports the reduction of biogenic amines, but is ineffective against DAO inhibitors!
Alcohol (ethanol) and its degradation product acetaldehyde
Certain biogenic amines
Certain medicinesTheobromine
Mate tea
Increase in intestinal permeability
Certain substances affect the intestinal permeability ("Leaky Gut Syndrome"). They make the intestines leak, so that macromolecules and other substances from the digestive tract can enter the body, which normally is not the case. This enhances the risk of developing an IgE or IgG food allergy or poisoning.
Medication: mast cell stabilizers with continuous application, H1 antihistamines. DAOSIN has no effect in this case.
Alcohol may increase the uptake of allergens from the gastrointestinal tract. Alcohol may influence the tolerance threshold of food allergens in a negative way.
Hot spices (pepper, chili, curry, etc.) are able to increase the intestinal permeability to histamine, which enhances histamine uptake.
Sources
Adapted from the SIGHI-Leaflet: Histamine Elimination Diet, published by the Swiss Interest Group Histamine Intolerance (SIGHI), version November 17, 2021.
View the original SIGHI Histamine Elimination Diet leaflet (PDF) for the complete guidance and additional information.
This food guide has been reorganized and simplified for readability. Please refer to the original source for its full context and recommendations.
Medical Disclaimer
This food guide is for informational and educational purposes only. It is not intended to diagnose, treat, cure, or prevent any medical condition, and it should not replace advice from a qualified healthcare professional.
Food tolerance varies from person to person and may be influenced by portion size, food freshness, stress, hormones, and other factors. Foods listed as “to avoid,” “risky,” or “well tolerated” may not affect everyone in the same way.
The simplified SIGHI histamine elimination diet may not be sufficient for people with mast cell activation disorders (MCAD). If you experience persistent symptoms or are considering an elimination diet, consult a qualified healthcare professional or registered dietitian for individualized guidance. Seek professional advice to help ensure that dietary restrictions do not compromise nutritional adequacy.