What is histamine?
Histamine is a biogenic amine that is found in a wide variety of foods. The main enzyme that breaks down histamine in the body is diamine oxidase (DAO). Normally, histamine from food is rapidly metabolised by enzymes. However, individuals with low DAO enzyme activity are at risk of undegraded histamine toxicity [1,2]. Consumption of foods rich in this amine causes a number of symptoms in people with intolerance to it. These include headaches, diarrhoea, hives, rhinitis, dyspnoea, hot flashes and hypotension. To prevent these, people with histamine intolerance should follow an antihistamine diet [1,2,3].
Antihistamine diet – what to eat?
An antihistamine diet is an essential part of the treatment of histamine intolerance. It should be based on foods containing small amounts of histamine [2,4,5]. These include:
- cereal products (bread, pastries, rice, pasta, millet, buckwheat) except wheat,
- beverages (water, home-made juices made from permitted fruit and vegetables, weak tea and coffee),
- some vegetables (celery, carrots, potatoes, peppers, lettuce, cauliflower, broccoli, radicchio, garlic, onions, cucumber, pumpkin, courgette, radish, artichoke),
- certain fruits (rhubarb, apple, pear, cherry, peach, apricot, watermelon, blueberries),
- fats (butter, margarine, vegetable oils, olive oil),
- fresh meat (lamb, poultry, veal),
- fresh fish (pikeperch, halibut, cod, pollock, trout),
- certain dairy products (milk, cream, cottage cheese, feta, mozzarella, ricotta)
- seeds and seeds (flaxseed, chia seeds, poppy seeds, pumpkin seeds)
- eggs [4].
Antihistamine diet – what to avoid?
The antihistamine diet consists primarily of excluding products with a high histamine content, but also those that stimulate histamine release [3,4,5,6].
Products with the highest histamine content are:
- alcohols (especially red wine, beer, champagne),
- cheeses (mouldy, processed and long-life cheeses),
- fermented dairy products (yoghurt, sour milk, buttermilk, kefir),
- red meat and meat products (salami, hams),
- wheat and yeast-containing cereal products,
- pickles,
- smoked fish, marinated fish, canned fish,
- certain fruits (pears, kiwi, bananas, pineapple, raspberries, strawberries, citrus fruit),
- selected vegetables (tomatoes, spinach, aubergines, pulses),
- nuts (especially walnuts),
- mushrooms,
- strong coffee and tea,
- ketchup, mayonnaise, vinegar (except spirits) [2,3,4,6].
What should the diet for histamine intolerance look like? The antihistamine diet and its principles
A low histamine diet aims to calm the symptoms of a person with histamine intolerance and improve their wellbeing. It is very important that meals are wholesome, i.e. provide all the necessary nutrients. Due to the exclusion of a large number of products, a low histamine diet seems restrictive. Many people fear that they will not be able to stick to it for the long term and ensure a well-balanced menu. However, a properly composed low-histamine diet can be attractive and tasty. This will ensure that it is not burdensome to maintain, while at the same time relieving symptoms and improving wellbeing. It is always advisable to seek support from a qualified dietitian [2,4,5] if you are struggling to arrange a low histamine diet.
On a low-histamine diet, it is advisable to choose fresh and unprocessed foods. It is better to avoid products that are:
- perishable,
- not stored in refrigeration (e.g. meat, fish),
- long kept warm or reheated,
- highly processed (with a lot of food additives),
- with a long shelf life [4,5].
It is important to note that no cooking techniques, e.g. boiling, baking, frying, reduce the amount of histamine in food. This amine is heat-resistant [4].
Due to individual tolerance of histamine and different foods, self-observation is key. It may be a good idea to keep a food diary. If some of the foods high in histamine are well tolerated and do not cause symptoms, there is no need to over-restrict the diet. Too much restriction may result in little variety in meals. This in turn translates into an increased risk of nutritional deficiencies [5].
Conversely, if a low-histamine diet does not work, it is necessary to look at whether other biogenic amines are still present in the diet. These include putrescine, cadaverine and tyramine, among others. It may be that their presence does not allow symptoms to be extinguished [5,7].
