Histamine Intolerance: What It Is & What to Do About It

Have you ever experienced headaches, skin rashes, or digestive issues after eating certain foods? Or maybe you’ve noticed that some days you feel more flushed or anxious than usual, especially after consuming alcohol, spicy foods, or other common “triggers” like cured meats and cheeses.

If so, you could be dealing with histamine intolerance, a common condition that affects women’s health in surprising ways, although many don't even realize it.

Below, we'll look closely at histamine intolerance, what causes it, and how you can manage it effectively—including how to recognize a histamine intolerance reaction and what to include on a low histamine foods list.

What Is Histamine Intolerance?

Histamine intolerance occurs when there’s an imbalance between histamine levels¹ in the body and your ability to break it down. 

Histamine is a naturally occurring compound involved in immune responses, digestion, and the nervous system. Its roles include helping to:

• Fight off allergens and pathogens by triggering inflammation, which is why you might get a runny nose or itchy skin during an allergy flare-up.
• Stimulate the production of stomach acid (gastric acid), which is necessary for breaking down food.
• Acts as a neurotransmitter, helping to regulate sleep-wake cycles, mood, and alertness (which is why ADHD and histamine intolerance symptoms are linked).
• Expand blood vessels to increase blood flow, which is useful during immune responses or injury.

In addition to your body making histamine, it's also found in certain foods², including cheese, wine, fermented foods, spinach, some fish types, meat, and others. 

Your body needs some histamine to function properly—and small, balanced amounts are not harmful. Issues arise when histamine builds up faster than your body can break it down, leading to histamine intolerance symptoms. 

As long as your body can efficiently metabolize and break down histamine—mainly through the enzyme called diamine oxidase (or DAO)—having histamine is not only normal but also important for general health.

Related: Is It Really Histamine Intolerance? The Misdiagnosed Epidemic Explained

What Causes Histamine Intolerance?

Several factors can decrease histamine breakdown³ or increase histamine production, leading to histamine intolerance (also called histamine sensitivity). These factors can include⁴:

• DAO deficiency: Reduced levels of the diamine oxidase enzyme, often due to genetics, gut inflammation, or medication use.

• Gut imbalance: SIBO (Small Intestinal Bacterial Overgrowth) or dysbiosis can impair DAO production. These conditions are characterized by an imbalance of “good” and “bad” microbes in the microbiome, which can contribute to digestive issues and inflammation.

• Genetic factors: Variants in genes⁵ that regulate DAO or HNMT enzymes.

• Chronic inflammation: Inflammatory conditions can lower DAO levels.

• Hormonal changes: Estrogen dominance or fluctuations can increase histamine production, making symptoms worse around menstruation or menopause. Mast cells not only release histamine, but they also have receptors for estrogen. When estrogen binds to these receptors, more histamine is released from the mast cells in your uterus, meaning the more estrogen you have, the more histamine is released—leading to histamine intolerance symptoms.

• Medications: Some antihistamines, antidepressants, NSAIDs, and diuretics can block DAO activity, leading to histamine buildup. It's estimated that about 20% of the population⁶ consumes medications that could decrease DAO activity.

• Alcohol use: Alcohol can increase inflammatory responses and disrupt gut health.

• Nutrient deficiencies: Certain deficiencies may compromise immune system function and make histamine sensitivity more common.

Related: Estrogen and Histamine Connection

Histamine Sensitivity vs. Intolerance: What's the Difference?

Histamine sensitivity may cause mild symptoms, while histamine intolerance often involves more systemic, ongoing reactions, especially after eating high-histamine foods. A histamine intolerance reaction can feel similar to an allergy but is driven by poor histamine breakdown rather than immune system antibodies.

Other names for histamine intolerance⁷ include enteral histaminosis or sensitivity to dietary histamine.

In other words, having histamine intolerance will likely cause more noticeable symptoms, similar to how having a gluten intolerance will be more severe than having a gluten sensitivity.

Histamine Intolerance Symptoms

Wondering what a histamine intolerance reaction looks like? Histamine's effects are more evident during inflammatory responses. Histamine can have an impact on cells, neurons, smooth muscle, and other tissues. It can even contribute to PMDD, chronic pain, IBS, ADHD, and more.

Symptoms of histamine intolerance⁸ can vary greatly from person to person but often include:

• Headaches or migraines
• Flushing or redness of the skin, or rosacea
• Itchy skin, hives, or eczema
• Runny nose, sneezing, or congestion
• Digestive issues like bloating, diarrhea, or gas
• Palpitations or irregular heartbeat
• Low blood pressure
• Anxiety, irritability, or mood swings
• Nausea or vomiting
• Menstrual irregularities or heavy periods

Related: Histamine and PMDD: The Hidden Link Worsening Your Symptoms

Conditions Linked to Histamine Intolerance

Histamine intolerance doesn’t exist in isolation—it’s often connected to other chronic health conditions⁹. These conditions can either worsen histamine intolerance symptoms or share common pathways (such as chronic inflammation and leaky gut) that make them more likely to occur together. 

Here’s a closer look at how histamine intolerance is linked to other conditions:

1. Endometriosis and Hormonal Imbalances

High estrogen levels can increase histamine production¹⁰, and histamine can, in turn, promote more estrogen release, creating a vicious cycle. 

Women with endometriosis often experience painful flare-ups correlated with hormonal changes, especially around menstruation. Common symptoms can include pelvic pain, heavy menstrual bleeding, bloating, and mood swings.

2. IBS (Irritable Bowel Syndrome) and Food Allergies

The gut is a major site for histamine production and breakdown. If the digestive system is compromised, as is the case with IBS and allergies, the body may have trouble breaking down histamine¹¹.

Histamine can increase intestinal permeability (leaky gut), leading to bloating, cramping, and digestive distress, such as by causing fluctuating diarrhea and constipation, gas, abdominal pain, and discomfort after eating high-histamine foods.

3. Migraines and Chronic Headaches

Histamine acts as a neurotransmitter and can influence blood vessel dilation, potentially triggering migraines. Elevated histamine levels can cause vascular changes, leading to pounding or throbbing headaches, especially after the consumption of aged cheeses, red wine, or fermented foods.

4. Mast Cell Activation Syndrome (MCAS)

MCAS¹² involves excessive histamine release from mast cells, leading to systemic reactions. Symptoms are often widespread and unpredictable, ranging from hives and flushing to abdominal pain and cardiovascular symptoms and respiratory issues that flare up unexpectedly.

5. Allergic Rhinitis or Chronic Sinusitis

Histamine is directly involved in allergic responses. When your body overproduces histamine, it can lead to nasal congestion, sneezing, and sinus pressure. Chronic histamine release may result in a constantly runny nose, sinus headaches, and postnasal drip, as well as itchy eyes, stuffy nose, frequent sneezing, and sinus discomfort.

6. Fibromyalgia and Chronic Fatigue Syndrome

Histamine can cause inflammation and pain sensitivity. Chronic inflammation in fibromyalgia patients may be partially driven by mast cell activation and histamine release. This can lead to muscle pain, joint aches, and ongoing fatigue¹³ (often due to sleep disturbances, especially eating histamine-rich foods).

7. Chronic Skin Conditions (Eczema, Rosacea)

Skin cells contain histamine receptors, and an increase in histamine can trigger or worsen skin inflammation¹⁴, causing redness, itching, dry patches, and flushing, particularly on the face and neck. Flare-ups often coincide with the consumption of histamine-laden foods or environmental allergens.

How to Test for Histamine Intolerance

If you have any of these conditions or cluster symptoms described above, it may be worth investigating histamine intolerance as a potential contributing factor. This condition can be difficult to diagnose at first, considering symptoms overlap with other conditions, so seek out help from an allergist or functional medicine specialist who can help you with testing and treatment options.

There’s no single definitive test for histamine intolerance, but some approaches can help identify if histamine is a factor involved in your symptoms. It's best to work with a healthcare provider to accurately assess your medical history and test results—this way, you know how to best manage your sensitivity and reactions.

Tests for histamine intolerance can include:

• Blood tests: Measure DAO activity and histamine levels.
• Elimination diet¹⁵: Temporarily removes high-histamine foods (like aged, cured, and fermented foods along with alcohol) to observe symptom changes.
• Histamine challenge: Reintroduce histamine-rich foods to see if symptoms return.
• Skin prick testing: Helps rule out true allergies.

Best Diet for Histamine Intolerance

If you have histamine intolerance, the best way to manage symptoms is by making changes to your diet¹⁶ (eating low-histamine foods and avoiding triggers¹⁷, along with using certain supplements if helpful, getting good sleep, and managing stress.

In terms of diet adjustments, focus on reducing histamine intake¹⁸ while supporting overall gut health and enzyme function.

Foods to Focus On (Low-Histamine Foods¹⁹ List):

• Fresh meat, poultry, and fish (not aged or smoked)
• Fresh, unprocessed vegetables (except tomatoes, spinach, and eggplant, which are “nightshades” that trigger some people's symptoms)
• Gluten-free grains like rice, quinoa, and oats
• Dairy alternatives like coconut or almond milk
• Olive oil and coconut oil
• Almonds, flax, and chia seeds
• Potatoes
• Herbal teas, including ginger, chamomile, and peppermint

Histamine Intolerance Foods to Avoid:

• Fermented foods like sauerkraut, kimchi, yogurt
• Aged cheeses and cured meats
• Alcohol, especially red wine and beer
• Citrus fruits, tomatoes, and avocados
• Spinach, eggplant, and soy products 
• Strawberries, oranges, tangerines, bananas, pineapple, grapes, other berries (for some people)
• Peanuts and potentially other nuts
• Chocolate

I’ve created a recipe guide aimed at supporting hormone health and blood sugar balance that you can download here.

Supplements For Histamine Intolerance/Sensitivity

Histamine intolerance can be tricky to manage since many foods naturally contain histamine or can trigger its release. These supplements help your body break down and manage histamine more efficiently, helping to limit the frequency and severity of symptoms.

1. DAO Enzyme Supplements

The Diamine Oxidase (DAO) enzyme is responsible for breaking down histamine in the digestive tract. Taking a DAO supplement before meals can help reduce symptoms when consuming high-histamine foods, as DAO acts as a histamine scavenger, reducing it before it enters your bloodstream.

DAO enzymes can be particularly useful for those with low DAO activity, which can result from gut inflammation, genetics, or medication use. This approach may help reduce common reactions like bloating, flushing, headaches, and nasal congestion after eating.

How to take it: 

• Take 1-2 capsules 15 minutes before meals that may contain histamine-rich foods.
• Choose supplements that contain pure DAO without additives for best results.

2. Vitamin B12 & B6

Vitamin B12 and B6 assist in metabolic functions and methylation, a process that helps break down histamine. In people with histamine intolerance, low B12 levels can worsen symptoms. 

Taking B12 and B6 (found in my Balance Women's Hormone Support formula) supports the methylation pathway, which helps degrade histamine and other compounds that cause inflammation. It can help decrease symptoms like brain fog, mood swings, and fatigue, which are common symptoms linked to histamine overload.

How to take it:

• Choose the methylated form of B12 (methylcobalamin) for better absorption.
• Take 500-1000 mcg daily, especially if you have MTHFR gene variations that affect methylation.
• Works particularly well when taken alongside folate (B9), as both are involved in homocysteine regulation.

3. Vitamin C

Vitamin C is a natural antihistamine that helps degrade histamine by increasing the activity of the DAO enzyme. It also stabilizes mast cells, preventing them from releasing histamine. Vitamin C can help break down excess histamine and clear it from the body and may reduce inflammatory responses and support immune system function, potentially decreasing the intensity of allergic reactions and skin issues.

How to take it:

• Opt for buffered or liposomal Vitamin C for better digestive tolerance.
• Typical dosage ranges from 500 mg to 2000 mg per day, but split doses (e.g., 500 mg twice a day) are often more effective.
• Combine it with bioflavonoids (like quercetin) to enhance the antihistamine effect.

4. Quercetin

Quercetin is a bioflavonoid found in foods like apples, onions, and capers. It acts as a mast cell stabilizer, reducing the release of histamine and other inflammatory compounds. It also inhibits the enzyme histidine decarboxylase, which converts histidine to histamine, thus lowering histamine levels. 

Quercetin may help reduce allergic reactions by blocking histamine from binding to its receptors, and in addition, it supports gut health by minimizing inflammation and oxidative stress.

How to take it:

• Look for high-potency quercetin supplements (500-1000 mg), often paired with Bromelain for enhanced absorption.
• Take with meals, as quercetin can sometimes cause stomach irritation if taken on an empty stomach.
• Combine with Vitamin C for a synergistic antihistamine effect.

5. Probiotics

Probiotics support a healthy gut microbiome and also help to regulate the gut-brain axis, improving mood stability, reducing hyperactivity, and enhancing energy and cognitive function. 

How to take it:

• Incorporate gut-friendly probiotics into your diet and supplement routine, and ideally choose low-histamine strains like Lactobacillus rhamnosus and Bifidobacterium infantis. 
• In my Women's Probiotic, you'll find a blend of probiotics (including those in the Lactobacillus family), prebiotics, and antioxidants designed to specifically support healthy hormones. 

Helpful Lifestyle Adjustments

• Stress Management: Stress and sleep deprivation can potentially increase histamine levels and take a toll on your immune system. Try practices like yoga, meditation, and deep breathing to help manage stress and regulate your nervous system. Be sure to get enough sleep, which is about 7 to 9 hours per night for most adults. Spend time in nature and get sunlight exposure during the daytime, which can lift your energy and mood and assist in sleep. Do things that you find uplifting and relaxing each day, like reading, journaling, socializing, art, and learning new things.

• Gut Health Support: Probiotics can help support gut function and immune defenses, however, it's key to choose low-histamine strains like Bifidobacterium infanti, which are usually tolerated well. Prebiotics (which help “feed” probiotics) are also helpful for gut health, as are collagen peptides, bone broth, and L-glutamine, which support the integrity of your gut lining.

• Medication Review: Discuss any histamine intolerance medications you’re taking with your doctor to decide if they may be contributing to your symptoms and if there are better alternatives. Keep in mind that sedating antihistamines (like Benadryl) can increase drowsiness and worsen symptoms like brain fog, so discuss other antihistamines with your provider.

Final Thoughts on Histamine Intolerance Symptoms, Causes, and Treatments

• Histamine intolerance can significantly impact your quality of life, leading to fatigue, hormonal imbalances, and digestive issues—but with the right diagnosis and management plan, you can reduce symptoms and feel better. 
• Histamine intolerance treatment typically includes a low-histamine diet, supplements like a DOA enzyme, vitamin C, probiotics, and B12, as well as stress management.
• Always work with a healthcare provider to develop a personalized treatment plan, especially if you suspect you have related conditions like MCAS or IBS.

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