Histamine Intolerance

Dr. Emily Dickerson, ND

Usually when we think histamine, we often think hives, hay fever, and skin rashes. However, did you know that it can also cause a myriad of other symptoms such as diarrhea, migraines, sinus congestion, headaches, coughing, difficulty breathi
ng, a racing heart, and
low blood pressure? Histamine is a hidden offender for many people. About 1% of the population is histamine intolerant, and due to the vagueness of its symptoms, it has the potential to be even more prevalent.

Histamine functions as a chemical neurotransmitter, meaning that it communicates with your brain much like neurotransmitters serotonin, epinephrine, and dopamine. This also means that it has impact through
out the body, not just in a specific location.

Histamine can be found in our food. In fact, histamine is much higher in some foods than in others. Histamine intolerance causes many symptoms, which makes it difficult to detect and diagnose for many patients and their healthcare providers. Symptoms can be due to food allergies causing leaky gut, or due to a high intake of histamine-rich foods directly instigating a pro-inflammatory response.

The symptoms of histamine intolerance are caused by an excess of histamine. Excess histamine is often caused by a deficiency of diamine oxidase (DAO), the main enzyme responsible for the breakdown of ingested histamine. A deficiency in DAO can be caused by inflammation in the gastrointestinal tract, most notably due to a disturbance in the healthy gut flora. Histamine Intolerance has been shown to be related to SIBO (small intestine bacterial overgrowth) and dysbiosis (gut flora imbalance). An imbalance in your gut flora can cause a histamine intolerance because some types of excess bacteria actually make histamine from undigested food. This buildup of histamine causes the body to have an increased sensitivity to high histamine foods.

Histamine Rich Foods:

– Very high histamine foods: seafood, canned or smoked fish
– High histamine foods: aged cheese, fermented foods like kimchi, sauerkraut, kombucha, yogurt, kefir, alcohol, vinegar, meat
– Medium histamine foods: spinach, mushrooms, tomatoes, eggplant, canned vegetables, dried fruit, strawberries, papaya, avocado, pineapple

Other foods can cause triggers even if they are not high histamine foods. They do so by triggering the body to increase more of its own histamine. This group includes strawberries, onions, and kiwi.

Histamine functions as a chemical neurotransmitter, meaning that it communicates with your brain much like neurotransmitters serotonin, epinephrine, and dopamine. This also means that it has impact throughout the body, not just in a specific location.


Evaluation and treatment for Histamine Intolerance is multifaceted. While it is good to be aware of the histamine rich foods, don’t simply avoid them, as many have high nutritional benefit and may not be causing your individual symptoms. It is important to have a healthcare provider guide you through the process of identifying your food sensitivities. Testing for a diamine oxidase is inaccurate and unnecessary, thus not done often. It is essential that we look to the diet for potential histamine triggers and that we support a healthy gut flora and appropriate immune response in order to address histamine intolerance.


  • An Elimination-Rechallenge Diet focusing on histamine-rich foods can be helpful in identifying a histamine intolerance. The Elimination Rechallenge Diet is the “Gold Standard“ for both conventional and alternative medicine alike for identifying food triggers and matching those triggers with a symptom profile. It can be useful in finding not only a histamine intolerance, but additional food sensitivities that may be present. In utilizing this technique, you will want to take special note of the histamine-rich foods during the elimination-rechallenge process. A healthcare provider can help you identify these patterns and get your diet and your health back on track.
  • Also useful is a Food Sensitivity Panel, which is a blood test that shows your body’s immune response when exposed to different foods. This will not diagnose a histamine intolerance, but can tell us if there are foods causing inflammation in the gut and potentially disrupting the delicate ecosystem within the gastrointestinal tract. This can be helpful in identifying foods that may be triggering inflammation and causing leaky gut and other symptoms. A Food Sensitivity Panel is followed by a streamlined Elimination Rechallenge Diet. If you have had a food sensitivity panel in the past and are still having symptoms, a histamine intolerance may be the problem.
  • Based on the results of the Elimination-Rechallenge Diet and the Food Sensitivity Panel, we can determine a diet that is optimally anti-inflammatory and specific to the individual needs of your body. It is important to have a healthcare provider guide you through the process of identifying food sensitivities.

Gut Flora:

  • If you have a gut flora imbalance, focus on healing your gut tissue and restoring your healthy gut flora in order to decrease your histamine response. A gut healing protocol is often very beneficial while undergoing identification of food triggers and is an essential component of treatment for histamine intolerance.

Allergy Elimination Technique:

Also beneficial for treatment of histamine intolerance is Nambudripad’s Allergy Elimination Technique (NAET). This technique helps the body to desensitize itself against triggering allergens, such as histamine foods for those that are histamine intolerant. Boise Natural Health’s own Emily Richmond (Yuen) is an experienced practitioner in NAET and is passionate about helping people overcome histamine intolerance.

If this sounds like you, we recommend a complete evaluation. Dr. Dickerson is now seeing patients full time both via telemedicine and in office. To schedule an appointment, call Boise Natural Health Clinic at (208)338-0405.”