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Histamine intolerance is a food intolerance that can be difficult to diagnose, as there are varying symptoms that often seem unconnected: allergies, hives, headaches, migraines, digestive disturbance, anxiety to name a few. It is a quite common, and yet poorly understood food intolerance.


The difficulty with histamine intolerance is that many foods that we all consider to be healthy are high in histamines – for example spinach, tomatoes, oranges, yogurt, cinnamon and vinegars. They are foods that most of us eat very regularly, and hence we don’t recognize a causal relationship between the foods they eat and how they feel. It is also a cumulative intolerance, meaning that small amounts of high-histamine foods will not cause symptoms, but if a certain threshold is passed, the body starts to react.

With histamine intolerance, there is a problem with enzyme pathways that break down histamines. This is possibly caused by genetic variation in enzyme function, but more likely is related to what is called dysbiosis or ‘SIBO’ (small intestine bacterial overgrowth), where the imbalance in digestive flora actually causes an overload of histamines in the intestinal tract, and hence overwhelms the enzyme system.

Some of the possible symptoms of histamine intolerance include:

  • Hives
  • Itching – skin, ears, nose and eyes
  • Nasal congestion
  • Drop in blood pressure
  • Heart racing
  • Symptoms of anxiety, and possibly panic attacks
  • Headaches (they can be significant and severe)
  • Feeling of throat tightening
  • Fatigue or irritability
  • Digestive upset – especially heartburn

If you experience several of these symptoms regularly, especially allergy symptoms, headaches and heartburn, this may be the link with food that you have been looking for.


The most important steps to treat a histamine intolerance are to 1) Strictly avoid all high histamine foods (see below); and 2) even more importantly to treat the digestive tract, and clear out small intestinal bacteria overgrowth. Most people feel a significant improvement in their symptoms very soon after cutting out high-histamine foods. What this means, is that the most accurate way to diagnose histamine intolerance is with a low-histamine diet as a trial.

Foods high in histamine include:

  • All fermented foods – alcohol, vinegars, miso, tempeh, yogurt, cheese, sauerkraut, soy sauce
  • Processed meats such as lunch meat, bacon, sausage, salami, pepperoni
  • Citrus fruits
  • Nuts: walnuts, cashews and peanuts especially
  • Dried fruits
  • Spinach
  • Tomatoes
  • Certain spices: especially cinnamon, cloves, chill powder, nutmeg, curry powder, cayenne
  • Tea (black and green)
  • Chocolate
  • Possibly: avocado, banana, eggplant, papaya, pineapple, strawberries

Who would have ever thought that a fresh spinach salad with tomato, a little cheese, and Balsamic vinegar dressing could possibly be a problem; or yogurt with cinnamon and berries! This is why people with histamine intolerance are often puzzled by their symptoms – because they sometimes feel very unwell after eating extremely healthy foods!

Rosacea is also a condition that has been linked to histamine intolerance, and many people with rosacea will notice the high histamine foods as triggers. From a naturopathic perspective, rosacea is a condition best treated by addressing the gastrointestinal tract – rebalancing small intestinal flora, identifying food intolerances, and supporting digestion with enzymes and betaine hydrochloride.

If this article is speaking to you, and you suspect that you may have a histamine intolerance, please book an appointment at the clinic to discuss further. The good news is that the symptoms such as allergies, headaches, rosacea and indigestion are connected, and treatable.

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