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Can Histamine Intolerance Be Cured?

Written by Dr. Michael Ruscio, DC on December 11, 2024

Written by Dr. Michael Ruscio, DC on December 11, 2024 — Reviewed by Hilary Watts

• What is Histamine Intolerance?|
• Causes|
• 3-Step Plan|

If you’ve ever experienced a runny nose, headache, hives, diarrhea, and bloating immediately after eating, it’s easy to see why you may point the finger at a specific food. While a food allergy or food intolerance may be the cause, these symptoms are also indicative of histamine intolerance.

Histamine is a natural compound produced by the body (and also high in some foods) that plays a role in immune system responses, digestion, and various central nervous system functions. Histamine is supposed to be there, but if your body can’t break it down like it should, histamine can build up causing uncomfortable symptoms. 

So, can histamine intolerance be cured? There may not be a straightforward answer to this question. Before I explain why and share the 3-step plan we use in the clinic to help quiet histamine intolerance symptoms (in as little as a few weeks), let’s dive into what histamine intolerance is.

What is Histamine Intolerance? 

To help you better understand histamine intolerance, allow me to share some background about histamine.

Histamine is a chemical messenger made by the immune system and stored in various cells of the body (like mast cells and basophils). It has many purposes, like helping with stomach acid secretion and aiding in blood cell formation. 

But histamine is probably most well-known for its role in the inflammatory response and allergic reactions 1. If you have ever taken an antihistamine medication, you have likely felt the natural effects of histamine—itchiness, swelling, and redness. All of these are part of a normal immune response but can be uncomfortable to tolerate. 

Normally, the diamine oxidase (DAO) enzyme breaks down histamine in the body 2. If a person is deficient in DAO or the enzyme isn’t working as it should, histamine can start to build up. This can cause allergy symptoms, allergic reaction-like symptoms, and immune responses in the gut and other parts of the body (i.e. histamine intolerance) 3. 

The most common tell-tale signs that clue us into a histamine problem in the clinic include:  

• Bloating 4
• Diarrhea 2
• Heart rate changes or palpitations 2
• Low blood pressure 5
• Headaches 6
• An increase in symptoms when eating high histamine foods 7

These may be the most common symptoms, but since histamine can impact many different body systems, an intolerance can cut a wide swath. Here’s a graphic detailing how high levels of histamine can impact the body:

As you can see, histamine intolerance symptoms mimic other conditions, which makes pinpointing histamine as the culprit a challenge. We have clients in the clinic who have had a battery of tests, tried various diets, and taken supplement after supplement without success—most of the time it’s because they didn’t know they needed to target histamine. 

So, how do you know if you have histamine intolerance?

Feeling better on a low histamine diet may be the most accurate way to find out 8.

As for testing, some research suggests that DAO levels in the blood correlate with histamine intolerance—specifically, levels below 10–40 U/mL may increase risk 3 9. And certain genetic tests can indicate a predisposition to poor histamine degradation and high histamine levels, but genetic testing may not be relevant for diagnosing histamine intolerance.

At this point, you’re probably wondering why histamine levels build up in the first place. Let me share some of the theories on how histamine intolerance develops. 

What Causes Histamine Intolerance?

DAO deficiency may be one factor in histamine intolerance, although it’s unclear why deficiency occurs—possibly genetics, certain disease states, medications, and age 10. 

Outside of a DAO deficiency, more and more research points to poor gut health as the origin of histamine intolerance 11. One study found 30–55% of people with digestive symptoms may also have histamine intolerance 12. 

Others have found people with histamine intolerance may be more likely than healthy people to have imbalanced gut bacteria, lower levels of DAO, and leaky gut 13. 

So, how does poor gut health impact histamine levels? It could be that people with gastrointestinal diseases have altered expression of gut histamine receptors 14. But gut dysbiosis (an imbalance in the gut microbiome) may also be a key player. 

Certain gut bacteria may produce excess histamine, and a leaky gut (a damaged intestinal lining), often caused by dysbiosis, may stimulate the immune system to produce more histamine. The gut barrier itself may also not be able to turn histamine into other compounds. 

Other histamine-related gut research has found:

• An association between low DAO levels and inflammatory bowel disease (IBD—Crohn’s disease and ulcerative colitis) 15.
• Over half of people with irritable bowel syndrome (IBS) may react to histamine-releasing foods 16.
• Higher levels of histamine seem to correlate with more severe IBS symptoms 16. 
• IBS patients tend to have higher histamine levels and more histamine-producing bacteria, which may contribute to IBS 16. 

If you suspect histamine intolerance, you may be asking the question, “Can histamine intolerance be cured?” Answering this is tricky because we don’t exactly know what causes histamine intolerance, and there’s a lack of definitive testing, so it’s hard to know who actually has it 17. 

While it can sometimes seem like an insurmountable mountain to climb, knowing that poor gut health may be an underlying cause of histamine intolerance gives us a solid target to aim for. Having a target makes it easier to create a plan for healing.

In our experience in the clinic, it’s absolutely possible to quiet the symptoms of histamine intolerance in just a few weeks. 

We do this by helping our clients remove roadblocks that are often in the way of healing and providing the ingredients their bodies need to thrive. So, without further ado, let me share our 3-step plan for healing histamine intolerance symptoms. 

3 Steps to Quiet Histamine Intolerance Symptoms

It’s difficult to know who actually has histamine intolerance. In the clinic, rather than start with testing, we let our clients’ symptoms guide us. We assess for the tell-tale signs I mentioned earlier, and if we suspect histamine as an issue (or any other gut-related problem for that matter), diet is our first line of defense. 

Step One: Dietary Treatments for Histamine Intolerance

In general, elimination diets are the best approach to symptoms that suggest histamine intolerance—they can reduce mast cell density in the digestive tract and since mast cells store histamine, this could lead to less histamine being released 18.

The two most impactful elimination diets for people with histamine intolerance are:

1. A low FODMAP diet, which  can significantly reduce histamine levels in people with IBS 19.
2. A low histamine diet, which can increase DAO levels, reduce histamine levels and histamine-producing bacteria, and significantly reduce symptoms 20 21. 

Lower dietary histamine tends to mean lower histamine intolerance symptoms, so it’s easy to see how someone would think they have to immediately start with a low histamine diet to calm their symptoms. But we’ve had clients in the clinic who have experienced significant symptom relief just by adopting a whole-foods meal plan—a reminder that we don’t always have to start with the most extreme option.

Here’s an overview of how we implement an elimination diet for histamine intolerance in the clinic:

Now let me fill in the details:

Phase 1: Before starting a low histamine diet, consider your current dietary pattern. If it could use some work, you may consider starting with a whole-foods diet free of common allergens and food additives—a Paleo diet or a low FODMAP diet are our go-to’s. 

When clients consistently follow a whole-food diet but still have histamine intolerance symptoms, we typically move on to phase two and adapt their foundational dietary pattern to be low histamine.

Phase 2: Consider removing high-histamine foods (like aged cheeses, salami, and sauerkraut), histamine-liberating foods (like citrus fruits and chocolate), and foods that block the action of the DAO enzyme (like mackerel and alcohol) from your diet for approximately three weeks. During this time, it’s good to be mindful of how you cook your food—a 2017 study found frying and grilling increased histamine levels in foods, whereas boiling either didn’t change histamine levels or decreased histamine 22.

If you follow a low histamine diet for three weeks without symptoms improving, histamine is likely not a part of your symptom picture. In that case, there’s no reason to continue with a low histamine diet. If you’re feeling better after three weeks on the diet, it’s time to consider reintroducing eliminated foods.

Phase 3: Now it’s time to reintroduce histamine-rich foods one at a time to test for a reaction—it may be helpful to use a food diary to track food reactions when you’re finding what works best for you. We have people start with the foods they miss the most, and remember that histamine intolerance is a result of the overall load of histamine foods. The goal is to find your ideal threshold—eating only as much histamine as you can tolerate is a key to remaining symptom-free.

Phase 4: The last step is to continue to avoid the quantity of high-histamine foods that trigger symptoms while you’re working to resolve the root causes of your histamine intolerance. 

This may seem like a complicated process but we’ve taught many clients how to manage their histamine intolerance symptoms with diet and other gut health treatments. Many of them eventually reintroduce higher-histamine foods and tolerate them well—so there is hope! 

If they go through the elimination diet process and their symptoms are well-controlled that’s great! If they still have some lingering symptoms, we move on to step two.

Step Two: Supplements for Histamine Intolerance Symptoms

Diet is unquestionably the most impactful strategy we use for our clients with histamine intolerance symptoms. But there are some supplements to consider if the elimination diet process doesn’t get someone where they want to be symptom-wise. 

Probiotics for Histamine Intolerance Symptoms

We don’t yet have solid evidence, but research indirectly suggests that probiotics can be used to treat histamine intolerance. Our experience with clients confirms that probiotics help to improve histamine intolerance symptoms. 

Because controversy exists when it comes to using probiotics for histamine intolerance, I want to share why we choose to have our clients trial them:

1. Research has shown a connection between histamine intolerance and gut conditions 15 23.
2. Research clearly shows that probiotics are effective against gut conditions, including:

• Small intestinal bacterial overgrowth (SIBO) 24
• Helicobacter pylori 25, fungi 26, and protozoan parasitic infections 27 28 
• Leaky gut 29 30

3. Though not specifically related to histamine intolerance, the following evidence suggests that probiotics might be effective against histamine-type symptoms:

• A 2022 meta-analysis found that multi-strain probiotics reduced histamine-related symptoms (nose-irritating allergies) 31.
• A meta-analysis and a clinical trial concluded that probiotics significantly reduced symptoms and clinical markers in people with allergic rhinitis 32.
• In a randomized controlled trial, Lactobacillus probiotics improved quality of life in people with seasonal allergies 33. 
• An in vitro study found that probiotics reduced the expression of histamine receptor genes on human mast cells, reducing the amount of histamine released 34.
• A mouse study found that probiotics reduced mast cell degranulation 35. Mast cells release histamine when they degranulate, so this would mean less histamine. 

All of these data points suggest that probiotics are a valid option for treating histamine intolerance symptoms, but is a special probiotic needed? Controversy exists here as well—some practitioners recommend looking for probiotics that are low-histamine. 

This makes sense mechanistically since some probiotics produce histamine 36. But in our experience in the clinic, the mechanism doesn’t translate into a real-world threat.  

Probiotics tend to be net antihistamine, so there’s no need to look for a special low-histamine probiotic if you have histamine intolerance. Any quality probiotic supplement should help to reduce histamine levels overall. 

Here’s the probiotic protocol we use in the clinic:

You’ll notice we use a combination of three categories of probiotics. We don’t have research yet on this triple therapy approach, but we created this mixture based on solid research suggesting a multi-strain approach is more effective than using single strains 37. And this has been our experience in the clinic—the triple therapy protocol works very well.

Aside from probiotics, quercetin is another supplement we consider for those with histamine intolerance symptoms.

Quercetin for Histamine Intolerance Symptoms

Quercetin is a plant flavonoid with anti-histamine and anti-inflammatory properties 38. There doesn’t appear to be research on using quercetin specifically for histamine intolerance symptoms, but it may reduce inflammation in the gut and restore the gut lining, making it a viable option 39 40 41.

Quercetin seems to be most effective when used in high doses (>500mg). In the clinic, we recommend starting with 500 mg twice daily. If symptoms haven’t improved, then we may recommend increasing to 1,000 mg twice a day.

Other Supplement Options for Histamine Intolerance Symptoms

Similar to probiotics and quercetin, there isn’t much solid evidence for how other supplements impact histamine intolerance symptoms. We do have some preliminary evidence suggesting various supplements have the potential to help improve it, so I’ve compiled the data into the following table:

There are plenty of options here, and it’s easy to go down the rabbit hole of trying supplement after supplement when looking for relief. Outside of using probiotics early on with our clients, we generally don’t start with supplements.  

We prefer to first use more foundational supports (like a low FODMAP diet and probiotics) to improve gut health and histamine intolerance symptoms. In our experience, the more healed the gut is, the more the gut lining can improve its DAO production, which means fewer symptoms. Fewer symptoms means better quality of life and less need for handfuls of supplements. 

That said, if a client has created a healthy foundation and still struggles, then we may tailor a supplement protocol using some of the supplements above.

Step Three: Lifestyle for Histamine Intolerance

While dietary changes and possibly probiotics may be the most effective strategies for improving the symptoms of histamine intolerance, we can’t overlook the powerful impact of other lifestyle changes. 

Although research on how lifestyle impacts histamine intolerance symptoms is limited, we have a lot of data confirming the benefits of a healthy lifestyle for gut health 49 50. Since poor gut health may be a significant cause of histamine intolerance, it makes sense that focusing on certain lifestyle changes that improve gut health will also alleviate histamine intolerance symptoms. 

I write extensively about how lifestyle impacts gut health in my comprehensive gut-healing guide, Healthy Gut, Healthy You. The following healthy lifestyle practices may improve gut health and, in turn, reduce histamine reactivity:

• Aim for 7–8 hours of restful sleep every night
• Manage or mitigate stress
• Nurture supportive relationships and healthy social connections 51
• Spend time in the sun and in nature
• Walk as much and as often as possible
• Engage in a healthy amount of exercise that makes you sweat

It can be overwhelming to change your diet and lifestyle all at once when you don’t feel well. If you choose to tackle diet, supplements, and lifestyle all at once, that’s great! If it seems daunting, consider starting with diet and probiotics, and then filter in other lifestyle measures as you feel able. The goal is to create a gut-health-supportive lifestyle that works for you.

Take Control of Histamine Intolerance Symptoms with Natural Therapies

When your body can’t break down histamine normally, uncomfortable symptoms like bloating, a runny nose, diarrhea, and headaches can disrupt your daily life. With the available research, we can’t definitively answer the question, “can histamine intolerance be cured?” But this doesn’t mean you have to accept the symptoms of histamine intolerance as a given—there’s a lot you can do to feel better in just a few weeks. 

In the clinic, we use a three-step process to help our clients quiet their histamine intolerance symptoms. An elimination diet is the first line of defense, followed by multi-strain probiotics (and possibly other supplements), and finally healthy lifestyle practices (like sleep, stress management, and time in nature). 

If you walk through these three steps and still experience lingering symptoms, we’d love to help you find a permanent solution. Contact us at the Ruscio Institute for Functional Medicine for an appointment.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.