Gut & symptomsOne of 8 articles on this topic

Histamine intolerance: symptoms, testing and what you can eat

Red face after red wine, headache after a salami pizza, stomach cramps after yesterday's leftovers? Then your body may not be keeping up with breaking down histamine, and no blood test can prove it. Which symptoms fit, how diagnosis works and what you can eat.

Frische histaminarme Lebensmittel auf hellem Stein: Zucchini, Paprika, Karotten, Kartoffeln, Apfel, Heidelbeeren, Reis, Frischkäse, Ei und frisches Hähnchen
Fresh instead of matured: courgette, peppers, potatoes, apple, blueberries, rice, cream cheese and fresh chicken. Histamine only forms when food matures, ferments or sits around for a long time.

The key points in 30 seconds

Time window after eating
4hrs

Symptoms linked to food show up within minutes to four hours. According to the guideline, anything that comes later usually has a different cause.

Have a “too low” DAO value
44%

In a sample of 1,051 people, almost one in two was below the lab threshold, with no link to symptoms. The blood test proves nothing.

Days of elimination, not months
10–14

That's how long the guideline recommends the low-histamine phase, followed by up to six weeks of testing. Permanent ban lists are explicitly not the goal.

The test that counts
Diary

No blood, stool or urine test proves the intolerance. Diagnosis comes from your symptoms, a food diary and how things develop once you change your diet.

01 Understand

What is histamine intolerance?

Histamine intolerance means: after eating, there's more histamine in your body than it can break down in that time. Histamine is a messenger substance that your body makes itself and that's also found in food, especially in matured, fermented and long-stored foods. In the gut, the enzyme diamine oxidase (DAO) intercepts histamine from food, and inside cells a second enzyme (HNMT) helps. If that's not enough, you get symptoms that look like an allergy. Other names: histamine sensitivity, histaminosis.

Histamine intolerance or histamine allergy?

"Histamine allergy" isn't a medical term, it's everyday language. In a true allergy, the immune system forms IgE antibodies against a protein, for example from peanut, and releases histamine itself in the process. In histamine intolerance, the immune system doesn't react; the problem is a lack of breakdown capacity. The World Allergy Organization classes it as a non-allergic food hypersensitivity. The practical difference: an allergy reacts to traces, an intolerance to amounts. To be honest, even "intolerance" is disputed: the German guideline only speaks of "intolerance to orally ingested histamine", because an enzyme deficiency as the cause has never been cleanly proven.

Flushing, a racing heart and diarrhoea after eating have four quite different explanations that feel similar but are tested and treated differently. The guideline says to rule out the other three first:

At a glance

What's behind it? Four causes for the same symptoms

Same symptoms, four mechanisms. Only the first column is an intolerance; the other three belong in a doctor's hands.

Histamine intoleranceFood allergyFish poisoningMast cell activation
What happensBreakdown can't keep upImmune system forms IgE against a proteinSpoiled fish with a lot of histamineMast cells release histamine for no reason
TriggerAmount of histamine, alcohol, freshnessEven traces, e.g. peanut, milk, eggTuna, mackerel, sardine without a cold chainStress, heat, medicines, some foods
Who reactsOnly sensitive people, depending on the dayOnly sensitised peopleEveryoneRarely, often with mastocytosis
TimeMinutes to 4 hoursMinutesMinutes, gone after 24 hoursIn episodes, even without eating
TestDiary and diet changeIgE in blood, skin test, challengeHistamine in fish over 100 mg per 100 gTryptase in blood during an episode
DangerousUnpleasant, not dangerousCan be life-threateningUsually harmless, rarely affects circulationCan trigger severe episodes

Classification based on the S1 guideline 2021 (AWMF 061-030), MSD Manual (fish poisoning 2025, mast cell activation 2024) and van Odijk 2023. If you have difficulty breathing or swelling in your throat, always call the emergency services.

02 Recognise

Histamine intolerance symptoms

Symptoms appear within minutes to four hours after eating and often affect several organs at once. The classic ones according to the guideline: sudden facial flushing, itching and redness on the body, plus nausea, vomiting, diarrhoea and stomach pain. Less common, but described: a runny or blocked nose, headache, dizziness, racing heart and a drop in blood pressure. Typically, the same meal causes symptoms one day and not the next, depending on the amount, freshness and what else you've had with it.

Interactive

Does it fit histamine?

Tick what applies to you. You'll then see how well the pattern fits histamine.

Histamine intolerance in the face and on the skin

On the face, histamine shows up as a flush: a sudden, blotchy redness of the cheeks, forehead and neck with a feeling of heat, often with itching, sometimes with hives or swelling around the eyes and lips. It comes on minutes to a few hours after eating and goes away by itself. People with rosacea or hives (urticaria) know the same redness, and so do people after alcohol, even without a histamine problem. For chronic hives, the 2026 international guideline even explicitly warns against diagnosing histamine intolerance too quickly, because it leads to unnecessary diets.

Emergency call instead of a diary

Swelling of the lips, tongue or throat, difficulty breathing, tightness in the chest, dizziness to the point of collapse: these are signs of a severe allergic reaction, not a question of intolerance. Call 112, even if you only suspect histamine.

Weight problems due to histamine intolerance?

Not directly: no study shows that histamine intolerance makes you put on weight or stops you losing it. The opposite effect is documented. If you cut out more and more foods for fear of symptoms, you eventually eat too little; the literature describes a case where supposed anorexia was in fact histamine intolerance, and the weight went back up on a low-histamine diet. A bloated belly after eating looks like weight, but it's gas and water. That's why the dietary change is aimed at a few weeks of elimination, not a permanent diet.

Woman with a flushed face at the supper table with red wine and cheese: a flush is the classic sign of histamine intolerance
Red wine and aged cheese bring histamine and alcohol together. The flush comes within minutes and goes away by itself, but the suspicion stays.

In surveys, people affected often report tiredness, sleep problems and “brain fog”, but the guideline doesn't list them as key symptoms. Many women find their symptoms get worse before their period, which is documented; that the menopause triggers histamine intolerance, on the other hand, is only a conjecture without a study behind it. For children the data is thin, and any diet there belongs in a paediatrician's hands.

03 Understand

What happens in the body

Three stops from plate to red face. Once you know them, you'll understand why freshness matters more than any list and why a blood test proves nothing.

1

Histamine comes in

Bacteria form histamine from the amino acid histidine: when cheese and sausage mature, during fermentation, and when fish or meat sit around too long. Your body also makes its own histamine, for example in mast cells during allergies.

2

DAO in the gut intercepts it

Diamine oxidase (DAO) in the gut lining breaks down histamine from food before it reaches the blood; inside cells, the enzyme HNMT takes over. DAO needs copper. No blood value can tell you how much DAO your gut has.

3

The bucket overflows

If more histamine arrives than DAO and HNMT can handle, it acts on blood vessels, skin, gut and nerves: flushing, cramps, palpitations. Alcohol, some medicines and other biogenic amines occupy the same enzymes and lower the threshold.

04 Causes

Causes: why do you suddenly have histamine intolerance?

Honest answer: in most cases the cause can't be proven. The guideline doesn't even consider it proven that a DAO deficiency is behind it, because controlled studies are missing. What can be shown are factors that slow down breakdown or weaken the gut lining, and they often come together: a gut infection, a new medication, more alcohol, more ready meals. That's why it starts “suddenly” for many people.

Diamine oxidase (DAO): the enzyme that breaks it down

Diamine oxidase, formerly histaminase, is produced in the lining of the small intestine, in the kidneys and in the placenta, and works outside the cells: it breaks down histamine from food, plus related amines such as putrescine. The enzyme needs copper, so a copper deficiency can slow it down. More than 50 variants that change its activity are known in the AOC1 gene; in a German study of 484 people, however, they weren't linked to symptoms. Genes alone don't explain it. The second breakdown enzyme, HNMT inside the cells, usually goes unmentioned in the discussion.

Damage to the gut lining has a similar effect: coeliac disease, chronic inflammatory bowel diseases, a severe stomach bug or bowel surgery lower DAO, often together with lactase. That's why histamine intolerance and lactose intolerance are often suspected together.

Medications that slow down histamine breakdown

For a number of active ingredients, lab tests have shown that they inhibit DAO: acetylcysteine (cough medicine), metamizole and diclofenac (painkillers), verapamil (heart), metoclopramide (for nausea), metronidazole and clavulanic acid (antibiotics), amitriptyline. The guideline calls the data on this older and contradictory; whether these drugs really trigger symptoms isn't proven. By some estimates, around one in five people in Europe regularly takes a DAO-inhibiting medication. Alcohol also inhibits breakdown, because it keeps the same enzymes busy.

Never stop them on your own

If you take a medication from this group and suspect histamine, talk to your doctor's surgery about it. Only stop or change the dose on medical advice; with blood pressure, heart or psychiatric medication, that's more dangerous than any flush.

Histamine liberators: what's behind them

Histamine liberators are supposed to be foods that contain little histamine themselves but get the body's mast cells to release their own histamine: citrus fruits, strawberries, tomatoes, nuts, cocoa, egg white, additives. The guideline is clear: there is no reliable evidence for this, neither for their existence nor for their clinical relevance. The lists come from anecdotal reports; the only review found just a few animal studies. Practical consequence: during the test phase, try them one by one instead of avoiding them across the board. If you tolerate strawberries, you don't have to cut them out just because they're on a list.

05 Clarify

Histamine intolerance test: how diagnosis works

There is no test that proves histamine intolerance. That's what the 2021 guideline says, and nothing has changed since. The diagnosis comes in three steps: first, other causes are ruled out; then you keep a food and symptom diary for two to four weeks; then the three-stage dietary change (chapter 6) shows whether histamine really plays a role. What labs offer can at best add to that.

DAO level in the blood: what it tells you

Not much. The guideline puts it bluntly: measuring DAO activity in serum has no diagnostic value, because the blood value says nothing about the enzyme in the gut lining. In a Swedish population study of 1,051 people, 44% were below the lab threshold of 10 U/ml, and the value wasn't linked to whether someone tolerated high-histamine foods badly. A low DAO value is therefore common and explains nothing on its own. The same goes for histamine in stool (gut bacteria produce it themselves) and methylhistamine in urine (it rises with a high-protein diet). Labs offer these tests anyway, mostly at your own expense.

Self-tests from the chemist and the internet

Chemists and online labs sell kits that measure DAO in blood, histamine in stool or gene variants. According to the guideline, all three measure something that tells you nothing about your tolerance: the DAO blood value is "too low" in almost one in two people, stool histamine often comes from gut bacteria, and in the largest study the gene variants weren't linked to symptoms. An abnormal result can put you on a diet you may not need. The honest home test is the diary: what you ate, how fresh it was, how much, what you drank with it, and when which symptoms appeared.

Food diary on the kitchen table next to a freshly cooked plate: the most important test if you suspect histamine intolerance
What, when, how fresh, how much, what you drank with it: two weeks of diary tell you more about your tolerance than any DAO value.

Which doctor tests for histamine intolerance?

Your first port of call is the GP surgery. They rule out anything that looks similar: allergies, lactose and fructose intolerance, coeliac disease, chronic inflammatory bowel diseases, thyroid problems and, if you get flushing, mastocytosis. Depending on your symptoms, you may be referred on to allergy, gastroenterology or dermatology. The guideline was written by allergists and nutrition therapists; health insurers generally subsidise nutrition counselling prescribed by a doctor. DAO tests and stool and urine histamine tests aren't covered by insurance. Because there's no reliable lab test, a detailed conversation is the most important part of the diagnosis.

At a glance

Tests compared: what each one tells you

Sorted by what the result tells you about yourself, according to the guideline. Not a rating of brands or labs.

What it measuresHow meaningful it is, according to the guidelineWho pays
Food and symptom diaryFood, freshness, amount, what you had alongside it and symptoms over 2 to 4 weeksHigh: the basis of every diagnosisCosts nothing
Three-phase dietary changeSymptoms during elimination, test phase and build-upHigh: the actual proof, ideally with nutrition counsellingCounselling: insurer usually pays part with a doctor's prescription
Histamine challengeRising doses of histamine under medical supervisionMedium: not a routine procedure, healthy people react too; often not reproducible when blindedSpecialist centres only
DAO activity in bloodAmount of enzyme in serumNone: says nothing about DAO in the gut, 44% of healthy people come out "too low"Self-pay (IGeL)
Histamine in stool or urineHistamine or methylhistamineNone: gut bacteria make histamine themselves, urine value depends on protein intakeSelf-pay (IGeL)
Gene test (AOC1)Variants in the DAO geneNone: variants weren't linked to symptomsSelf-pay
Histamine prick testHow long the wheal stays on the skinNone: says nothing about breakdown in the gut, no follow-up studiesRarely offered
Self-test kit from the chemist or internetDepending on the kit, DAO in blood, stool or genesNone: measures the same as above, without a doctor's interpretationSelf-pay

Assessment based on the 2021 S1 guideline (AWMF 061-030), van Odijk 2023, Maintz 2011, DAAB and the consumer advice centre. Not a rating of brands or labs.

06 Food

Low-histamine diet: what can you eat?

Almost everything that's fresh. A low-histamine diet doesn't mean a ban list, it means three phases: 10 to 14 days of cutting back, up to six weeks of testing, then eating long term in the way you tolerate. That's what the guideline recommends, and it states the goal explicitly: away from blanket, needlessly strict restrictions and towards a personal list.

From suspicion to everyday eating: the three-phase plan

  1. Days 1 to 14 Elimination

    Fresh, vegetable-focused mixed diet with enough protein and fat. Leave out anything matured, fermented or stored for a long time, plus everything marked red in the histamine table, and alcohol too. Keep a diary. If your symptoms clearly improve, histamine is a candidate.

  2. Up to week 8 Test phase

    Reintroduce foods one at a time and in increasing amounts, keeping each one for two or three days: yellow first, then red. Note down stress, your cycle, medication and alcohol too, as they shift your threshold. That's how you find out what you really need to avoid.

  3. Long term Your own list, not a ban list

    Only leave out what demonstrably causes symptoms and eat the rest in amounts you tolerate, enough to meet your needs and with enjoyment. After a few months, test the foods you couldn't tolerate again, as your sensitivity can decrease.

  4. Any time Back to the GP surgery

    No improvement after two weeks of elimination, weight loss, blood in your stool, diarrhoea at night or shortness of breath: that's one for your GP surgery, not the next list. With children, never go it alone.

What shouldn't you eat with histamine intolerance?

During elimination, three groups. First, foods high in histamine, meaning anything matured, fermented, smoked or stored for a long time: red wine, sparkling wine, beer, Parmesan, mountain cheese, Camembert, salami, raw ham, sauerkraut, tinned fish, smoked fish, soy sauce, wine vinegar. Second, anything that slows breakdown: alcohol in any form; energy drinks, black tea and green tea appear on the lists, but no histamine was measured in them. Third, the so-called liberators: citrus fruit, strawberries, tomatoes, nuts, cocoa. The third group is based on experience, hardly on studies; in the test phase it's the first to come back. For every individual food, see the histamine table in chapter 7.

Fresh beats any list

Histamine forms when bacteria convert the amino acid histidine, and that happens during storage: in fresh meat, fish, egg and milk, histamine couldn't be detected in market samples, while tinned sardines had up to 657 mg/kg. Once it has formed, it can't be destroyed by cooking or freezing. So: use meat and fish on the day you buy them or freeze them straight away, only eat mince that was freshly minced, and cool and freeze leftovers quickly instead of leaving them in the fridge for days. With fried potatoes from the day before, heating isn't the problem, it's the time they stood around beforehand. Keeping the cold chain also means: don't let your shopping get warm in the trolley.

Man freezing freshly bought meat and fish straight away: freshness stops histamine from forming
Histamine forms during storage, not when you heat food. Use meat and fish on the day you buy them or freeze them straight away, and don't leave leftovers in the fridge for days.

What to eat with histamine intolerance: breakfast and dinner

Breakfast: porridge oats with milk or almond drink, apple and blueberries; or bread made without long dough proofing with butter, cream cheese, cucumber and egg; with herbal tea or decaf coffee. Lunch and dinner: rice, potatoes, millet or pasta with freshly cooked chicken, beef or frozen white fish and plenty of vegetables such as courgette, pumpkin, carrots, broccoli and peppers, seasoned with salt, herbs and turmeric. In the evening, keep it light and eat early, not because histamine works differently at night, but because symptoms disturb your sleep. Snacks: apple, grapes, rice cakes, pistachios, quark with honey. Sweet: white chocolate instead of dark, jam made from fruit you tolerate.

Instead of … have …

Have this instead
  • Young Gouda, mozzarella, cream cheese, quark: unaged, no histamine in 20 market samples
  • Freshly cooked roast, boiled ham: cooked meat averages 0.3 mg/kg
  • Pepper, pumpkin or courgette sauce: histamine not detectable
  • Frozen white fish, cooked on the day it's defrosted: averages 1 mg/kg
  • Salt, herbs, turmeric, a little spirit vinegar: no maturation
  • Water, herbal tea, decaf coffee: no wine is histamine-free, and alcohol slows down the breakdown
Instead of
  • Parmesan, mountain cheese, Camembert, aged Gouda: matured, up to over 200 mg/kg
  • Salami, cured ham: dry-cured sausage averages 22 mg/kg, peaks above 400
  • Tomato sauce, ketchup: little histamine measured, but suspected histamine liberator
  • Tinned tuna, smoked salmon, matjes herring: up to 657 mg/kg measured
  • Soy sauce, miso, wine vinegar, balsamic: fermented, up to 730 mg/kg
  • Red wine, sparkling wine, beer: histamine plus alcohol, which ties up the same enzymes

Measured values from Spanish market samples (Sánchez-Pérez 2021, Comas-Basté 2020), with wide variation. Intended for the elimination phase; check each food individually during the test phase.

For days without cooking: a powder you mix up has a practical advantage during the elimination phase, because you mix each portion fresh and nothing is stored. The Natural flavour of the Balanced Powder contains no soya, cocoa, fruit, coffee, sweeteners or flavouring; the protein sources are pea and rice. There's no histamine measurement for it, just as for hardly any food; the test phase will show whether you tolerate it.

Balanced Powder
From the Saturo range

Balanced Powder: a meal you mix up, soya-free

Powder made from oats, pea protein, flaxseed and rice protein. One 100 g serving provides 400 kcal, 30 g protein, 9.9 g fibre and 26 vitamins and minerals, including folic acid, iodine and calcium. The Natural flavour has no sweeteners or flavouring. Contains oats (gluten).

26Vitamins & minerals
30 gProtein per serving
400kcal per serving
Pea + riceProtein sourceno soya, cocoa, fruit or flavouring
Choose a flavour
£2.07per meal
Balanced Powder · Natural£2.07 per meal ·
07 Look it up

Histamine table: how well is … tolerated?

The table below rates 160 foods for the elimination phase. It's based on measured values from market samples and the guideline's classification, not on an association's list of anecdotal experience: Red is anything matured, fermented or stored for a long time, or that measurably contains histamine; Yellow is where the sources contradict each other or only experience speaks; Green is what's fresh and was measured without histamine.

Foods high in histamine

Foods high in histamine are almost always products where bacteria were given a long time to work: matured cheese (up to just under 400 mg/kg in market samples, blue cheese over 1,000 in individual values), dry-cured sausage such as salami (peaks above 400 mg/kg), tinned fish and smoked fish (up to 657 mg/kg in tinned sardines), sauerkraut (average 44 mg/kg), fermented soya products such as soy sauce and miso (up to 730 mg/kg), red wine and beer. Among fresh plants, only spinach (average 32 mg/kg) and aubergine (39 mg/kg) stand out. The ranges are huge: the same cheese can come in under 0.1 or at 2,000 mg/kg. That's why the food group counts, not the number.

Interactive

How well tolerated is …?

160 foods with a traffic light for the elimination phase, the reason, and the measured value where there is one. Type in cheddar, banana, coffee or soy sauce, or filter by group.

  • Apple fresh, rated as well toleratedAvoid overripe fruit and bruised spots.
  • Pear nashi pear experience-based, sources disagreeNo measurement; experience-based lists contradict each other. Check early in the test phase.
  • Banana no histamine measured (n = 8), experience-basedContains putrescine, which occupies the same enzymes. Many lists avoid it, but studies are missing.
  • Strawberry no histamine measured (n = 9), suspected liberatorLiberator effect in humans not proven (guideline). Check early in the test phase.
  • Blueberry bilberry fresh or frozen, rated as well toleratedNo measurement found, no source advises against it.
  • Apricot fresh, no histamine measured (n = 4)Dried fruit only unsulphured, as sulphites cause symptoms for many people.
  • Mango experience-based, sources disagreeNo measurement; one list calls it controversial, the fact sheet says well tolerated.
  • Orange no histamine measured (n = 12), suspected liberatorHigh in putrescine, histamine not detectable. Liberator role not proven.
  • Citrus fruits lemon, mandarin, grapefruit no histamine measured (n = 38), suspected liberatorPutrescine up to 174 mg/kg; histamine not detectable. Test individually.
  • Pineapple no histamine measured (n = 6), suspected liberatorThe fruit contains no histamine; the juice can contain some if hygiene is poor.
  • Kiwi mostly no histamine (n = 13), one value 1.9 mg/kgSources disagree, suspected liberator effect not proven.
  • Papaya no histamine measured (n = 6), suspected liberatorLiberator effect not proven; check during the test phase.
  • Avocado mostly no histamine (n = 5), one value 23 mg/kgRipe avocados can contain more; sources disagree.
  • Melon except watermelon fresh, rated as well toleratedWatermelon is rated slightly worse on experience-based lists.
  • Grapes fresh, no histamine measured (n = 10)Well tolerated; wine is a different matter.
  • Coconut, coconut milk experience-based, sources disagreeNo measurement; with tinned products, watch out for thickeners.
  • Tomato fresh mean 2.5 mg/kg (up to 17), n = 53, suspected liberatorHistamine mostly low; liberator effect suspected, not proven. Test phase.
  • Tomato purée derived from tomato, no measurementConcentrate; no measurement found. Check during the test phase.
  • Tomato sauce passata mean 1.2 mg/kg (n = 3), suspected liberatorLow histamine measured; rated the same as tomato.
  • Ketchup mean 0.4 mg/kg (n = 3), vinegar and sugarLittle histamine measured, one literature value 22 mg/kg. Check the type of vinegar.
  • Spinach mean 32 mg/kg (10 to 70), n = 18Keeps rising during storage; a lot ends up in the cooking water when boiled.
  • Aubergine mean 39 mg/kg (4 to 101), n = 23Content varies widely by variety.
  • Sauerkraut fermented, mean 44 mg/kg (7 to 80), n = 5Lactic fermentation; levels vary a lot.
  • Cucumber fresh fresh, no histamine measured (n = 10)Pickled cucumbers are a different case.
  • Gherkins, salted cucumbers pickled fermented or matured in vinegarSometimes tolerated with spirit vinegar and without mustard; test phase.
  • Courgette fresh, no histamine measured (n = 41)Well tolerated.
  • Pumpkin fresh, mean 0.3 mg/kg (n = 12)Histamine in only a few samples, very low.
  • Carrot fresh, no histamine measured (n = 13)Well tolerated.
  • Broccoli fresh, rated as well toleratedPutrescine measured at 2 to 11 mg/kg, histamine not recorded.
  • Potato freshly cooked, no histamine measured (n = 10)Leftovers from the day before are a storage issue, not a potato issue.
  • Bell pepper mild fresh, no histamine measured (n = 17)Hot varieties (peperoncini, chilli) are rated worse on experience-based lists.
  • Onion fresh, no histamine measured (n = 4)Well tolerated.
  • Button mushrooms no histamine measured (n = 11), experience-basedMushrooms are listed as uncertain on experience-based lists; eat them fresh and prepare them straight away.
  • Olives no histamine measured (n = 5), brine may be fermentedOlives without lactic fermentation are usually fine; test phase.
  • Rice freshly cooked, no histamine measured (n = 2)Once cooked, keep it in the fridge for one day at most, then freeze it.
  • Millet rated as well toleratedNo measurement found, no source advises against it.
  • Oats, rolled oats no histamine measured (n = 2)Vitamin-fortified products appear on experience-based lists, but studies are missing.
  • Wheat flour no histamine measured in breadExperience-based lists mention digestive complaints, not a histamine issue.
  • Noodles, pasta wheat no histamine measured (n = 7)Freshly cooked; leftovers are a storage issue.
  • Spelt rated as well toleratedNo measurement found.
  • Bread wheat, wholegrain no histamine measured (n = 8)Long dough proving and malt are mentioned on experience-based lists, but studies are missing.
  • Sourdough bread long fermentation, no measurementExperience-based lists advise against it during the elimination phase; test phase.
  • Yeast baking yeast no relevant histamine (guideline)The guideline names yeast as an example of a food that is avoided unnecessarily.
  • Milk pasteurised fresh, no histamine measured (n = 5)Lactose is a separate topic.
  • Yoghurt plain fermented, n.d. to 13 mg/kgMeasurements contradict each other; check early in the test phase.
  • Kefir fermented, 2 to 4 mg/kg (2 samples)Only two individual measurements; test phase.
  • Butter sweet cream butter fresh, rated as well toleratedSour cream butter is fermented, sweet cream butter is not.
  • Cream, whipping cream no additives fresh, rated as well toleratedPure cream only; thickeners such as carrageenan appear on experience-based lists.
  • Crème fraîche, sour cream fermented, not measuredLactic acid fermentation; try small amounts during the test phase.
  • Quark unripened, no histamine measured (n = 20)Eat fresh.
  • Cream cheese unripened, no histamine measured (n = 20)Check prepared products for thickeners.
  • Cottage cheese unripened, no histamine measured (n = 20)Counts as a fresh cheese.
  • Ricotta unripened, no histamine measured (n = 20)Eat fresh.
  • Mascarpone unripened, no histamine measured (n = 20)Eat fresh.
  • Mozzarella unripened, no histamine measured (n = 20)Eat fresh; a bit more when stored as pizza cheese.
  • Gouda, young briefly matured, rated as well toleratedLevels rise with every week of maturing; young cheese only.
  • Gouda, matured old matured; matured cheeses up to 390 mg/kgNo individual measurement, but the group of matured cheeses is clearly high in histamine.
  • Emmental matured, 24 mg/kg (1 sample), range up to 2,000The guideline names Emmental as an example of extreme variation.
  • Parmesan long matured, 11 to 29 mg/kg, Grana up to 249The longer it matures, the more histamine it has.
  • Mountain cheese Bergkäse long matured, no individual measurementGroup of long-matured hard cheeses.
  • Cheddar matured, 25 mg/kg (1 sample)Single value; levels vary a lot with maturing.
  • Camembert matured, no individual measurementSoft cheese with maturing; the group is clearly high in histamine.
  • Blue cheese Gorgonzola, Roquefort matured, 24 to 1,042 mg/kgExtremely wide variation between batches.
  • Feta matured in brine, 85 mg/kg (1 sample)A single value, but a high one; test phase.
  • Sheep's cheese derived from feta, not measuredFresh sheep's cheese is more like cream cheese, matured more like feta.
  • Chicken, turkey fresh fresh, no histamine measured (n = 199)Only fresh and chilled; histamine forms during storage.
  • Beef fresh fresh, no histamine measured (n = 199)Dry-aged and long-hung meat doesn't belong in the elimination phase.
  • Pork fresh fresh, no histamine measured (n = 199)Experience-based lists are a bit more cautious; freshness decides.
  • Minced meat, cooked immediately freshly minced, cooked immediatelyMincing raises the risk of spoilage; never leave it sitting around.
  • Minced meat loose counter, protective atmosphere freshness unknown, histamine rises with mincingTime since mincing unclear.
  • Salami raw sausage, average 22 mg/kg, peaks 475 (n = 424)Some individual samples over 400 mg/kg.
  • Cured ham raw dry-cured, average 5 mg/kg, peaks 150 (n = 23)Median low, peaks high; elimination phase.
  • Cooked ham cooked, average 0.3 mg/kg (n = 48)Freshly sliced; use up opened packs quickly.
  • Sausage products bratwurst, liver sausage, cold cuts low in histamine when cooked, but stored and with additivesFresh scalded sausage is usually fine; experience-based lists advise against them across the board.
  • Fish, freshly caught or frozen white fish average 1 mg/kg (n = 31)Only freshly caught or frozen immediately; thaw quickly and use up.
  • Fish from the chilled aisle or fish counter freshness unknown, oily fish up to 111 mg/kgCold chain unknown; buy frozen during the elimination phase.
  • Tuna fresh rich in histidine, the only fish with EU maximum levelsForms histamine quickly if there are gaps in the cold chain.
  • Tuna tinned tinned fish average 14 mg/kg, peaks 657 (n = 96)Cooking and preserving don't destroy histamine.
  • Mackerel rich in histidine, derivedLike tuna: only absolutely freshly caught.
  • Sardine fresh, tinned tinned sardines up to 657 mg/kgHighest measured value in the tinned group.
  • Herring matjes, rollmops matured or marinated, derivedFermented and stored products.
  • Salmon fresh some samples up to 111 mg/kgOnly freshly caught or frozen; otherwise avoid in the elimination phase.
  • Smoked salmon smoked, average 4 mg/kg, peaks 35 (n = 49)Varies strongly from batch to batch.
  • Pollock, cod, trout frozen white fish average 1 mg/kg (n = 31)Buy frozen, cook on the day you thaw it.
  • Seafood prawns, mussels, crab no histamine measured (n = 7), freshness is crucialOnly 7 samples; experience-based lists advise against it. Frozen during the test phase.
  • Egg whole no histamine measured (n = 14)Egg white is considered a liberator on experience-based lists, but this is only proven in a 1952 animal study.
  • Egg yolk no histamine measuredWell tolerated.
  • Egg white suspected liberator, no histamine measuredNot proven in humans; test phase.
  • Soybeans unfermented, no histamine measured (n = 5)Experience-based lists avoid legumes; the reason is the suspected liberator effect.
  • Tofu unfermented, no histamine measured (n = 6)Experience-based lists rate it lower anyway; try it early in the test phase.
  • Soy milk soy drink unfermented, no histamine measured (n = 3)Like tofu: clean measurement, but experience-based lists are cautious.
  • Soy yoghurt fermented, not measuredFermented soy products as a group up to 730 mg/kg.
  • Soy sauce fermented, group average 74 mg/kg, up to 730 (n = 21)One of the highest-histamine foods there is.
  • Miso fermented, group up to 730 mg/kgGroup value, no individual measurement.
  • Tempeh fermented, group up to 730 mg/kgGroup value, no individual measurement.
  • Soy protein isolate unfermented, not measuredNo measured value or rating; soybeans themselves contain no histamine.
  • Pea protein isolate unfermented, not measuredNo measured value or rating; peas themselves contain no histamine.
  • Broad bean fava bean based on experience, not measuredA pulse; histamine liberator suspicion unproven.
  • Lentils no histamine measured (n = 7), based on experienceExperience-based lists avoid pulses; no studies.
  • Chickpeas no histamine measured (n = 4), based on experienceLike lentils: clean measurement, cautious lists.
  • Peas garden peas no histamine measured (n = 9)Experience-based lists are a bit more cautious.
  • Beans, green no histamine measured (n = 12)Experience-based lists are a bit more cautious.
  • Beans, white no histamine measured (n = 6), liberator suspicionUnproven; test phase.
  • Beans, black based on experience, not measuredUnproven; test phase.
  • Almonds no histamine measured (n = 7), based on experienceSmall amounts are considered tolerable.
  • Cashew no histamine measured (n = 47, nuts), based on experienceSources disagree; test phase.
  • Peanut no histamine measured (n = 7), based on experienceBotanically a pulse; lists are cautious, no studies.
  • Walnut no histamine measured, based on experienceThe worst-rated nut on experience-based lists; unproven.
  • Hazelnut no histamine measured (n = 9), liberator suspicionUnproven; test phase.
  • Pistachio no histamine measured (n = 7)Well tolerated.
  • Sunflower seeds no histamine measured (n = 2), based on experienceOnly 2 samples; lists are cautious.
  • Flaxseed rated as tolerableNo measurement found, no source advises against it.
  • Coffee practically no histamine, caffeine stimulates gut and nervesDAO inhibition by caffeine is unproven. In the test phase, try one cup.
  • Espresso like coffeeConsidered slightly better tolerated than filter coffee.
  • Coffee, decaffeinated caffeine-free, rated as tolerableA good choice in the elimination phase.
  • Green tea no histamine measured (n = 9), considered a DAO inhibitorInhibition unproven; test phase.
  • Black tea no histamine measured (n = 9), considered a DAO inhibitorInhibition unproven; test phase.
  • Herbal tea chamomile, peppermint, fennel rated as tolerableCheck blends with unknown ingredients.
  • Cola based on experience, not measuredCaffeine and additives; no known histamine reason.
  • Energy drinks according to lists, caffeine and theobromine slow down breakdownUnproven, but easy to skip in the elimination phase.
  • Orange juice traces of histamine (up to 1.3 mg/kg), liberator suspicionHigh in putrescine; test phase.
  • Oat drink made enzymatically, based on experienceLists say it contains a little histamine, no measurement available.
  • Almond drink rated as tolerableCheck the ingredients list for thickeners.
  • Cocoa drink, hot chocolate cocoa: based on experience, other aminesCocoa contains tyramine; liberator suspicion unproven.
  • Red wine fermented, mean 3.8 mg/l, up to 55 (n = 260)Alcohol slows down breakdown even more.
  • White wine fermented, mean 1.2 mg/l, up to 13 (n = 83)Less than red wine, but alcohol slows down breakdown.
  • Sparkling wine, champagne fermented, not measuredLike wine; alcohol slows down breakdown.
  • Beer fermented, mean 1.2 mg/l, up to 22 (n = 176)Usually low in histamine, but yeast and alcohol.
  • Spirits, clear vodka, gin hardly any histamine, alcohol slows down breakdownAlcohol occupies the same enzymes; leave it out in the elimination phase.
  • Spirits, not clear whisky, rum, brandy cask-aged, alcohol slows down breakdownNo measured values; ageing plus alcohol.
  • 'Histamine-free' wine < 0.1 mg/l alcohol and sulphites remainTerm not legally defined; alcohol slows down breakdown.
  • Sugar household sugar no histamineTolerable.
  • Honey rated as tolerableOne list calls it controversial, the leaflet says tolerable.
  • Sweeteners, sucralose rated as tolerableSucralose is considered tolerable.
  • Chocolate, dark no histamine measured (n = 15), tyramine 2 to 6 mg/kgCocoa is on experience-based lists; test phase.
  • Milk chocolate cocoa: based on experience, no histamine measuredLike dark chocolate, with less cocoa.
  • White chocolate no cocoa mass, based on experienceSources disagree; usually tolerated.
  • Cocoa powder based on experience, other aminesCocoa butter is considered tolerable, cocoa mass is not.
  • Jam, preserves made from tolerable fruitsApple, apricot, blueberry are fine; strawberry or citrus like the fruit itself.
  • Ginger rated as tolerableSmall amounts are considered unproblematic.
  • Wine vinegar red, white wine made from wine, agedSpirit vinegar is the alternative.
  • Balsamic vinegar aceto balsamico aged for a long timeSpirit vinegar is the alternative.
  • Apple cider vinegar fermented, based on experienceWatch out for additives; test phase.
  • Spirit vinegar alcohol vinegar the lowest-histamine vinegarNot histamine-free, but well tolerated in small amounts.
  • Mustard vinegar and mustard seeds, based on experienceMustard seeds are considered liberators, unproven.
  • Yeast extract glutamate, based on experienceExperience-based lists avoid it; no studies.
  • Stock cubes, bouillon often yeast extract and glutamateCheck the ingredients list; use homemade stock fresh.
  • Black pepper based on experience, not measuredHot spices are on experience-based lists; unproven.
  • Turmeric rated as tolerableA good seasoning in the elimination phase.
  • Tinned goods, ready-made and semi-ready products long storage, ageing, additivesCook fresh in the elimination phase; check the ingredients list.
  • Kimchi fermentedLike sauerkraut; test phase in small amounts.
  • Carrageenan E407 thickener, based on experienceConsidered a liberator, unproven; often found in cream products.
  • Xanthan gum E415 rated as tolerableNo source advises against it.
  • Lecithin E322, mostly soy lecithin rated as tolerableSoy lecithin is also considered unproblematic.
  • Maltodextrin rated as tolerableNo source advises against it.
  • Flavouring, flavourings composition unknownLots can hide behind it; go without in the elimination phase.
  • Sodium citrate E331 acidity regulator, considered tolerableNo measurement, no source clearly advises against it.
  • Gum arabic acacia gum, acacia fibre based on experienceConsidered a liberator on experience-based lists; unproven.
  • Vitamin C ascorbic acid, E300 cofactor in breakdown, weak DAO inhibitor in the labAmounts from food are unproblematic.
  • Folic acid vitamin B9 based on experience, controversialExperience-based lists avoid vitamin-fortified products; no studies.

Which cheese is low in histamine?

The shorter the ripening, the less histamine. Cream cheese, quark, cottage cheese, ricotta, mascarpone and fresh mozzarella had no detectable histamine in 20 market samples, and young Gouda and Butterkäse are considered well tolerated. The level rises with every week of ripening: Emmental, Cheddar, Parmesan, mountain cheese, aged Gouda, Camembert and blue cheese don't belong on your plate during the elimination phase, and feta sits in between with a measured value of 85 mg/kg. Lactose-free cheese doesn't help here. Ripening is the issue, not milk sugar. If you have both, you'll find the right cheese table in our article on lactose intolerance.

Coffee and histamine

Coffee contains practically no histamine; analyses of brewed coffee found only traces of biogenic amines, mostly from low-quality beans. The claim that caffeine inhibits DAO appears on lots of advice sites, but in no study we could find; caffeine is missing from the overview of proven DAO inhibitors. What is true: caffeine stimulates your gut and nerves and can make palpitations or diarrhoea worse, which are among the typical symptoms anyway. In practice: stick to decaf coffee or herbal tea during the elimination phase, then try an espresso in the testing phase. Black and green tea appear on the lists as DAO inhibitors, but no histamine was measured in them.

Soya and histamine

Two different worlds: soy sauce, miso and tempeh are fermented and, at up to 730 mg/kg, are among the foods highest in histamine of all. Soya beans, tofu and soya drink are unfermented, and no histamine was detectable in market samples. The fact that experience-based lists also class them as poorly tolerated comes from the unproven suspicion that pulses act as histamine liberators. For soya protein isolates, as used in shakes, there are neither measured values nor a rating. In practice: leave out fermented soya during the elimination phase, and check tofu and soya drink early in the testing phase. Usually they're fine.

08 Treatment

What helps with histamine intolerance?

The most effective treatment is the three-step dietary change from chapter 6, ideally with dietary counselling. According to the guideline, everything else, from DAO capsules to vitamin C, is unproven or at best worth a time-limited trial. What honestly helps: tackle the causes, meaning your gut, medication, alcohol and freshness, and keep your list of forbidden foods as short as possible.

DAO capsules: what they can do

DAO supplements provide the enzyme from pig kidneys. They're approved in the EU as food supplements or as dietary foods for special medical purposes, and are taken before a meal. The evidence is thin: a blinded study with 39 participants showed fewer symptoms than with placebo, but missed its main goal because the symptoms weren't reproducible; in 100 migraine patients, attacks got a good hour shorter, while their number and severity stayed the same. The guideline says: effectiveness not proven, not recommended. A court has banned the advertising claim that DAO tablets support histamine breakdown as impermissible. If you try them, treat it as a trial, not as therapy.

The best therapy is a short list. If you test systematically after two weeks of elimination, you'll usually end up eating almost everything again, just fresher.

Joerg Hauke, Nutrition expert, expert reviewer of this article

Antihistamines, vitamin C and healing clay

Antihistamines such as cetirizine block the effect of histamine; there is no placebo-controlled study for the intolerance, and the guideline considers a time-limited trial acceptable, under medical supervision and not as a long-term solution. Vitamin C, copper and vitamin B6 are thought to help with breakdown; the only thing proven is that DAO needs copper, and there's no study on B6 in histamine intolerance. Supplementing is worth it if you have a confirmed deficiency, otherwise not. Healing clay, zeolite and probiotics haven't been studied; some lactic acid bacteria even produce histamine themselves.

Dietary counselling for histamine intolerance: counsellor and client going through the food diary
The guideline recommends making the change with dietary counselling. If your doctor prescribes it, health insurers usually cover part of the cost.

Can histamine intolerance be cured?

It isn't described as curable, but it's rarely permanent. If the weak breakdown is down to a cause that can be fixed, such as a gut infection, treated coeliac disease, a medication you've stopped or less alcohol, your tolerance often recovers. The guideline states that tolerance to histamine can increase through the three-step change, and recommends retesting foods you couldn't tolerate after a few months. What doesn't help: a strict long-term diet. It makes your list longer, your choice smaller and your life no better. The aim is a short, personal list.

09 Look it up

Common questions about histamine intolerance

What lowers histamine immediately?

Nothing reliable. There's no remedy that “flushes” histamine out of your body. Symptoms fade by themselves within hours; drink plenty, rest, and keep your next meal fresh and light. If you have difficulty breathing or swelling in your throat, call the emergency services. That's not an intolerance.

What should you eat in the evening with histamine intolerance?

Freshly cooked and light: rice, potatoes or millet with vegetables such as courgette, pumpkin or carrots, plus chicken, beef or frozen white fish from the same day. No leftovers from the day before, no wine. Histamine doesn't work any differently in the evening, but symptoms at night disturb your sleep.

Which doctor diagnoses histamine intolerance?

Your GP first rules out allergies, lactose, fructose, coeliac disease and gut conditions, then you see an allergy specialist or gastroenterologist. The diagnosis is based on a diary and dietary change, not on a lab value; health insurers usually subsidise dietary counselling prescribed by a doctor.

How much does a histamine intolerance test cost at the GP?

Your health insurer pays for the consultation and the tests to rule out other causes. A DAO blood test and stool or urine histamine tests are self-pay, because the guideline attributes no diagnostic value to them. You save money by skipping them and keeping a diary for two weeks instead.

Can histamine intolerance appear suddenly?

Yes, often after a stomach bug, a new medication, a bowel condition, or during stretches of lots of alcohol and ready meals. Often your threshold was already low and only gets crossed once an extra factor comes in. Any new symptoms should be checked by a doctor.

Can you eat yoghurt and oats with histamine intolerance?

Oats are fine. Yoghurt is fermented, and measurements range from undetectable to 13 mg/kg: leave it out during the elimination phase and check it early in the test phase. Fermented foods like sauerkraut, kefir or kimchi, which are recommended for your gut flora, stay off the menu during the elimination phase.

Does it make sense to take cetirizine long term for histamine intolerance?

No. Antihistamines block the effect, not the cause, and there are no studies on their use for the intolerance. The guideline allows a time-limited trial under medical supervision. Better long term: find out the causes, eat fresh and use the test phase to keep your own list short.

Can histamine intolerance go away again?

Often yes, if the cause goes away: after a gut infection, after stopping a medication that inhibits DAO, or once the gut lining heals. Even without a clear cause, sensitivity drops for many people, so test foods you couldn't tolerate again after a few months.

Sources · 32 sources anzeigen
  1. Reese I. et al.: Guideline on management of suspected adverse reactions to ingested histamine (S1 guideline, AWMF register 061-030, DGAKI/ÄDA/GPA/SGAI/ÖGAI). Allergol Select 2021; 5: 305–314.
  2. Reese I. et al.: German guideline for the management of adverse reactions to ingested histamine. Allergo Journal International 2017; 26(2): 72–79.
  3. Comas-Basté O. et al.: Histamine Intolerance: The Current State of the Art. Biomolecules 2020; 10(8): 1181.
  4. Sánchez-Pérez S. et al.: Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content? Nutrients 2021; 13(5): 1395.
  5. Sánchez-Pérez S. et al.: Biogenic Amines in Plant-Origin Foods: Are They Frequently Underestimated in Low-Histamine Diets? Foods 2018; 7(12): 205.
  6. Linares D. M. et al.: Factors Influencing Biogenic Amines Accumulation in Dairy Products. Frontiers in Microbiology 2012; 3: 180.
  7. van Odijk J. et al.: Determination of Diamine Oxidase in a Population Based Study. Nutrients 2023; 15(13): 2887.
  8. Maintz L. et al.: Association of single nucleotide polymorphisms in the diamine oxidase gene with diamine oxidase serum activities. Allergy 2011; 66(7): 893–902.
  9. Maintz L., Novak N.: Histamine and histamine intolerance. American Journal of Clinical Nutrition 2007; 85(5): 1185–1196.
  10. Hrubisko M. et al.: Histamine Intolerance – The More We Know the Less We Know. A Review. Nutrients 2021; 13(7): 2228.
  11. Jochum C.: Histamine Intolerance: Symptoms, Diagnosis, and Beyond. Nutrients 2024; 16(8): 1219.
  12. Jackson K. et al.: Evidence for Dietary Management of Histamine Intolerance. International Journal of Molecular Sciences 2025; 26(18): 9198.
  13. Nazar W. et al.: Histamine Intolerance in Children: A Narrative Review. Nutrients 2021; 13(5): 1486.
  14. Schnedl W. J. et al.: Evaluation of symptoms and symptom combinations in histamine intolerance. Intestinal Research 2019; 17(3): 427–433.
  15. Schnedl W. J., Enko D.: Histamine Intolerance Originates in the Gut. Nutrients 2021; 13(4): 1262.
  16. Komericki P. et al.: Histamine intolerance: lack of reproducibility of single symptoms by oral provocation with histamine. Wiener klinische Wochenschrift 2011; 123(1–2): 15–20.
  17. Izquierdo-Casas J. et al.: Diamine oxidase (DAO) supplement reduces headache in episodic migraine patients with DAO deficiency: A randomized double-blind trial. Clinical Nutrition 2019; 38(1): 152–158.
  18. Zuberbier T. et al.: The International Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. Allergy 2026.
  19. Vlieg-Boerstra B. J. et al.: Mastocytosis and adverse reactions to biogenic amines and histamine-releasing foods: what is the evidence? Netherlands Journal of Medicine 2005; 63(7): 244–249.
  20. U.S. Food and Drug Administration: Fish and Fishery Products Hazards and Controls Guidance, Chapter 7: Scombrotoxin (Histamine) Formation.
  21. Ruiz-Capillas C., Herrero A. M.: Impact of Biogenic Amines on Food Quality and Safety. Foods 2019; 8(2): 62.
  22. Nerurkar P. V. et al.: Medium Roasting and Brewing Methods Differentially Modulate Global Metabolites, Lipids, Biogenic Amines, Minerals, and Antioxidant Capacity of Coffee. Metabolites 2023; 13(3): 412.
  23. Restuccia D. et al.: Brewing effect on levels of biogenic amines in different coffee samples as determined by LC-UV. Food Chemistry 2015; 175: 143–150.
  24. R-Biopharm: What to consider when producing histamine-free wine. Food & Feed Analysis, 26 October 2017.
  25. AGES, Austrian Agency for Health and Food Safety: Biogenic amines. Retrieved 29 October 2026.
  26. MSD Manual Professional Edition: Fish poisoning and shellfish poisoning. Last updated April 2025.
  27. MSD Manual Professional Edition: Mastocytosis and mast cell activation syndrome. Last updated September 2024.
  28. German Allergy and Asthma Association (DAAB): Histamine intolerance.
  29. Verbraucherzentrale: Supplements for histamine intolerance: What do DAO products actually do? As of 13 August 2025.
  30. Verbraucherzentrale NRW: Unlawful advertising claims about histamine breakdown for Daosin. Frankfurt am Main Regional Court, case no. 3-12 O 28/22. As of 20 March 2024.
  31. Swiss Interest Group Histamine Intolerance (SIGHI): Food compatibility list DE, histamine. As of 29 August 2024. Experience-based ratings, listed as recommended reading.
  32. SIGHI: Information sheet on a low-histamine diet. Version of 17 November 2021.
Gregor Aßlaber
Gregor AßlaberAuthor · Editor at Saturo

Has been writing for Saturo since 2019 about nutrition, nutrients and how to get well nourished in everyday life, in practice.

Joerg Hauke
Joerg HaukeFachliche Prüfung · Nutrition expert

Hat diesen Artikel am 29. Oktober 2026 auf fachliche Richtigkeit geprüft. The content does not replace medical advice.