Low-histamine cheese

Cheese is the food in this guide where histamine depends most on how it was made. Every cheese starts as milk, and five milks tested in Spain had no detectable histamine. What adds it is ripening: the weeks, months or years in which bacteria break down milk protein, and some of them turn the amino acid histidine into histamine. Fresh cheese skips that stage, which is why one cheese here can be rated low and the next high.

The figures come from a University of Barcelona team's surveys of cheese sold in Spain. In their 2020 review, 20 unripened (fresh) cheeses had no detectable histamine: the average, the median and the highest sample were all below the detection limit. The other cheeses are grouped by the milk they were made from. Twenty cheeses made from pasteurised milk averaged 18.05 mg/kg, with a median of 4.59 mg/kg and a highest sample of 162.03 mg/kg. Twenty made from raw milk averaged 59.37 mg/kg, with a median of 18.38 mg/kg and a highest sample of 389.86 mg/kg. In both groups the average sits far above the median, so most samples were moderate and a few were very high. The team's 2021 survey of 80 cured, semi-cured and grated cheeses found an average of 33.10 mg/kg, and one sample in twenty was above 203.30 mg/kg. Tyramine, another amine, averaged 128 mg/kg in the same cheeses. Fresh tomatoes, for comparison, averaged 2.51 mg/kg.

A 2012 review of amines in dairy foods explains the pattern. Ripening breaks protein down into free amino acids, the raw material bacteria use to make amines, and in general the longer a cheese ripens, the more amines it holds; the highest histamine levels are usually found in long-ripened cheeses. Pasteurisation cuts the number of bacteria in raw milk, including many that make histamine, so cheese made from pasteurised milk is usually lower. It is not a guarantee: some of these bacteria survive the heat or get in during cheesemaking. Warm ripening and storage raise amine levels, cold storage slows them without stopping them, and in some cheeses grating after ripening was followed by more histamine-forming bacteria and more histamine.

The published diets agree on aged cheese. All ten low-histamine diets in the team's 2021 review exclude cured, semi-cured and grated cheese, one of only four foods they all exclude, and a 2024 clinical review lists aged cheese among the foods to avoid. Fresh cheese does not appear on the 2021 chart of excluded foods. Cheese is also the one food besides fish named in a 2018 analysis of reported histamine poisonings, cited in the 2020 review: fish caused 98% of cases and cheese the rest.

The Spanish surveys do not say which cheeses were in each group, so every cheese page is marked "measured as a food group" and explains which group fits that cheese. Mozzarella, ricotta, cottage cheese, cream cheese and mascarpone are fresh cheeses. Parmesan and cheddar are hard cheeses ripened for months; feta matures in brine; brie and many goat cheeses ripen under a rind. Other amines were not reported for fresh cheese, and none of the studies followed fresh cheese after the pack was opened. Blue cheese, halloumi and processed cheese do not have pages yet. Milk allergy and lactose intolerance are separate conditions that these ratings do not cover.

Sources

1. Comas-Basté O, Sánchez-Pérez S, Veciana-Nogués MT, Latorre-Moratalla M, Vidal-Carou MDC. Histamine Intolerance: The Current State of the Art. Biomolecules 10(8):1181, 2020. doi:10.3390/biom10081181
2. Sánchez-Pérez S, Comas-Basté O, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content? Nutrients 13(5):1395, 2021. doi:10.3390/nu13051395
3. Linares DM, del Río B, Ladero V, Martínez N, Fernández M, Martín MC, Álvarez MA. Factors Influencing Biogenic Amines Accumulation in Dairy Products. Frontiers in Microbiology 3:180, 2012. doi:10.3389/fmicb.2012.00180
4. Jochum C. Histamine Intolerance: Symptoms, Diagnosis, and Beyond. Nutrients 16(8):1219, 2024. doi:10.3390/nu16081219