Low-histamine diet: what to eat, what to avoid, and the evidence

Who a low-histamine diet is for

The diet is meant for histamine intolerance: a reduced ability to break down histamine from food in the gut, because the enzyme that does most of that work, diamine oxidase (DAO), is not active enough. The shortfall can be inherited, can follow a bowel disease that damages the gut lining, or can come from medicines that block the enzyme. Histamine that is not broken down reaches the bloodstream and causes symptoms.¹

Those symptoms are vague and spread across the body. In a study of 133 patients diagnosed with histamine intolerance, 92% had bloating, and fullness after meals, diarrhoea, abdominal pain and constipation affected 55–73%. Dizziness, headaches and palpitations came next, then breathing and skin complaints; 97% of patients had three or more symptoms in different organs, with an average of 11 each.¹ Some authors estimate that 1–3% of people have the condition, but there is too little data to be sure.¹

Because those symptoms overlap with many other conditions, histamine intolerance is diagnosed by ruling other causes out.^{1, 3} The 2020 review by the University of Barcelona group describes the steps: rule out a food allergy (with a skin prick test) and systemic mastocytosis (with a blood tryptase test), find out whether any medicine you take may block DAO, and only then see whether two or more typical symptoms improve on a low-histamine diet.¹ Blood tests for DAO activity are sold, but the evidence that they can diagnose the condition is limited and conflicting, and results vary with the time of day.^{1, 3}

So the first step is a doctor, not a food list. A 2024 clinical review notes that the condition is easily overlooked or misdiagnosed and that a diagnosis should rest on a combination of tests and medical history.³ Nor is the diet the answer to histamine poisoning (scombroid), a food poisoning from fish, or occasionally cheese, with an unusually high histamine content, generally above 500 mg/kg.¹

Does a low-histamine diet work?

Probably for some people, but the evidence is weak. The 2020 review lists 13 clinical studies of the diet in its Table 4. They were small: 38 patients on average, from 10 to 157. Ten found that more than half of patients improved, two found improvement in 33% and 46%, and one, in people with chronic hives, found no improvement and no change in antihistamine use.¹

The design matters more than the percentages. None of the 13 is described as randomised or blinded: ten followed patients forward and three looked back at records, and ten list no comparison group at all. Most lasted three or four weeks; two ran for 6–12 and 7–18 months, and the review found no sign that longer diets worked better.¹ Without a group that kept eating normally, a study cannot separate the effect of the diet from symptoms that fade on their own. The one study in the table whose comparison group is described as not following the diet is the one that found no benefit.¹

The review adds that dermatology societies still consider the diet of unproven use for skin conditions until randomised, double-blind, placebo-controlled trials are done.¹ The 2024 review reaches the same place from the clinic: the diet often brings substantial relief, but clinical evidence is insufficient, and current practice rests largely on doctors' experience and case reports.³

The published lists disagree

There is no single low-histamine diet. A 2021 review by the same Barcelona group compared ten published diets that spell out which foods to avoid. Only four foods were excluded by all ten: dry-fermented sausages, cured cheese, wine and beer. Most foods on the combined list were excluded by half of the diets or fewer, and most diets based their choices on earlier histamine measurements or on foods that patients linked to their symptoms.²

The authors then checked every excluded food against histamine measured in foods sold in Spain. Only 32% of the exclusions could be justified by histamine content, and 68% of the excluded foods showed no significant histamine in any sample. Some of those, such as citrus fruit, bananas, soybeans, pumpkin and nuts, contain notable amounts of putrescine, a related amine that may compete with histamine for DAO; the evidence for that effect comes from a few old laboratory and animal studies. About half of the excluded foods (53%) had no histamine and no more than low levels of any other amine measured.²

There is not even agreement on what "low" means. Thresholds from 5 to 50 mg/kg have been proposed, while some authors count only foods under 1 mg/kg as low, and food labels do not have to declare histamine.² The disagreement is easy to see in the sources themselves. The 2024 review names milk and legumes among foods to avoid and eggs among foods low in histamine.³ In the 2020 review's tally of published diets, milk, lentils and chickpeas are excluded by fewer than 20% and eggs by 20–60%,¹ and in the Spanish measurements neither milk (5 samples) nor eggs (14 samples) had detectable histamine.² That is why Lowmina rates each food from its measurements first and shows the list count beside the rating; our methodology sets out the rule.

How a low-histamine diet is usually done

There is no agreed protocol, but the sources describe the same shape: a strict phase, then reintroduction, ending with a personal list rather than a permanent ban.^{1, 3}

1. The strict phase

Leave out the foods most likely to be high in histamine (listed below) and keep a record of everything you eat and drink and every symptom. The 2020 review recommends a thorough 24-hour record, so that any link between a food and symptoms can be seen. How long is not settled: some studies suggest 4 to 8 weeks to confirm a diagnosis, while the clinical studies mostly ran for 3 to 4 weeks.¹ The 2024 review says people who respond should continue for a month, until symptoms are gone.³

If nothing changes, that is useful information too. Improvement on the diet is what points to histamine intolerance in the diagnostic steps above,¹ so no improvement is a reason to go back to your doctor, not to cut out more foods.

2. Reintroduction

Foods are then added back gradually, and the 2024 review stresses telling patients that the excluded food groups can return in certain quantities.³ Bringing back one food at a time, in a normal portion, keeps the diary readable: if two new foods arrive on the same day, you cannot tell which one caused a reaction. A sensible order to agree with your dietitian is to begin with foods that were excluded on weak grounds (see the disputed foods below) and leave aged, cured and fermented foods, the ones with high measured histamine, until last.²

3. Your own long-term list

The end point is a list of what you tolerate and in what amounts, which is likely to be longer than any published list. Tolerance differs a lot between people: in studies where volunteers were given the same dose of histamine, not all had symptoms, and those who did reacted differently.¹ The 2024 review warns that strict diets can lower quality of life and lead to poor adherence, and it recommends care from a team that includes a nutrition professional to reach an individual plan.³ Our printable list builder is made for this stage.

What to eat on a low-histamine diet

Most fresh, unprocessed food is low in histamine. In the Spanish surveys, histamine was not detected in any of 199 samples of fresh meat, nor in milk or eggs.² It was not detected in 11 samples of legumes, 12 of spices or 20 of unripened (fresh) cheese, and it averaged 0.07 mg/kg in 136 fruit samples and 0.12 mg/kg in 28 cereal samples.¹ Fresh meat and fish fit a low-histamine diet as long as they really are fresh.¹

Foods we rate 0, "low: generally well tolerated", by category:

Another 53 foods are rated 1, "mostly low: fine for many people", usually because of other amines or because many lists exclude them. See every rated food, with filters by category and rating.

Foods to avoid or limit

Histamine in food is made mostly by bacteria, which turn the amino acid histidine into histamine. So the highest levels turn up in two kinds of food: fermented foods, where the bacteria are part of the process, and fish, meat and their products that have lost freshness or been handled without enough care.¹

• Fermented and aged foods. In the Spanish survey, fermented foods averaged between 22 and 74 mg/kg, but 5% of samples were above 203 mg/kg in cheese, 130 mg/kg in dry-fermented sausages such as salami, and 486 mg/kg in fermented soy products. Sauerkraut averaged 43.74 mg/kg in 5 samples.²
• Histidine-rich fish. Tuna, mackerel, sardines and anchovies contain a lot of free histidine and can build up histamine when fish is not kept cold. Most fresh and canned fish tested had little or none, but one fresh oily fish sample reached 111.26 mg/kg and one can of sardines 657.05 mg/kg.²
• A few vegetables. Eggplant (aubergine) averaged 39.42 mg/kg in 23 samples and spinach 31.77 mg/kg in 18. Tomato was far lower, 2.51 mg/kg across 53 samples, though 9 of the 10 diets exclude it.²

Many lists also exclude so-called histamine liberators, foods said to make the body release its own histamine, such as citrus fruit, papaya, tomato, nuts, pineapple, spinach, chocolate and strawberries. No human study supports the idea; it rests on a few inconclusive laboratory and animal studies.² On our scale, being called a liberator can never make a food moderate or high by itself.

Foods we rate 3 (high)

• AnchoviesLower-rated swap: Cod, Shrimp3High
• BrieLower-rated swap: Cream cheese, Mascarpone3High
• CheddarLower-rated swap: Mozzarella, Cream cheese, Cottage cheese3High
• EggplantLower-rated swap: Zucchini3High
• FetaLower-rated swap: Ricotta, Cottage cheese3High
• Goat cheeseLower-rated swap: Ricotta, Cream cheese3High
• MackerelLower-rated swap: Trout, Salmon3High
• MisoLower-rated swap: Tofu3High
• ParmesanLower-rated swap: Ricotta, Mozzarella3High
• SalamiLower-rated swap: Chicken, Turkey, Ham3High
• SardinesLower-rated swap: Trout, Salmon3High
• SauerkrautLower-rated swap: Cucumber, Carrot3High
• SpinachLower-rated swap: Zucchini, Chard, Lettuce3High
• TempehLower-rated swap: Tofu3High
• TunaLower-rated swap: Cod3High

Foods we rate 2 (moderate: small portions, watch freshness)

• BaconLower-rated swap: Pork, Ham2Moderate
• BeerLower-rated swap: Vodka, Whisky2Moderate
• Bone brothLower-rated swap: Chicken2Moderate
• CiderLower-rated swap: Gin, Vodka2Moderate
• KefirLower-rated swap: Yogurt, Milk2Moderate
• KombuchaLower-rated swap: Green Tea, Herbal Tea2Moderate
• Oat MilkLower-rated swap: Almond Milk, Coconut Milk2Moderate
• Pineapple JuiceLower-rated swap: Apple Juice2Moderate
• Red WineLower-rated swap: Gin, Vodka2Moderate
• Rice MilkLower-rated swap: Almond Milk, Coconut Milk2Moderate
• Rye breadLower-rated swap: Wholemeal bread, White bread2Moderate
• Sourdough breadLower-rated swap: White bread, Wholemeal bread2Moderate
• Sparkling WineLower-rated swap: Vodka, Gin2Moderate
• TomatoLower-rated swap: Zucchini2Moderate
• White WineLower-rated swap: Gin, Vodka2Moderate
• WineLower-rated swap: Gin, Vodka2Moderate

All high-histamine foods, with how many diets exclude each one

Where the lists and the measurements disagree

For these foods the measured histamine points one way and the published diets another; each page explains why. They are good candidates to discuss with your dietitian when you reintroduce foods.

• BlueberriesBlueberries were not measured on their own. A group the study calls "red fruits" had no detectable histamine, yet four of ten published low-histamine diets exclude red fruits.0Low
• CrabSeafood had no detectable histamine in lab tests, but only seven samples were measured, and some published diets and a 2024 clinical review exclude shellfish or seafood.0Low
• EggsFourteen eggs tested in Spain had no detectable histamine or other biogenic amines, but four of ten published diets exclude eggs, more than most foods without histamine.0Low
• MusselsSeafood had no detectable histamine in lab tests, but only seven samples were measured, and some published diets and a 2024 clinical review exclude shellfish or seafood.0Low
• PineappleFresh pineapple had no detectable histamine and little of other amines, but four of ten published diets exclude it, mostly on the unproven claim that it releases the body's own histamine.0Low
• RaspberriesRaspberries were not measured on their own. A group the study calls "red fruits" had no detectable histamine, yet four of ten published low-histamine diets exclude red fruits.0Low
• ShrimpSeafood had no detectable histamine in lab tests, but only seven samples were measured, and three of ten published diets plus a 2024 clinical review exclude seafood.0Low
• SquidSeafood had no detectable histamine in lab tests, but only seven samples were measured, the paper does not say whether squid was among them, and some published diets and a 2024 clinical review exclude seafood.0Low
• YogurtFive yogurts tested in Spain had no detectable histamine, but four of ten published diets exclude yogurt, more than most foods without histamine.0Low
• AvocadoMeasurements disagree. Avocados bought in Spain had no detectable histamine, while other studies report up to 23 mg/kg. Three of ten published low-histamine diets exclude avocado.1Mostly low
• BananaBananas had no detectable histamine in tests, but they carry notable putrescine, an amine some researchers think competes with histamine for the DAO enzyme. Four of ten published diets exclude them.1Mostly low
• CodFresh white fish measured very low (95% of samples had none), but nine of ten published diets exclude fish as a group.1Mostly low
• GrapefruitGrapefruit had no detectable histamine in lab tests, but it carries notable putrescine, a related amine, and six of ten published diets exclude citrus fruit as a group.1Mostly low
• LemonLemons had no detectable histamine and little putrescine in lab tests, but six of ten published diets exclude citrus fruit as a group.1Mostly low
• LimeLimes have not been measured on their own. Citrus fruit as a group had no detectable histamine but notable putrescine, a related amine, and six of ten published diets exclude citrus.1Mostly low
• MandarinMandarins had no detectable histamine in 21 lab samples, but they are among the richest fruits in putrescine, a related amine, and six of ten published diets exclude citrus fruit.1Mostly low
• OrangeNo citrus sample in the lab surveys had detectable histamine, but six of ten published diets exclude citrus fruit. Oranges do carry a lot of putrescine, a related amine.1Mostly low
• Orange JuiceOrange juice had no histamine or only traces in the studies we use, yet six of ten published diets exclude citrus. The juice is rich in putrescine, a related amine, which is the likelier reason.1Mostly low
• SalmonSalmon has far less free histidine than tuna-type fish and fresh oily fish measured low on average, but nine of ten published diets exclude fish as a group.1Mostly low
• StrawberryNo histamine and little of other amines in tests, yet six of ten published diets exclude strawberries, mostly on the untested idea that they release histamine.1Mostly low
• TilapiaFresh white fish measured very low (95% of samples had none), and tilapia is not from a histidine-rich family, but nine of ten published diets exclude fish as a group.1Mostly low
• TroutTrout belongs to the salmon family, which has far less free histidine than tuna-type fish, and fresh fish measured low on average, but nine of ten published diets exclude fish as a group.1Mostly low
• BaconOnly 2 of 10 published diets exclude cured meat, but histamine was found in at least half of the cured meat samples tested, and one sample reached 150 mg/kg.2Moderate
• BeerBeer's measured histamine is low, averaging 1.23 mg/L, but all ten published diets exclude it, and alcohol itself slows the breakdown of histamine.2Moderate
• Red WineRed wine averaged 3.81 mg/L of histamine, a fraction of what cured cheese carries, yet all ten published diets exclude wine. The alcohol, which hampers histamine breakdown, is the larger reason for caution.2Moderate
• Sparkling WineSparkling wine itself was not measured. Wine as a whole averaged 3.63 mg/L of histamine, moderate on our scale, while all ten published diets exclude wine and the alcohol slows histamine breakdown.2Moderate
• TomatoNine of ten published diets exclude tomato, but measured histamine is low on average (2.51 mg/kg). The concern rests on occasional higher samples, putrescine and an unproven "liberator" claim.2Moderate
• White WineWhite wine had the lowest histamine of the wines measured, averaging 1.24 mg/L, but all ten published diets exclude wine, and its alcohol slows histamine breakdown just as red wine's does.2Moderate
• WineWine's measured histamine is moderate, far lower than cured cheese or sausage, but all ten published diets exclude it, and alcohol itself slows the breakdown of histamine.2Moderate
• EggplantEggplant had the highest average histamine of any vegetable measured, yet only three of ten published diets exclude it. We follow the measurements.3High
• MisoFermented soy had the highest average histamine of any food group in the survey we use, but only four of ten published diets exclude it. We follow the measurements.3High
• TempehFermented soy had the highest average histamine of any food group in the survey we use, but only four of ten published diets exclude it. We follow the measurements.3High

Freshness, leftovers and cooking

Histamine keeps forming after food is bought. In fresh fish and meat it is a sign of lost freshness or poor hygiene.¹ It happens in vegetables too: in one study, histamine in spinach rose over 12 to 15 days of storage at 6 °C. Refrigeration slows the bacteria that make amines but does not stop them, and amine formation at 4–10 °C has been reported. The 2018 review concludes that plant foods for people with histamine intolerance should be as fresh as possible for this reason.⁴

Cooking does not undo it. Histamine is heat-stable, so frying, grilling, canning and reheating do not lower it; the heat used to make canned fish does not reduce histamine that has already formed.^{2, 4} The exception is boiling vegetables in water that you then pour away. Boiling spinach cut its histamine by 83% on average because it passed into the cooking water, but boiled eggplant lost only 11–14%.⁴

Leftovers have the least data: none of our sources measured typical home leftovers, so there is no number to give. What the studies show is that time and bacteria add histamine and heat does not remove it. In practice: cook fish and meat fresh, chill what is left without delay, eat it soon, and take most care with leftover fish, meat and sauces reheated over several days.

Alcohol

All ten diets in the 2021 review exclude wine and beer. Their histamine is modest: 299 wines sold in Spain averaged 3.63 mg/L and 176 beers 1.23 mg/L.² Red wine (3.81 mg/L across 260 samples) had about three times the histamine of white (1.24 mg/L across 83).¹

The bigger issue is the alcohol itself. Alcohol and its breakdown product, acetaldehyde, compete with histamine for the enzyme aldehyde dehydrogenase, so histamine builds up in the body.² Alcohol can also temporarily reduce DAO activity,¹ and the 2024 review reports that it increases the release of the body's own histamine.³ Spirits were not measured in our sources. Because the alcohol effect applies to any alcoholic drink, none can be called low-histamine on the evidence we have.

Medicines that can block DAO

Some medicines reduce DAO activity. The 2020 review lists the active ingredients below as having inhibited the enzyme in experiments. In laboratory tests, chloroquine and clavulanic acid (an antibiotic often combined with amoxicillin) inhibited DAO by more than 90%, verapamil and cimetidine also had a significant effect, and the others less. The review cites an estimate that about 20% of people in Europe regularly take a medicine that inhibits DAO.¹

Source: Comas-Basté et al. 2020, Table 2.¹

These are laboratory findings. The table gives no doses and does not say that a medicine on it will cause symptoms. Two vitamins are on it, ascorbic acid (vitamin C) and thiamine (vitamin B1), and it cannot tell you whether the amounts in food or a tablet matter.

Never stop, skip or change a medicine because it appears on this list. If you think a medicine may play a part, take the list to the doctor who prescribed it; checking medicines is part of the diagnosis described in the same review.¹

Common mistakes

• Combining several lists. The lists disagree, so merging them leaves very little to eat, and most of their exclusions are not backed by measured histamine.²
• Staying strict for months. Most studies lasted 3 to 4 weeks and longer ones did not do better,¹ while strict diets cost quality of life and are hard to keep up.³
• Trusting "fresh" over time. Fish, meat or spinach that was fresh when bought but kept for days has had time to build up histamine.^{1, 4}
• Expecting cooking to fix it. Heat does not destroy histamine; only boiling vegetables and pouring away the water lowers it.⁴
• Treating "liberators" as proven. No human study shows that any food releases the body's own histamine.²
• Starting the diet instead of seeing a doctor. The diet is one step of a diagnosis made by ruling other conditions out.^{1, 3}

Questions about the low-histamine diet

How long should you follow a low-histamine diet?

The strict phase is short. Most studies of the diet lasted 3 to 4 weeks, some authors suggest 4 to 8 weeks to confirm a diagnosis,¹ and the 2024 review says people who respond should keep to it for a month before foods are gradually reintroduced.³

Is a low-histamine diet forever?

It is not meant to be. The strict phase is followed by reintroduction, and the excluded food groups can often come back in some quantity.³ What lasts is your own list of what you tolerate, which a dietitian can help you build.

What can I eat on a low-histamine diet?

Most fresh, unprocessed food: fresh meat and fish eaten soon after buying, eggs, milk, rice and other grains, and most fruit and vegetables.^{1, 2} The foods we rate 0 are listed above, and you can look up any food.

Does a low-histamine diet work?

Small studies suggest it helps many people with suspected histamine intolerance, but none of the 13 in the main review is described as randomised or blinded, so the evidence is weak.¹ It is a short trial to do with medical guidance, not a proven treatment.

Is any alcohol low in histamine?

Not on the evidence we have. Wine and beer contain histamine, spirits were not measured in our sources, and alcohol itself makes histamine harder to clear.^{1, 2}

Do I need a test before starting?

There is no single reliable test. Histamine intolerance is diagnosed by ruling out other causes, such as a food allergy or mastocytosis, and then seeing whether symptoms improve on the diet; DAO blood tests are not validated for diagnosis.^{1, 3} See a doctor first.

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 (Comas-Basté O et al. 2020)
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 (Sánchez-Pérez S et al. 2021)
3. Jochum C. Histamine Intolerance: Symptoms, Diagnosis, and Beyond. Nutrients 16(8):1219, 2024. doi:10.3390/nu16081219 (Jochum C 2024)
4. Sánchez-Pérez S, Comas-Basté O, Rabell-González J, Veciana-Nogués MT, Latorre-Moratalla ML, Vidal-Carou MC. Biogenic Amines in Plant-Origin Foods: Are They Frequently Underestimated in Low-Histamine Diets? Foods 7(12):205, 2018. doi:10.3390/foods7120205 (Sánchez-Pérez S et al. 2018)

Measurements are from foods sold in Spain; retail foods elsewhere may differ. Spotted an error? Tell us. See also our medical disclaimer.