Low-Histamine Diets: Is the Exclusion of Foods Justified by Their Histamine Content?

Abstract

A low-histamine diet is currently the most advised strategy to prevent the symptomatology of histamine intolerance. Conceptually, these diets should be founded on the exclusion of histamine-containing foods, although a certain disparity is found within the list of excluded foods in accordance with the different low-histamine diets available in the literature. This study aimed to critically review low-histamine diets reported in the scientific literature, according to the histamine and other biogenic amine contents of the excluded foods. A total of ten scientific studies that provided specific recommendations on the foods that must be avoided within the framework of a low-histamine diet were found. Overall, the comparative review brought out the great heterogenicity in the type of foods that are advised against for histamine intolerant individuals. Excluded foods were, in most cases, different depending on the considered diet. Only fermented foods were unanimously excluded. The exclusion of 32% of foods could be explained by the occurrence of high contents of histamine. The presence of putrescine, which may interfere with histamine degradation by the DAO enzyme at the intestinal level, could partly explain the reason why certain foods (i.e., citrus fruits and bananas) were also frequently reported in low-histamine diets. Finally, there was a range of excluded foods with an absence or very low levels of biogenic amines. In this case, certain foods have been tagged as histamine-liberators, although the mechanism responsible has not yet been elucidated.

The Rate of Histamine Degradation by Diamine Oxidase Is Compromised by Other Biogenic Amines

“…These findings could help explain the variable susceptibility to dietary histamine and the discrepancies in the literature and scientific databases regarding the amount of histamine responsible for triggering adverse health effects. In fact, certain fermented products (i.e., dry-fermented sausages, cheeses, and plant-fermented products) and semi-preserved fish derivatives frequently contain higher levels of putrescine and/or cadaverine than histamine ( 16 , 35 ). For example, 71% of samples of dry-fermented sausages and 55% of ripened cheeses were found to have concentrations of putrescine and/or cadaverine at least fourfold higher than histamine.…”

“…The inability (or impaired ability) to degrade histamine from food is a clinical disorder known as histamine intolerance. Histamine intolerance, beyond helping to resolve the aforementioned uncertainties, includes a wide range of non-specific gastrointestinal and extra-intestinal symptoms (dermatological, respiratory, neurological, and hemodynamic), due to the ubiquitous distribution of the four histamine receptors in organs and tissues ( 4 , 15 , 16 ). Despite the similarity of certain symptoms, histamine intolerance differs from allergy in that no immune mechanism is involved.…”

“…For example, dose-response studies have found that pure histamine triggers symptoms of intoxication at far higher doses than the histamine ingested from spoiled fish, which may contain other amines, such as putrescine and cadaverine ( 2 , 14 , 22 ). Moreover, according to a recent critical review of different low-histamine diets, certain foods without histamine but containing high levels of other biogenic amines could be responsible of the onset of clinical symptoms in histamine-intolerant individuals ( 16 ). Thus, it seems feasible that these other biogenic amines, especially diamines, could compete for deamination by DAO in the intestines, and thus impede histamine degradation, with more noticeable effects in susceptible individuals.…”

Histamine Intolerance—The More We Know the Less We Know. A Review

“…There is a great variability between studies regarding type of foods that is recommended to avoid during elimination diet. Some of routinely excluded foods contain only low levels of biogenic amines and become designated as histamine liberators [ 77 ]. In Figure 4 , we present examples of foods that are often recommended to exclude in low-histamine diet.…”

Food Intolerance: The Role of Histamine

“…Finally, increased plasma levels of histamine were shown in pig and dog models after intravenous administration of this metabolite [ 36 , 37 ]; however, it is possible to avoid enteral-induced histaminosis by avoiding DAO-blocking drugs [ 19 ], a low-histamine diet [ 38 ], and the use of antihistamines in the intensive care unit to reduce the likely risk of high plasma histamine levels.…”