Summary:
Histamine intolerance is a condition where the body can’t break down histamine effectively, leading to its accumulation and a range of symptoms, including digestive complaints, headaches, skin reactions, and other allergy-like symptoms. As these symptoms overlap with conditions such as food allergies, irritable bowel syndrome, and other gastrointestinal disorders, histamine intolerance is often under-recognised and difficult to diagnose. This narrative review examined the role of diet, gut microbiota, and supplementation in managing histamine intolerance. The review found that the condition is caused by an imbalance between histamine exposure or production and the body’s ability to degrade it. Reduced activity of histamine-metabolising enzymes, particularly diamine oxidase (DAO), may contribute to symptom development. Histamine levels can also be influenced by genetic factors, medications, alcohol, nutrient deficiencies, gastrointestinal disorders, and alterations in the gut microbiome. The review highlighted that increased numbers of histamine-producing bacteria, together with reduced microbial diversity and impaired gut barrier function, may contribute to higher histamine levels and symptom severity. However, the role of the gut microbiota in histamine intolerance remains an emerging area of research. A personalised low-histamine diet was identified as the primary treatment. This involves temporarily restricting high-histamine foods before gradually reintroducing them to determine individual tolerance levels. Evidence suggests that this approach may reduce gastrointestinal, skin, and respiratory symptoms in some individuals. The review also discussed DAO supplements, probiotics, and nutrients involved in histamine metabolism, including vitamin C, vitamin B6, copper, zinc, and magnesium. Overall, this study concluded that histamine intolerance is a multifactorial condition influenced by interactions between diet, gut microbiota, genetics, and histamine metabolism. A personalised low-histamine diet currently has the strongest evidence for symptom management, while supplementation and microbiome-targeted therapies show potential as complementary approaches.
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Abstract:
Introduction: It is estimated that about 20–35% of the Western population reports symptoms of food intolerances, which is a growing trend. Intolerance to histamine, a dose-dependent, non-allergic food hypersensitivity reaction, despite similar clinical manifestations, has mechanisms distinct from food allergies. Objectives: This narrative review aims to ascertain and synthesize the evidence on the role of nutrition, microbiota modulation, and food supplementation in histamine intolerance. Methods: The search was conducted between September and October 2025 in the PubMed and ScienceDirect databases, using terms related to “histamine intolerance” and considering the last 10 years. 43 scientific articles and 5 additional regulatory and guidance documents were included. Results: The clinical manifestations of histamine intolerance are heterogeneous and complex, and different responses may occur in the same individual with equal doses of histamine. In the literature, intestinal dysbiosis promotes a local and systemic increase in histamine, triggering symptoms in predisposed individuals. The low-histamine diet induced a significant reduction in cutaneous and gastrointestinal symptoms. The literature also shows that diamine oxidase enzyme supplementation is promising in the treatment of migraines and chronic urticaria, contributing to a reduction in the dose and frequency of drugs. In addition, vitamins C and B6, S-adenosylmethionine, and magnesium have been studied in therapy. Conclusions: Histamine intolerance represents a challenge in clinical practice due to its complexity, symptomatologic diversity, and the lack of consensus regarding diagnosis and treatment.
Article Publication Date: 20/07/2026
DOI: 10.3390/nutraceuticals6030046
