Histamine-Restricted Diet

Information on this page comes from Dietary Management of Food Allergies & Intolerances: A Comprehensive Guide, by Janice Vickerstoff Joneja. 1998. J. A. Hall Publications.

Food Sources of Histamine

Histamine occurs in food as a result of microbial enzymes converting the amino acid histidine (present in all proteins) to histamine. All foods subjected to microbial fermentation in the manufacturing process contain histamine. Included in this category are cheeses, fermented soy products, other fermented foods (e.g. sauerkraut), alcoholic beverages, and vinegars.

Foods exposed to microbial contamination also contain histamine in levels determined by the extent and rate of action of the microbes. Histamine levels reach a reactive level long before any signs of spoilage occur in the food. This characteristic has important implications in fin fish, where bacteria in the gut are particularly active in converting histidine to histamine. The longer the fish remains ungutted, the higher the levels of histamine in the flesh.

Some foods such as eggplant and spinach contain high levels of histamine naturally. In addition, a number of food additives such as azo dyes and preservatives mediate the release of histamine.

Some of these chemicals such as benzoates occur naturally in foods, especially fruits, and may have the same effect as the food additive in releasing histamine.

The histamine restricted diet excludes all foods known to contain high levels of histamine or to contain chemicals that can promote the physiological release of histamine.
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From the Urticaria Chapter

The foods most commonly reported to induce urticaria are shellfish, fish, egg, nuts, chocolate, berries, tomatoes, cheese, milk, and wheat.

Foods reported to release histamine directly from mast cells are uncooked egg whites, shellfish, strawberries, tomatoes, fish, chocolate, pineapple and alcohol.

Foods containing histamine—Aged protein containing foods and fermented foods commonly have increased histamine levels.

Foods reported to be high in histamine are fermented cheeses (e.g. Camembert, Brie, Gruyere, Cheddar, Roquefort, Parmesan), brewer’s yeast, shellfish, many fin fish, canned fish, tomato, spinach, red wine (especially Chianti), beer, unpasteurized milk (e.g., cow, goat or human milk), chicken, dry pork sausage, beef sausage, ham, chocolate, fermented soy products, and all fermented vegetables, such as sauerkraut.
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Allowed/Restricted Foods

This diet excludes all:

  • foods with naturally high levels of histamine
  • fermented food
  • artificial food coloring, especially tartrazine
  • Benzoates including food sources of benzoates, benzoic acid and sodium benzoate
  • Butylated hydroxyanisole (BHA) and butylated hydoxytoluene (BHT)

Type of Food

Foods Allowed

Foods Restricted

Milk and dairy Plain milk
Ricotta cheese
All prepared dairy products made with restricted ingredients
All cheese
All yogurt
Buttermilk
Breads and cereals Any pure unbleached grain or flour

Any plain fresh bread, buns, biscuits, pizza dough with allowed ingredients

Homemade or purchased baked cookies, pies etc made with allowed ingredients

Products made with:

  • Anise
  • Artificial colors
  • Artificial flavors
  • Bleached flour
  • Cheese
  • Chocolate
  • Cinnamon
  • Cloves
  • Cocoa
  • Margarine
  • Preservatives
  • Restricted fruits
  • Some jams, jellies
  • Any food made with or cooked in oils with hydrolyzed lecithin, BHA, BHT
  • Commercial pie, pastry, and fillings
  • Baking mixes
  • Dry dessert mixes
Breakfast cereals made with allowed foods, including:

  • All plain grains
  • Plain oats and oatmeal
  • Plain cream of wheat
  • Puffed rice and wheat

Plain crackers with allowed ingredients:

  • Grissol Melba toast
  • RyVita Rye Krisp
  • Wasa light or golden crackers
All others
Plain pasta All packaged rice and pasta meals

Vegetables

All pure fresh and frozen vegetables and juices except those listed Eggplant
Pumpkin
Sauerkraut
Spinach
Tomato and all tomato productsAll vegetables prepared with restricted ingredients

Fruits

Apple
Banana
Cantaloupe (rock melon)
Figs
Grapefruit
Grapes
Honeydew
Kiwi
Lemon
Lime
Mango
Pear
Rhubarb
WatermelonFruit dishes made with allowed ingredients
Apricot
Cherry
Cranberry
Currant
Date
Loganberry
Nectarine
Orange
Papaya (pawpaw)
Peach
Pineapple
Prunes
Plums
Raisins
Raspberries
Strawberries
Fruit dishes, jams, juices made with restricted ingredients

Meat, poultry and fish

All pure, freshly cooked meat or poultry All fish and shellfish
All processed meats
All leftover cooked meats

Eggs

All plain, cooked egg All prepared with restricted ingredients

Raw egg white (as in some eggnog, hollandaise sauce, milkshake)

Legumes

All plain legumes except those listed opposite

Pure peanut butter

Soy beans
Red beans

Nuts and seeds

All plain nuts and seeds All with restricted ingredients

Fats and oils

Pure butter
Pure vegetable oil
Homemade salad dressings with allowed ingredientsLard and meat drippings
Homemade gravies
All fats and oils with color and/or preservatives
Hydrolyzed lecithin
Margarine
Prepared salad dressings with restricted ingredientsPrepared gravies

Spices and herbs

All fresh, frozen or dried herbs and spices except those listed opposite Anise
Cinnamon
Cloves
Curry powder
Hot paprika
Nutmeg
Seasoning packets with restricted ingredients
Foods labeled “with spices”

Sweeteners

Sugar
Honey
Molasses
Maple syrup
Corn syrup
Icing sugar
Pure jams, jellies, marmalades, conserves made with allowed ingredients
Plain artificial sweeteners
Homemade sweets with allowed ingredients
Flavored syrups
Prepared desert fillings
Prepared icings, frostings
Spreads with restricted ingredientsCake decorations
Confectionary
Commercial candies

Miscellaneous

Baking powder
Baking soda
Cream of tartar
Plain gelatin
Homemade relishes with allowed ingredients
All chocolate and cocoa
Flavored gelatin
Mincemeat
Prepared relishes and olives
Soy sauce
Miso
Commercial ketchup
Gherkin pickles
Most commercial salad dressing

Beverages

Plain milk
Pure juices of allowed fruits and vegetables
Plain and carbonated mineral water
Coffee
Alcohol: plain vodka, gin, white rum
Flavored milks
Fruit juices and cocktails made with restricted ingredients
All other carbonated drinks
All tea
All drinks with “flavor” or “spices”
Beer
Wine
Cider
All other alcoholic beverages

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Histamine Restricted Diet for Control of Urticaria/Angioedema

Do not eat the following food during the 4 week trial elimination period.
Meat/Poultry/Fish

  • All seafood including shellfish or fin fish, fresh, frozen, smoked or canned
  • Egg (a small quantity in a baked product such as pancakes, muffins, cakes is usually tolerated)
  • Processed, smoked and fermented meats such as luncheon meat, sausage, weiner, bologna, salami, pepperoni
  • Leftover meat: eat freshly cooked meat ONLY (side note from Jackie—After meat is cooked, the histamine levels increase due to microbial action as the meat sits.)

Milk and Milk Products

  • All fermented milk products, including cheese (any milk product that is curdled rather than fermented is allowed, such as cottage cheese, ricotta cheese and panir)
  • Cheese products such as processed cheese, cheese slices, cheese spreads
  • Yogurt, buttermilk, kefir

Fruits and Vegetables

  • Orange
  • Grapefruit
  • Lemon
  • Lime
  • Cherries
  • Strawberries
  • Raspberries
  • Cranberries
  • Loganberries
  • Apricot
  • Pineapple
  • Dates
  • Raisins
  • Prunes
  • Currants
  • Relishes
  • Pickles
  • Spinach
  • Tomatoes
  • Ketchup
  • Tomato sauces

Food Additives

  • Tartrazine and other artificial food colors
  • Preservatives, esp. benzoates, sulfites and BHA, BHT

Note: Many medications and vitamin pills contain these additives, especially colors. Ask the pharmacist to recommend additive-free supplements and medications.
Seasonings

  • Cinnamon
  • Chili powder
  • Cloves
  • Anise
  • Nutmeg
  • Curry powder
  • Hot paprika (cayenne)

Miscellaneous

  • Fermented soy products
  • Fermented food
  • Tea—herbal or regular
  • Chocolate, cocoa, and cola drinks
  • Alcohol
  • Vinegar and foods containing vinegar such as pickles, relishes, ketchup, and prepared mustard

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