Information on this page comes from Dietary Management of Food Allergies & Intolerances: A Comprehensive Guide, by Janice Vickerstoff Joneja. 1998. J. A. Hall Publications.
Table of Contents
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 vinegar.
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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 finfish, 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 finfish, 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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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 hydroxytoluene (BHT)
- Butylated hydroxyanisole (BHA) and butylated hydoxytoluene (BHT)
|Type of Food||Foods Allowed||Foods Restricted|
|Milk and dairy||Plain milk|
|All prepared dairy products made with restricted ingredients|
|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: |
Some jams, jellies
Any food made with or cooked in oils with hydrolyzed lecithin, BHA, BHT
Commercial pie, pastry, and fillings
Dry dessert mixes
|Breakfast cereals made with allowed foods, including:|
All plain grainsPlain oats and oatmeal
Plain cream of wheatPuffed rice and wheat
Plain crackers with allowed ingredients:
Grissol Melba toast
Ry Vita Rye Krisp
Wasa light or golden crackers
|Plain pasta||All packaged rice and pasta meals|
|Vegetables||All pure fresh and frozen vegetables and juices except those listed||Eggplant|
Tomato and all tomato products
All vegetables prepared with restricted ingredients
Fruit dishes made with allowed ingredients
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 that listed opposite|
Pure peanut butter
|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 ingredients
Lard and meat drippings
|All fats and oils with color and/or preservatives|
Prepared salad dressings with restricted ingredients
|Spices and herbs||All fresh, frozen, or dried herbs and spices except that listed opposite||Anise|
Seasoning packets with restricted ingredients
Foods labeled “with spices”
Pure jams, jellies, marmalades, conserves made with allowed ingredients
Plain artificial sweeteners
Homemade sweets with allowed ingredients
Prepared dessert fillings
Prepared icings, frostings
Spreads with restricted ingredients
Cream of tartar
Homemade relishes with allowed ingredients
|All chocolate and cocoa|
Prepared relishes and olives
Most commercial salad dressing
Pure juices of allowed fruits and vegetables
Plain and carbonated mineral water
Alcohol: plain vodka, gin, white rum
Fruit juices and cocktails made with restricted ingredients
All other carbonated drinks
All drinks with “flavor” or “spices”
All other alcoholic beverages
Histamine Restricted Diet for Control of Urticaria/Angioedema
Do not eat the following food during the 4 week trial elimination period.
- 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
- Tomato sauces
- 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.
- Chili powder
- Curry powder
- Hot paprika (cayenne)
- Fermented soy products
- Fermented food
- Tea—herbal or regular
- Chocolate, cocoa, and cola drinks
- Vinegar and foods containing vinegar such as pickles, relishes, ketchup, and prepared mustard
Low Salicylate Diet
Many people with CU are sensitive to salicylates. Salicylates are the active ingredient in aspirin and are found in all plant matter to some extent (fruits, veggies, herbal supplements, etc). If you find that taking aspirin makes your hives worse, you may have discovered your cause. This is also true if you cannot tolerate other non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen or Aleve, since they are cross-reactive with salicylates.
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The following low salicylate diet may help.
Of all foods, fruits have the highest levels of salicylates, especially berries, pineapple, and dried fruits. Avoid all fruits with the exception of fresh, peeled, and cored apples, pears and mangoes. Read labels carefully to avoid foods sweetened with fruit juices.
Veggies are generally low in salicylates, except for gherkins. Peeling and cooking removes some of the salicylates they contain. Choose only fresh ones, or frozen or canned ones that have no added ingredients other than salt. This eliminates canned tomato sauce, spaghetti sauce, etc.
This category, which includes dairy products, is the lowest in salicylates. Cheeses containing artificial colors or preservatives should be avoided. Continue to abide by any dietary restrictions regarding fat, cholesterol, etc., while pursuing the elimination program.
Legumes, Seeds, Nuts, and Cereals
These generally fall within the acceptable range, with the exceptions of almonds, water chestnuts, and peanuts.
Herbs, Seasonings, and Spices
These vary wildly from fresh to dried and brand to brand. Two fresh herbs may contain vastly differing amounts according to what kind of soil they were grown in. Stick to table salt or sea salt.
Stay away from all juices, since these concentrate the salicylates present in fruits and vegetables. Avoid soft drinks because of the artificial flavorings and colorings. Decaffeinated teas and coffees appear to be acceptable as long as they aren’t flavored or contain chicory. Alcoholic beverages are difficult to assess, but white wines appear to be acceptable. Red wines, liquors, and liqueurs tend to have quite high levels and should be avoided. Water is the beverage of choice.
Eat nothing that has been pre-processed. Read all labels for artificial preservatives and colors, particularly red and yellow. If a product contains an ingredient you are not familiar with or cannot pronounce, put it back on the shelf. Be especially careful to read labels of products you buy frequently and take for granted, like bread, pasta and cheeses. The two highest levels of salicylates in foods were measured in licorice and mints. Therefore, avoid items like hard candy and chewing gum.
Be vigilant in your avoidance of anything labelled “all-natural”, because this generally means derived from plant products. Try to avoid any of the things listed below, even though it may mean making drastic changes in your lifestyle.
- Avoid aspirin and all non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil. Take Tylenol instead.
- Avoid oleander, aloe, ginseng, seed oils, nut oils, bioflavonoids, menthol and metholatum, St. John’s Wort, geranium, flower oils, plant oils, Rosehips, quercetin, camphor, castor oil.
- Vitamin supplements derived from “natural” sources must be avoided completely.
- Take special care to read cosmetics and personal care item labels.
- All arthritis creams contain high levels of salicylate, as do sunless tanning products, and sunscreens.
- Avoid all lip balms except for plain Vaseline.
- Acne medications, astringents, and facial cleansers often contain salicylates.
- Herbal shampoos, conditioners, and hair styling products should always be avoided.
- In dandruff shampoos, avoid salicylic acid compounds, selenium sulfide, and coal tar.
- All wart and callus removers contain salicylates, as do mouthwashes and other gum care products.
- Brush your teeth with a paste of baking soda and water and flossed with unflavored, unwaxed dental floss.
- Pepto Bismol is almost pure bismuth subsalicylate.
- When gardening, wear gloves, and cover any portion of the body that might come in contact with the plants.