The Bio-Individual Triggers of Histamine Intolerance

Histamine intolerance is often misperceived as a diagnosis with a one-dimensional solution aimed at lowering dietary histamines.

I believe that this one-dimensional focus is misconceived. At best this leaves someone who is histamine intolerant managing symptoms. At worst it leaves them ignoring he main source of histamine intolerance.

I believe that histamine intolerance has its root cause not in an elimination diet but in two things:

Spoilt Food

Few fresh whole foods are high in histamine.

High and very high histamine foods have one thing in common – bacterial contamination during the processing, transport or storage of food – that spoils the food.

Even someone with the most robust health would not tolerate high quantities of these contaminated foods and can experience ‘scombroid’ poisoning.

Addressing food quality can dramatically improve food tolerance. I live by the mantra “Buy fresh””Cook Fresh” “Eat Fresh.”

Health Status

Most (but not all) histamine intolerance is acquired.

This suggests that it is the health status of the individual that is key and that the histamines produced by our body are key.

Histamine is a symptom. Symptoms are just how we experience the cause. They are not the cause and the cause is an underlying health concern.

The body is designed to be in homeostasis. Homeostasis is a functional state where the body meet its metabolic needs. When the body becomes stressed symptoms commence.

Histamine is a perfect example. The body is designed to rapidly deactivate excessive histamine. When the body cannot keep up with the demand to deactivate excessive histamine the result is metabolic chaos!

So it is my opinion, that the single biggest determinant of histamine tolerance is not the food lists, but the overall health status of the person. Optimising health can optimise our histamine tolerance.

Low Histamine Diet

Food is still important but not because it is the cause.

Food sensitivities (including histamine intolerance) are a major internal stressor on the body as:

  • They elicit an immune response or histamine reaction.
  • SigA production can shut down with chronic inflammation.
  • Cortisol increases in response to food sensitivities.
  • Food sensitivities contribute to intestinal permeability that can escalate the number of food sensitivities, making the gut susceptible to parasites and infections, and reduce digestion and absorption of key nutrients.
  • Lead to auto-immune disease if not addressed.

Establishing your histamine threshold is important to reducing the internal stress on your body until triggers are identified and removed. As triggers are removed histamine tolerance can rise.


Within my work as a health coach, and functional diagnostic nutritionist, I have identified a blueprint for addressing the most common histamine triggers which are:


The hypothalamus and pituitary forms a bi-directional axis with mast-cells, adrenals, the thyroid, and gonads. Dysregulation of adrenals is common feature of mast cell activation.

The Histamine and Nervous System Connection
Coming Soon:  The Adrenal Mast Cell Connection

Lab Tests:
Functional adrenal stress profile (Cortisol x 4, 2 averaged DHEA-S, estradiol, estriol, testosterone (AM), melatonin (bedtime), progesterone (bedtime)) saliva test, or
DUTCH urine test (more comprehensive; as it identifies pathways) 


Excessive estrogen (relative to progesterone) releases histamines. Estrogen is a histamine releaser and progesterone is anti-histamine.

Estrogen dominance creates a double-whammy. Escess estrogen stimulates mast-cells to make histamine, and also down-regulates DAO and MAO that clears histamine.

At the same time histamine stimulates the ovaries to make estrogen which creates a vicious circle in which histamine stimulates estrogen which stimulates mast-cells and inhibits degradation.

This may explain why histamine intolerance is common at the commencement of menstruation (when estrogen rises) and amongst middle aged women (at the commencement of peri-menopause).

Lab Tests:
Functional adrenal stress profile (Cortisol x 4, 2 averaged DHEA-S, estradiol, estriol, testosterone (AM), melatonin (bedtime), progesterone (bedtime)) saliva test, or
DUTCH urine test (more comprehensive; as it identifies pathways).


Protein digestion, liver and gallbladder detoxification, and oxidative stress (Inflammation) give us vital information as to the support that our body needs whilst identifying and resolving stressors. Inflammation is highly prevalent with mast-cell activation but not necessarily with histamine intolerance.
Lab Tests
Metabolic Assessment Profile (Lipid peroxides, bile acids, indican)


Gut dysfunction is directly implicated in the production of histamines, the release of histamines from mast-cells, escalating food intolerances, and DAO deficiency. Restoring function can have a profound affect on overall health.

Fungal Infections, Histamine Intolerance, and Mast Cells

Lab Tests
Intestinal Permeability Test and Comprehensive Stool Analysis
MRT and/or IGG/IGA food sensitivity test


SIBO is the most prevalent form of food intolerance and can mimic histamine intolerance symptoms.

Lab Tests:
Lactulose and glucose breath test.


Histamine degrading enzymes rely upon adequate nutritional precursors including Vitamin C, Vitamin B6, and copper (as DAO, HNMT and MAO are copper dependent).

Why Your Vitamin B6 Level Is Important
Vitamin C Increases Diamine Oxidase

Lab Tests:
Blood test to determine vitamin c, B6, zinc, copper, and ceruloplasmin levels.
Pyrroles urine test (optional)


Mineral imbalances are highly prevalent with histamine intolerance.

Severe stress can cause metal imbalances that can deplete minerals (particularly magnesium or potassium) within cells.

Inflammation can cause copper and iron to increase, where they can deplete both magnesium and potassium from within the cell, and cause oxidative stress.

Many heavy metals (such as mercury and aluminium) can cause mast-cell degranulation.

Lab Tests:
Hair Mineral Analysis


Liver function can be impaired by drug intolerances (phase 1 liver) or methylation (phase 2). The liver plays a central role in degrading histamines (through the HNMT enzyme) and degrading hormones including estrogen that can cause histamine intolerance.

What if this was about the liver?
The CYP450 Medication Inflammation and Histamine Connection

Lab Tests
Drug Tolerance Test (Phase 1 (CYP450))
Liver Function Test (Phase 2 pathways)


There is a range of other tests available, depending upon your bio-individuality and budget, including 23andMe. These include tests for thyroid, neurotransmitter function, other nutrient deficiencies.

I am increasingly finding that rather than starting with 23andMe (and the hard stuff) that health can be optimised by focusing on the basic tests.


If you need help figuring histamine intolerance out I am now a qualified in functional diagnostic nutrition, working jointly with a leading naturopath, and a functional doctor, to provide comprehensive laboratory testing, and evidenced based solutions. If you want to find out more about the Living Health Clinic, you can schedule a FREE appointment to find out about working with us.

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  • Shelley

    “Allergen-specific immunotherapy” is what gave my son histamine intolerance – it uses LOTS of aluminum as an adjuvant. It is usually given over the course of a year or more. I would give great caution when recommending it.

  • Mca

    do you mean supplement with 2000mg of Vit C not 2 mg?

  • LF

    Alison, thank you for your extensive research and outreach. I downloaded your guide to probiotics. You recommend Lactobacillus casei Shirota for SIBO, which I tested positive for and just finished a round of antibiotics to wipe out. The only product I can find that contains only Lactobacillus casei Shirota is Yakult, a japanese milk-based beverage that has 18%sugar. Do you have any experience with this product? Do you have suggestions for sources of Lactobacillus casei Shirota?

    • HI LF thankyou. Unfortunately Yakult is the only available product as it is proprietary. I do have experience with this and it works well although with SIBO there are herbal supplements which can be exceptionally helpful.

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  • Jenna Durant

    What do you think the trigger would be with ehlers danlos syndrome? Mast cell disorders (including mcad) are really common with this connective tissue disorder

    • Hi Jenna I am not sure. I have another post which is on a broad range of diseases including mast-cell disorders which have a histamine link. It is hypothesized that histamine is being released from cells in an attempt to regulate the progression of the disease (rather than the trigger) through inflammation. This is why an anti-inflammatory diet for these diseases (as opposed to histamine intolerance) is often helpful. Thanks for asking!

  • holly jenkins

    I’ll be 40 in a few months & after almost 2 years of severe eczema & many tests, I think I’ve narrowed it down to being a histamine issue (though histamine was tested twice & came back fine both times). My nutritionist wants me to take food sensitivity test to alleviate leaky gut, if that is indeed the root of the issue. My head is swimming as to how to proceed. Thoughts?

    • It is difficult to give you individual advice without a medical history and knowing what test you have taken. You need someone who is versed in functional testing and is not married to one modality. The gut is extremely important but as my post suggests it is not always the root cause.

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