Letzte Aktualisierung am 9. March 2025 von Dr. Michael Zechmann-Khreis
Histamine intolerance is an intolerance to histamine and other biogenic amines, which are found in many foods and can trigger a variety of symptoms. These symptoms can occur within 20 minutes to four hours after eating histamine-rich foods and are often difficult to distinguish from those of other diseases. The most common symptoms include headaches, reddening of the skin (flushing), abdominal pain, diarrhea and nausea. However, symptoms can also occur less frequently, such as dizziness, palpitations, sleep disturbances or skin rashes.
Classic symptoms of histamine intolerance
Histamine influences numerous physiological processes in the body, as a result of which the symptoms of intolerance can occur in almost all tissues and organs. There are four main types of histamine receptors (H1, H2, H3 and H4), which have different functions and are found in different parts of the body. These receptors are crucial for the reactions triggered by histamine.
| Rezeptor | Funktionen | Beispiele für Wirkung |
|---|---|---|
| H1 | Allergie Typ I, Entzündung, Juckreiz, Übelkeit | Heuschnupfen, Asthma, Schwellungen |
| H2 | Magensäureproduktion, Herzfrequenz Steigerung | Sodbrennen |
| H3 | Neurotransmitter-Regulation | Schlaf-Wach-Rhythmus, Hungergefühl |
| H4 | Immunregulation, Entzündungen | Allergien, Asthma, Autoimmunerkrankungen |
In our study with 141 participants, we found the following distribution of symptoms: Headache (38%) and flushing (36%; redness of the skin on the face and neck) were the most common, followed by abdominal pain (31%), diarrhea (26%), runny nose or nasal mucous membrane swelling (19%). Flatulence and nausea were each recorded at around 17%, followed by palpitations at only around 12%.
Less frequently, but still in more than 5% of cases, rash, itchy skin, tiredness, dizziness and circulatory problems occur.
The symptoms of histamine intolerance can be summarized and divided into symptom groups as follows:
Gastrointestinal symptoms:
- Abdominal pain
- Flatulence
- Diarrhea
- Nausea, rarely vomiting
Neurological symptoms:
- Headache
- Dizziness
- Nervousness
- Sleep disorders
- Tiredness or chronic fatigue
Skin reactions
- Itching
- Skin rashes or urticaria (hives)
- Blotchy redness of the skin
- Hot flushes
- Small swellings (e.g. eyelids)
- Quaddles
Cardiovascular symptoms:
- Palpitations, tachycardia
- Increased pulse
- Low blood pressure (then often also dizziness, tiredness, concentration problems, feeling faint or collapsing, cold hands and feet)
- Frequent circulatory problems
Respiratory problems:
- Nasal grooves
- Stuffy nose
- Sneeze
- Cough
- Shortness of breath or wheezing
Genital tract
- Period pains
- Irregular cycle
The symptom group “genital tract” could not be confirmed in our 2012 survey, as not a single respondent mentioned this symptom group. Jarisch describes in his book that a connection between cramp-like menstrual pain and histamine intolerance could be plausible.
These symptoms occur to varying degrees depending on the person and the day and often cannot be clearly identified, as they depend on the day and can be influenced by many other factors.
When do the symptoms of histamine intolerance occur?
Most symptoms usually become noticeable a few minutes to four hours after consuming histamine-rich foods or foods that block the DAO enzyme. According to a study of 141 sufferers, 41% of those affected experienced symptoms just a few minutes after eating the food in question and 47% a few hours later. Only about 12% reported symptoms on subsequent days. However, this is probably due to other factors, but not to histamine intolerance.
The following symptoms are also reported by some sufferers, but are probably not directly related to HIT, or are possibly secondary symptoms of other HIT symptoms:
- Problems urinating
- Sweating
- Tingling in fingers, legs
- Muscle/joint pain
- Itchy eyes
- Heartburn
- Visual disturbances
- Tinnitus, ringing in the ears
- Tooth and jaw pain
- Rough, furry tongue (more likely to be a symptom of heartburn)
- Oral aphthae or other inflammations in the mouth (also suspected to be linked to heartburn)
- Increased acne
- Lack of drive
- Concentration difficulties
- Mood swings/whining/aggressiveness
- Increased temperature or flu-like feeling
- …
Thoughts on the “histamine barrel”
With histamine intolerance, symptoms usually occur within a few minutes to four hours after eating histamine-rich foods. If the symptoms occur later, they are probably not directly related to histamine intolerance. Histamine reaches the small intestine quickly (within 10-20 minutes) and is rapidly absorbed or broken down there. It does not remain in the body for long and is normally processed quickly.
On the internet, the image of a “histamine barrel” is often used, which continues to fill up throughout the day. This image is not entirely inaccurate, but can easily be misunderstood, as the human body is much more complex than a simple barrel. The comparison falls short, as our body has numerous mechanisms and interactions that influence and vary the histamine level. A more appropriate image would be a barrel with many holes through which the contents are continuously changed, with chemical processes and feedback mechanisms, with a capacity that can constantly adapt. So not a very good image. Histamine intolerance is a much more complex matter than this image suggests, which is why it is better to refrain from this comparison.
Sources
Hrubisko, M., Danis, R., Huorka, M., & Wawruch, M. (2021). Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients, 13(7), 2228. https://doi.org/10.3390/nu13072228
Jarisch, R. (ed.). (2022). Histamine intolerance: causes, symptoms, treatment: everything for a symptom-free life (1st edition). TRIAS.
Kamp, A. (2008). Histamine intolerance from a dietary perspective. News from science and care.
Och, U. (2024). Histamine intolerance. Ernährungs Umschau – Special issue 9: Food intolerances – intolerances – allergies, 88-95.
Reese, I., Ballmer-Weber, B., Beyer, K., Dölle-Bierke, S., Kleine-Tebbe, J., Klimek, L., Lämmel, S., Lepp, U., Saloga, J., Schäfer, C., Szépfalusi, Z., Treudler, R., Werfel, T., Zuberbier, T., & Worm, M. (2021). Guideline on the procedure for suspected intolerance to orally ingested histamine. Allergology, 44(10), 761-772. https://doi.org/10.5414/ALX02269
Smollich, M., & Vogelreuter, A. (2018). Food intolerances: Lactose – Fructose – Histamine – Gluten: with 45 illustrations, 43 tables and a work sheet for taking a medical history to download at www.Online-PlusBase.de (2nd, revised and expanded edition). WVG, Wissenschaftliche Verlagsgesellschaft.
Zechmann, M. (2012) Survey of affected persons on the nmi portal, nahrungsmittel-intoleranz.com
