Histamine-Related Reactions

Histamine reactions present with varied symptoms, and even healthy individuals respond to high levels of dietary histamine.1 Individuals with persistent or wide-ranging allergies may have low diamine oxidase (DAO), an enzyme which degrades histamine in the body.2,3 Histamine plays a role not just in allergic conditions, but also in IBD.4 In the following video, Elizabeth Board, MD, shares her experience treating patients with histamine reactions.

Elizabeth Board, MD, is a board certified anesthesiologist and pain medicine physician who currently practices non-narcotic pain management and Functional Medicine. She is an IFM Certified Practitioner (IFMCP), and much of the time she finds that nutritional interventions help her patients.


Histamine intolerance in my patients–I’ve seen a lot of that, actually, in my practice. Patients have seen a lot of other practitioners and they don’t have good solutions for it.

I recently attended an excellent internal medicine conference and asked about for example, eosinophilic esophagitis (EoE), and the solutions that the practitioners were teaching…were very unsatisfying. They basically suggested the patients go on PPIs.

What I know, from a Functional Medicine standpoint, is that [PPIs] can actually make this [EoE] worse long-term. What I’ve been doing with my patients is taking them through an elimination diet and helping them become curious about which foods actually create the symptoms.

In addition, there are some things we can do to actually help histamine-related reactions. One is for example, providing a little bit more of the diamine oxidase [DAO] that this particular individual might be lacking. It could be that the food is overwhelming their own endogenous diamine oxidase, or perhaps they don’t make as much diamine oxidase. They can actually take a little bit of diamine oxidase with foods that they’re concerned about. I have had some great success with patients that were having histamine related food reactions.

I can think of a particular patient who was losing weight. A lot of practitioners think that treating patients that gain weight is difficult; I can tell you that patients that lose weight are very difficult to treat, because you often have to eliminate foods and yet the person is losing weight.

In that case, the diamine oxidase has been very helpful. I’ve also found that just working with patients around specific food types and having them keep food diaries gives some of the power back to the patient, and they tend to be more compliant that way.


  1. Kovacova-Hanuskova E, Buday T, Gavliakova S, Plevkova J. Histamine, histamine intoxication and intolerance. Allergol Immunopathol (Madr). 2015 Sep-Oct;43(5):498-506. doi:1016/j.aller.2015.05.001
  2. Maintz L1, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. doi:1093/ajcn/85.5.1185
  3. Manzotti G, Breda D, Di Gioacchino M, Burastero SE. Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol. 2016;29(1):105–111. doi:1177/0394632015617170
  4. Xie H, He SH. Roles of histamine and its receptors in allergic and inflammatory bowel diseases. World J Gastroenterol. 2005;11(19):2851–2857. doi:3748/wjg.v11.i19.2851


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