Exploring Treatments for Histamine Intolerance: From Doctor-Prescribed to Over-the-Counter Solutions

samanthagreenlmhc
Jun 30
5 min read

Histamine intolerance (HIT) can be a challenging condition, marked by symptoms like bloating, headaches, diarrhea, and skin reactions due to the body’s inability to properly break down histamine. This often stems from reduced activity of the enzyme diamine oxidase (DAO), leading to histamine buildup. Fortunately, a range of treatments—both doctor-prescribed and over-the-counter (OTC)—can help manage symptoms and improve quality of life. Drawing from recent research, this blog post explores effective strategies to tackle histamine intolerance, offering practical insights for those seeking relief.

couple cooking low-histamine dinner filled with fresh veggies — This could be you and your spouse preparing a nice low-histamine dinner together

Understanding Histamine Intolerance

Before diving into treatments, it’s helpful to understand what histamine intolerance entails. Histamine is a natural compound involved in immune responses, digestion, and neurological functions, but when it accumulates—often due to DAO deficiency—it can trigger a cascade of symptoms. These can mimic allergies or digestive disorders, making diagnosis tricky. Triggers include histamine-rich foods (like aged cheese or fermented products), stress, and even fasting in some cases. Effective management hinges on reducing histamine levels and supporting the body’s ability to process it.

Doctor-Prescribed Treatments

When symptoms of histamine intolerance are severe or persistent, consulting a healthcare provider is crucial. Doctors can offer tailored treatments based on your medical history and symptom profile. Here are the primary doctor-prescribed options supported by research:

Antihistamines: Medications like H1 and H2 receptor antagonists (e.g., cetirizine, loratadine, or ranitidine) can block histamine’s effects, reducing symptoms such as itching, headaches, or digestive distress. These are often prescribed for short-term relief in severe cases, as noted in studies on histamine intolerance management.
Low-Histamine Diet Plans: Doctors often work with dietitians to design personalized low-histamine diets, avoiding foods like alcohol, fermented products, and certain vegetables (e.g., spinach, tomatoes). Research highlights that a 4–8 week low-histamine diet can confirm diagnosis and significantly alleviate symptoms.
DAO Supplementation: Prescription-grade DAO supplements, derived from porcine kidney extracts, can enhance histamine breakdown in the gut. Studies suggest these are particularly effective for patients with confirmed DAO deficiency, often prescribed alongside dietary changes.
Probiotics: Emerging research points to specific probiotic strains (e.g., Bifidobacterium) that may reduce histamine-producing bacteria in the gut. Doctors may recommend medical-grade probiotics to restore gut microbiota balance, though this is still an area of ongoing study.

Pro Tip: Always consult an allergist or gastroenterologist to rule out conditions like food allergies or mast cell disorders before starting treatment. A detailed food and symptom diary can help your doctor pinpoint triggers and tailor a plan.

Over-the-Counter Solutions

For those with milder symptoms or as a complement to prescribed treatments, OTC options can be effective and accessible. These are often used to manage symptoms at home, but it’s wise to discuss them with a healthcare provider to ensure safety and efficacy.

OTC Antihistamines: Non-prescription antihistamines like cetirizine (Zyrtec) or loratadine (Claritin) are widely available and can help with symptoms like itching, hives, or nasal congestion. They’re a quick fix for flare-ups but should be used sparingly to avoid side effects like drowsiness.
DAO Supplements: OTC DAO supplements (e.g., brands like Seeking Health or Histamine Block) are available without a prescription. These can be taken before meals to aid histamine digestion, particularly when eating out or consuming potentially high-histamine foods. Research supports their use, though effectiveness varies by individual.
Vitamin C: Known for its histamine-lowering properties, vitamin C supplements (500–1000 mg daily) can act as a natural antihistamine. Studies suggest it boosts DAO activity, making it a popular OTC choice for mild symptoms.
Vitamin B6: This vitamin is a cofactor for DAO production, and OTC supplements (25–50 mg daily) may support histamine metabolism. Research indicates it can enhance DAO activity, particularly when combined with a low-histamine diet.
Quercetin: A natural flavonoid found in OTC supplements, quercetin has antihistamine and anti-inflammatory properties. Doses of 500–1000 mg daily may help stabilize mast cells and reduce histamine release, though evidence is preliminary.

Caution: OTC supplements like DAO, vitamin C, or quercetin can interact with medications or cause side effects in high doses. Start with low doses and consult a pharmacist or doctor, especially if you’re on other medications.

Lifestyle and Dietary Strategies

Beyond medications and supplements, lifestyle changes play a pivotal role in managing histamine intolerance. These strategies, supported by research, can be implemented at home and often complement medical treatments:

Adopt a Low-Histamine Diet: Focus on fresh foods like rice, potatoes, fresh poultry, and low-histamine vegetables (e.g., zucchini, broccoli). Avoid triggers like aged cheeses, cured meats, and alcohol. Keeping a food diary, as recommended in clinical studies, helps identify personal triggers.
Avoid Fasting: Research suggests fasting can exacerbate histamine release in some individuals, potentially worsening symptoms like urticaria or anaphylaxis. Eating small, frequent meals may stabilize histamine levels.
Manage Stress: Stress can trigger histamine release, so practices like yoga, meditation, or deep breathing can help. Studies link stress reduction to improved symptom control in histamine-related conditions.
Support Gut Health: A balanced gut microbiota is crucial, as dysbiosis can increase histamine production. Incorporate prebiotic foods (e.g., bananas, asparagus) and consider OTC probiotics, but choose strains low in histamine production (e.g., Bifidobacterium infantis).

When to Seek Professional Help

While OTC solutions and lifestyle changes can manage mild cases, professional help is essential if symptoms persist, worsen, or significantly impact daily life. Signs to see a doctor include:

Severe or frequent symptoms (e.g., chronic diarrhea, migraines, or hives).
Suspected food allergies or other underlying conditions.
Lack of improvement after 4–8 weeks of a low-histamine diet.

Doctors may order tests like DAO activity levels, skin prick tests, or gut microbiota analysis to refine the diagnosis and treatment plan.

Final Thoughts

Managing histamine intolerance requires a multi-faceted approach, blending doctor-prescribed treatments, OTC remedies, and lifestyle adjustments. Antihistamines and DAO supplements offer quick relief, while a low-histamine diet and gut health support provide long-term benefits. Research underscores the importance of personalization—working with healthcare providers to tailor treatments to your unique needs is key. By combining medical guidance with accessible OTC options, you can take control of histamine intolerance and reclaim your well-being.

Note: Always consult a healthcare professional before starting any new treatment, especially if you have underlying health conditions or are taking medications.

References

Pinzer, T. C., Tietz, E., Waldmann, E., Schink, M., Neurath, M. F., & Zopf, Y. (2018). Circadian profiling reveals higher histamine plasma levels and lower diamine oxidase serum activities in 24% of patients with suspected histamine intolerance compared to food allergy and controls. Allergy, 73(4), 949–957. https://doi.org/10.1111/all.13361
San Mauro Martin, I., Brachero, S., & Garicano Vilar, E. (2016). Histamine intolerance and dietary management: A complete review. Allergologia et Immunopathologia, 44(5), 475–483. https://doi.org/10.1016/j.aller.2016.04.015
Schnedl, W. J., & Enko, D. (2020). Considering histamine in functional gastrointestinal disorders. Critical Reviews in Food Science and Nutrition, 61(18), 2960–2967. https://doi.org/10.1080/10408398.2020.1791049
Schnedl, W. J., Lackner, S., Enko, D., Schenk, M., Holasek, S. J., & Mangge, H. (2019). Evaluation of symptoms and symptom combinations in histamine intolerance. Intestinal Research, 17(3), 427–433. https://doi.org/10.5217/ir.2018.00152
Smolinska, S., Winiarska, E., Globinska, A., & Jutel, M. (2022). Histamine: A mediator of intestinal disorders—A review. Metabolites, 12(10), 895. https://doi.org/10.3390/metabo12100895
Tamasi, J., & Kalabay, L. (2024). Spectrum, time course, stages, and a proposal for the diagnosis of histamine intolerance in general practice: A nonrandomized, quasi-experimental study. Journal of Clinical Medicine, 13(20), 6039. https://doi.org/10.3390/jcm13206039