Histamine intolerance is thought to result from an imbalance between accumulated histamine and the capacity for histamine degradation. However, histamine and other biogenic amines, such as tyramine, putrescine, spermine, spermidine, and cadaverine, are also formed during the course of desired or undesired microbial fermentation of food or as a consequence of food spoilage.
Avoidance of the main histamine- or tyramine-containing or –releasing food is best performed under the guidance of an experienced dietician due to the complexity of the adaptation. Avoidance of nutritional deficiencies due to an over-restrictive diet is important. A wide range of foods are relevant in histamine and tyramine intolerance and tolerance levels vary between individuals. Some of the most relevant foods are:
- Plants: citrus fruit, papaya, strawberries, pineapple, nuts, tomatoes, spinach and chocolate.
- Animals: fish, crustaceans (seafood), pork, egg white.
- Other sources: additives, licorice, herbs and spices.