HISTAMINE FOOD LIST

Why a Histamine Food List Matters for MCAS

Diagnosing MCAS (Mast Cell Activation Syndrome): A Quick Summary

There is no fixed number of symptoms required to diagnose MCAS. Instead, diagnosis is based on:

• Symptoms in at least two organ systems (for example, skin and gut, or cardiovascular and respiratory)

• Recurrent or persistent symptoms not fully explained by another condition

• Evidence of mast cell activation, if possible – though lab markers may often be negative because mast cells are distributed across different tissues and produce diverse mediators (including histamine, tryptase, prostaglandin D2, leukotrienes, heparin, cytokines, platelet-activating factor, and chymase), which may not all be elevated in a single test. This variability explains why some patients have negative lab tests but still show a positive response to an elimination diet or to mast cell-directed therapy.

• Improvement with mast cell-directed therapy (such as antihistamines, mast cell stabilisers, or leukotriene modifiers)

In short, MCAS is a clinical diagnosis supported by patterns of multi-system symptoms, laboratory evidence if available, and a positive treatment or elimination challenge response.

Common Symptoms of MCAS / Histamine Intolerance

• Skin rashes, flushing, itching

• Hives (urticaria)

• Gastrointestinal symptoms (bloating,

diarrhoea, nausea, reflux,

abdominal pain)

• Headaches

• Low blood pressure

• Light-headedness or dizziness

• Palpitations or rapid heartbeat

• Easy bruising

• Fluid retention

• Stubborn weight gain

• Joint pain

• Back pain

• Tinnitus (ringing in the ears)

• Sinus congestion or rhinitis

• Anxiety

• Insomnia

• Early waking between 1–4 a.m.

• Vivid dreams or nightmares

• Night sweats

• Frequent urination

• Vaginal dryness

• Brain fog

• Fatigue

• Anaphylaxis-like reactions

Other associations

These symptoms often overlap with other conditions, including:

• Hypermobility spectrum disorders, now referred to as hEDS (hypermobile Ehlers-Danlos Syndrome)

• POTS (Postural Orthostatic Tachycardia Syndrome) or POTS-like symptoms, which can involve palpitations, dizziness on standing, fatigue, and exercise intolerance

Because of these overlaps, many people with MCAS may notice their symptoms align with hypermobility and autonomic

VERY HIGH HISTAMINE FOODS

(typically problematic for those with histamine intolerance)

Aged Cheeses

• Parmesan

• Roquefort

• Emmental

• Gouda

• Cheddar

• Swiss

• Blue cheese

Cured and Processed Meats

• Salami

• Pepperoni

• Prosciutto

• Ham

• Bacon

• Hot dogs

• Sausages

Fermented Foods

• Sauerkraut

• Kimchi

• Miso

• Tempeh

• Soy sauce

• Tamari

• Fish sauce

• Pickles (fermented)

• Fermented olives

Fish and Seafood

• Smoked fish (sardines, herring, mackerel)

• Anchovies

• Tuna (especially canned)

• Canned sardines

• Shellfish (shrimp, crab, lobster, mussels, oysters, clams)

• Dried fish

• Surimi

Alcoholic Beverages

• Red wine

• Champagne

• Beer

• Cider

Vinegar Products

• Balsamic vinegar

• Apple cider vinegar

• Wine vinegar

• Pickled products with vinegar

Other

• Stock cubes / bouillon

• Soy-based condiments

• Kombucha

• Certain food colorings and additives (sulfites, benzoates)

MEDIUM HISTAMINE FOODS

(can trigger symptoms if consumed often or in excess)

Vegetables

• Tomatoes

• Spinach

• Eggplant (aubergine)

• Pumpkin

• Peas

Fruits

• Strawberries

• Bananas (ripe)

• Citrus fruits (oranges, lemons, limes, grapefruit)

• Pineapple

• Papaya

Nuts and Seeds

• Walnuts

• Cashews

• Peanuts

• Sunflower seeds

Chocolate and Cocoa

Legumes

• Chickpeas

• Lentils

• Kidney beans

• Black beans

Other

• Green tea

• Black tea

• Energy drinks

LOW HISTAMINE FOODS

(best tolerated if fresh and properly stored)

Fresh Meats and Fish (not aged, canned, or smoked)

• Chicken

• Turkey

• Lamb

• Beef (fresh, not aged)

• Pork (fresh cuts only)

• Fresh fish caught and eaten the same day or flash-frozen (salmon, cod, sole, trout)

LOW HISTAMINE

Most Fresh Vegetables (except those listed in medium/high)

• Carrots

• Zucchini

• Broccoli

• Cauliflower

• Green beans

• Kale

• Lettuce

• Cucumber

• Sweet potato

Most Fresh Fruits

• Apples

• Pears

• Melons

• Grapes

• Mango

• Blueberries

Gluten-Free Grains

• Rice

• Quinoa

• Millet

• Buckwheat

• Oats

Plant-Based Fats

• Olive oil

• Coconut oil

• Avocado oil (some may react, so test tolerance)

Herbal Teas

• Rooibos

• Chamomile

• Peppermint

• Ginger tea

Non-Dairy Milks

• Coconut milk

• Rice milk

• Almond milk (homemade is best to avoid additives)

Other

• Eggs (fresh)

• Honey

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