Hives Driving You Crazy? Your Diet May Helpby Marisa Zeppieri-Caruana Patient Advocate
This story isn't about the kind of hives that pop up and then promptly disappear. Instead, chronic hives, or chronic idiopathic urticaria (CIU), are uncomfortable, itchy red welts and can last six weeks or longer. They affect approximately 1.5 million people, and they're usually treated with antihistamines and immunosuppressive drugs. But it isn’t uncommon for people living with CIU to use complementary therapies to help manage symptoms and prevent flare-ups. Following a low-histamine diet is one them. Here's what you need to know if you'd like to give it try, too.
What Are Histamines Anyway?
Your body produces histamine in response to allergens, like pets, pollen, or food. (They're what make your nose run and your eyes itch.) The chemical can also be introduced into the body through histamine-rich foods and by foods that trigger its release (aka histamine liberators).
If levels get too high, some people develop histamine intolerance and may experience headaches, hives, flushing, sneezing, difficulty breathing, or tissue swelling. These folks may also notice that certain histamine-rich foods trigger allergy-like symptoms.
Low-Histamine Diet How-To
For people with chronic hives, the goal of following a low-histamine diet is to help identify which foods may be particularly irritating. Typically, you remove all high-histamine foods (we've got a list!) from your diet for up to four weeks max. Then, one by one, you re-introduce them and document your physical reactions to each. Experts advise that this restrictive diet not be followed on a long-term basis, as it could lead to nutritional deficiencies. Repeat: It's meant to be a test not a forever plan.
Consider Allergy Testing
Before beginning a low-histamine diet, you may want to know which foods you're actually allergic to. “Food-allergy testing in urticaria is really at the discretion of the patient and doctor,” says Anitha Shrikhande, M.D., an allergist with Westside Allergy Care in Rochester, NY.
“I test more often for food allergies than some of my colleagues because I want to make sure I don’t miss a true food allergy. It’s not necessary, however, to have extensive tests done, especially when the hives occur randomly and in the middle of the night. A true food-allergy reaction typically occurs within a few hours of ingestion.”
Histamine-Rich Foods to Avoid
If you’re trying a low-histamine diet, Viseslav Tonkovic-Capin, M.D., a board-certified dermatologist and dermatopathologist in Kansas City, MO, recommends avoiding these:
- Fruits: bananas; citrus; dried fruits; papayas; pineapples; strawberries.
- Vegetables: avocado; eggplant; pickles; sauerkraut; spinach; tomato.
- Meat/fish: bacon and other cured meats; jerky; pork; tuna; mackerel.
- Dairy: aged cheese; fermented dairy (kefir, yogurt).
- Also: alcohol; fermented beverages (kombuchas); green tea.
Dr. Tonkovic-Capin also advises his patients against eating leftovers, which can have higher levels of histamine than fresh foods due to microbial contamination.
“While we cannot influence the production of histamine in our body, we can reduce its intake,” Dr. Tonkovic-Capin says. In other words, the effort to reduce histamine in the body is worthwhile, even if the exact cause of CIU is unknown.
Histamine and Probiotics
According to Ann Haiden, D.O., a physician specializing in functional medicine in Los Gatos, CA, some probiotics can lessen the amount of histamine in the body, while other probiotics can actually increase it. “Many people take probiotics thinking they are doing a good thing, but some popular probiotics are histamine-formers, such as the Lactobacillus strains of acidophilus, casei, reuteri, lactis, Bulgaricus, thermophilus, delbrueckii, and helveticus,” she says.
Instead, she says to try one that's a histamine-degrader, such as Lactobacillus strains of rhamnosis, salivarius, gasseri and plantarum, and the Bifidobacteria strains of infantis, longum, breve, lactis and bifidum.
Low-Histamine Foods to Enjoy
For what you can eat on a low-histamine diet, researchers suggests the following:
- Fruits: apple; cantaloupe; mango; pear; watermelon. Vegetables: asparagus; beets; bell peppers; broccoli; cabbage; carrots; cauliflower; cucumber; garlic; lettuce; radish; sweet potato; summer squash; turnip.
- Proteins: grilled beef; cooked egg yolk (not the whites, which are known to be histamine-releasers).
- Grains: breads and crackers; cooked egg yolk; quinoa; white rice; whole-grain pastas.
- Milks: almond, coconut, hemp, or rice milks.
A Different Kind of Grocery List
When planning for a low-histamine diet, you'll want to make a shopping list of what to avoid as well as what to buy. It will make it easier to keep track, especially in the beginning. By the end of your experiment, your list of potential trigger foods will likely be much smaller, and in fact, some people may even find that food isn't much of an issue for them.
While you should run trying a low-histamine diet by your doctor, don't be surprised if you don't get a total buy-in: Unlike the European guidelines for managing chronic hives, the U.S. guidelines do not include dietary interventions, says Dr. Shrikhande. "There really is limited data to support it."
Even so, she isn’t against her patients trying to figure out if food could be making their UIC worse: “Sometimes any small intervention can make a big difference in someone’s life when they are having daily hives. If you want to try to avoid foods that have higher histamine content for a limited period of time, it may help and not harm you.”