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Track: All foods and beverages consumed Time of consumption Symptom onset time Type and severity of symptoms Duration of symptoms High-Histamine Foods to Watch Common dietary sources of histamine include: Fermented foods: Aged cheese, sauerkraut, kimchi, yogurt Alcoholic beverages: Wine (73% trigger), champagne (68% trigger), beer Processed meats: Various sausages (58% trigger), cured meats, deli meats Fish: Especially mackerel, tuna, sardines, anchovies Tomato products: Tomato concentrate (55% trigger), sauce, paste Vinegar and vinegar-containing foods: Pickles (34% trigger), condiments Leftovers and aged foods: Histamine increases with storage time Other triggers: Strong spices (52%), chocolate (35%), citrus fruits (39%), certain vegetables including eggplant and spinach Management Strategies Dietary Intervention The low-histamine diet remains the gold standard for managing histamine intolerance: Elimination Phase (3-6 weeks): Focus on fresh, unprocessed foods: Fresh fruits (except citrus) Fresh vegetables (except high-histamine varieties) Fresh poultry and meat Rice and potatoes Certain grains (gluten-free not required) Dairy can be included based on tolerance Reintroduction Phase: Gradually reintroduce foods one at a time to identify personal tolerance levels

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