Chances are you’ve heard of antihistamines - medications used to control allergic reactions and allergy symptoms. But have you heard of histamine intolerance? I hadn’t either and learned a lot from the mother of one of my patients. Now I regularly treat patients with this problem and the improvements can be dramatic if you’re suffering with the symptoms.

A Determined Mom Paves the Way

I first learned about the impact of histamine intolerance not in medical school, but from the dedicated mother of one of my patients. Her teenaged daughter was struggling with a host of seemingly disconnected, and to her doctors somewhat bizarre, symptoms: racing heart and severe weakness and dizziness after eating, extreme low blood pressure that sometimes cause fainting, skin rashes and hives, severe abdominal pain, and debilitating anxiety. She’d been seen by a whole host of practitioners who largely dismissed her as making them up, and she was ultimately diagnosed with an anxiety disorder. When I met her she was 14 years old, weak and underweight because every food she ate seemed to make her worse. This previously high achieving student had now missed her entire first year of high school due to disability. In fact, she was so weak she was barely able to get out of bed.

Desperate to find an answer, her mother became a ‘citizen scientist,’ and when she brought her daughter in for her first appointment with me, she asked if I’d ever hear of histamine intolerance. I explained to her that I’d learned a great deal about the impact of histamine on the body as a medical student, and was familiar with mastocytosis and allergic reactions, but not histamine intolerance as a medical condition per se. But I’ve learned to learn from my patients, did my homework, and sure enough, this mom, who’d previously been told by several of her daughter’s doctors in no uncertain terms that she was too pushy (she was pretty sure she’d heard the term ‘pain in the ass’ get used about her in a doctor’s office) did in fact figure out what was going on with her daughter.

In the years since I’ve seen and treated many patients with HIT and while it’s not common in the general population, it’s often a hidden cause of symptoms that should be taken seriously and that your doctor might not know anything about. It’s especially important to consider if you’ve tried an elimination diet and it just hasn’t done the trick for you, because there are very specific dietary changes that are necessary to make.

The Lesser-Known Food Intolerance

The term “food intolerance” refers to foods to which you are sensitive and that can therefore cause you symptoms when you eat them. Lactose intolerance is one of the most common, and gluten intolerance is another that’s been on the rise in that past decade. Food intolerances can cause myriad symptoms that often get chalked up to “normal” facts of life, like seasonal allergies, headaches, and aches and pains (none of which actually are ‘just normal’ – they are reflect deeper imbalances going on). Food intolerances can also cause more serious illness, for example, diabetes and autoimmune disease.

In fact, many foods can cause intolerance in an individual for a variety of reasons, often having to do with imbalances in the gut or over-activation of the immune system, though they are not true food allergies.

One of the lesser-known types of food intolerances is called histamine intolerance (HIT). It appears to be on the rise and can cause a range of symptoms. The good news is that most often, it is readily treatable.

 

Wait, What is Histamine?

Histamine is a chemical your immune system releases from a variety of cells in which it is stored, in response to a variety of allergic and toxic exposures, for example, bee stings and certain foods like peanuts in those with peanut allergies. When such an exposure happens, histamine-containing cells (mostly mast cells and basophils) dump histamine into your bloodstream leading to a rapid inflammatory reaction that causes the blood vessels to become more permeable, allowing the immune system’s white blood cells to reach the area where the ‘invasion’ has occurred. Its also activates nerves that stimulate your respiratory passages to constrict, your eyes to water, and nose to run. Because cells throughout your body including your digestive system, heart and vascular system, skin, and lungs respond to histamine as part of its protective response, the response occurs widely throughout the body and can be multi-systemic causing all of the symptoms I list in the next section. Histamine produced in the brain acts as a neurotransmitter – a chemical involved in signaling in your nervous system; in the stomach, histamine stimulates the production of gastric acid necessary for digestion.

 

Do You Have Histamine Intolerance?

While histamine intolerance is not a true food allergy, and thus not usually considered life threatening, the symptoms can be quite severe and have led many people to the emergency department! If you’re experiencing any of the following symptoms, it could be that you, too, have HIT. Here are the most common symptoms:

  • Abdominal cramps, diarrhea
  • Anxiety
  • Difficulty falling asleep or staying asleep
  • Dizziness, vertigo
  • Feeling too hot or frequently chilled for now reason
  • Fatigue or weakness
  • Low of high blood pressure (can be extreme in either direction)
  • Migraines or headaches
  • Hives, Itching, Eczema
  • Menstrual cramps or premenstrual headaches
  • Nasal congestion, sneezing, itchy eyes, difficulty breathing
  • Nausea or vomiting
  • Puffiness, swelling
  • Racing heart, especially but not always after eating certain foods
  • Skin flushing, especially but not always after eating certain foods
  • Wine/alcohol intolerance

When you have impaired histamine breakdown, excess histamine can build up, resulting in symptoms that mimic an allergic reaction – which are many of those I’ve just listed.

What Causes Histamine Intolerance?

Histamine intolerance results from an imbalance between the amount of histamine that is released from your cells in response to certain triggers, or builds up in your body as a result of foods you eat – and your body’s ability to break it down and clear it out, which it does using two naturally occurring enzymes your body is supposed to produce – Diamine oxidase (DAO) and histamine N-methyltransferase (HNMT).

However, due to either genetics or acquired reasons, your body might not produce enough of one or the other, or both of these. HNMT is produced inside the cells and is usually more genetically influenced. DAO, however, is produced in the intestine, and is also the enzyme responsible for breakdown of ingested histamine, so if there has been intestinal damage, DAO production might be reduced. This can occur as a result of:

DAO-blocking foods including alcohol can also lead to decreased availability of DAO to break down histamine, resulting in elevated levels. Consuming high histamine foods can also cause a problem, especially if your enzyme system is impaired.

HIT is more common in people with Inflammatory Bowel Disease (IBD – Ulcerative colitis and Crohn’s), celiac disease, and SIBO, as well as eczema, all conditions that have been associated with intestinal inflammation.

Dysregulation in the stress response system – whether adrenal overdrive with high cortisol, or inhibited adrenal function with low cortisol – can also impair the immune system leading to increased reactivity to foods, and stress seems to worsen HIT in many individuals.

Can I Get Tested to See If I Have Histamine Intolerance?

There are currently no tests that are proven to diagnose histamine intolerance, and though blood and urine levels of histamine can be measured, because histamine levels are so naturally variable depending on time of day and also when you’ve eaten, it’s just not a reliable way to test for this problem. Similarly blood levels of DAO can be measured, but these levels don’t really correlate neatly with symptoms. Because it’s not a true allergic condition, allergy testing, including food allergy testing, is not useful.

The best way to ‘test’ for histamine intolerance is through a low histamine diet, which I describe below. A reduction in symptoms on the diet, and a return of symptoms when higher histamine foods are re-introduced, suggests that there is histamine intolerance.

It’s also important to remember that you can get checked for true allergies and other medical conditions that may lead to similar symptoms.

Can I Treat This?

Depending on the root cause of your histamine intolerance it can be reversed (usually if there’s gut damage causing the problem), reduced dramatically (if there’s low DAO production), or reduced to a tolerable extent (genetic). Most of my patients go on to live completely normal healthy asymptomatic lives, but usually do have to pay attention to food triggers. There are 3 steps to treating histamine intolerance:

  1. Eat a low histamine diet
  2. Heal your root causes
  3. Supplement

Let’s explore these.

 

The Low Histamine Diet

A low histamine diet is the first line of treatment. The best approach is to remove all high histamine containing foods, as well as foods that cause the release of histamine, as well as avoiding all DAO blocking foods and whatever DAO blocking medications you can also avoid (work with your prescribing doctor to come off of medications) for 30 days. During this time keep a food journal to record how you feel (you can download a sample food journal here) both immediately and about 2-3 hours after each meal. Symptoms don’t always appear immediately, they may appear when your body accumulates histamine over the course of the day. So paying close attention throughout your day during this 1-month period is very important, but it’s not always 100% possible to identify the individual triggers for you. That said, sometimes it is. For example, I had one patient who discovered that popcorn shot her blood pressure up sky high and caused her to break out in hives.

If during this 30-day period you notice that your symptoms have disappeared or have been dramatically reduced, I highly recommend sticking with the low-histamine diet for 3 months total before trying to reintroduce foods from the lists below. If and when you do reintroduce foods you’d removed, do so slowly, adding in foods from one group at a time over 3 days each, so for example, you might add in higher histamine fruits for 3 days and record any symptoms if they arise. If they do, you are probably sensitive to those fruits, and omit them for now. Wait until the symptoms have passed before introducing the next group, for example, nuts, and again track, and so on.

Histamine intolerance varies highly amongst different people – some can’t reintroduce some of the higher histamine provoking or containing foods at all, while some can include small amounts in their diets. You have to sort of experiment with it – and ideally, work with a knowledgeable practitioner who can help guide you. And hang in there – it can feel quite restrictive and like a long road when you eliminate all of these triggers, but chances are you won’t mind as much when you’re feeling better, and if gut damage was a component of your histamine intolerance, then once your gut is healed, you may be able to resume a diet that includes a broader variety of foods. Gut healing can take weeks to up to a year so you have to be patient with the process.

 

High Histamine Foods to Eliminate

Aged and fermented foods, leftover meats, poultry and fish, and wine are often the biggest triggers; however, any of the foods on this list may be a problem for you, so remove them all for 30 days.

  • Alcohol: Champagne, red wine, beer, white wine
  • Aged cheeses: Parmesan, Gouda, Swiss, and cheddar
  • Grains: Wheat
  • Legumes: Chickpeas, soybeans
  • Fermented or smoked Meats/Fish: Sardine, mackerel, herring, tuna, salami
  • Fermented and pickles vegetables: Pickles, sauerkraut, kimchi, relish, soy sauce/tamari
  • Fermented milk products: Yogurt, kefir, and buttermilk
  • Fruit: Dried fruit, citrus, strawberries
  • Vegetables: Tomatoes and tomato products, spinach, avocado, and eggplant
  • Also: Cinnamon, chocolate

 

Histamine Liberators to Avoid

Citrus, bananas, dairy products, chocolate (sorry ladies!), papaya, pineapple, nuts, strawberries, food additives, shellfish, artificial dyes and preservatives

 

DAO Inhibitors to Avoid

Alcohol, black and green tea, mate

 

What You CAN Eat

Now if you’re wondering what you can eat, rest assured, there’s still plenty, though admittedly, this is a more restrictive food plan than many.

 

Low-histamine foods you can enjoy include:

  • Freshly cooked meat and poultry (fresh or frozen – no leftovers!)
  • Freshly caught or flash frozen fish
  • Eggs
  • Gluten-free grains: rice, quinoa
  • Peanut butter
  • These fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes
  • Most vegetables except those listed earlier
  • Dairy alternatives: coconut milk, rice milk, hemp milk, almond milk
  • Oils: olive oil, coconut oil
  • Many of the non-caffeinated herbal teas

Note that methylated B vitamins, in my clinical experience, seem to aggravate some people with histamine intolerance; if you are taking methylfolate or methyl-B12 I recommend stopping these while you are on the 30 Day Low Histamine Diet and re-introducing them as a ‘food group’ to see how you respond. If you are planning to conceive, however, it is still important to be on folate or folic acid in some form for at least 30 days prior to conception and during pregnancy.

 

Heal the Root Causes

4R Gut Healing: Healing the gut is central to my work with patients with histamine intolerance and is described in detail in my book, The Adrenal Thyroid Revolution, in my 28-Day Gut Reset program, and you can read about it here in this article. It is usually done in conjunction with the 30-Day Low Histamine Diet, and continued for about 3 months or longer if needed (i.e., with celiac or IBD the damage is likely high).

Tame the Stress Response: As mentioned earlier, when your stress response system is disrupted, your immune response may also be over-activated. Include simple daily stress reduction practices in your lifestyle and head over here to see if you have symptoms of adrenal imbalances that suggest this area needs more attention. My book The Adrenal Thyroid Revolution will support you in a stress response reset.

 

Supplement

While supplements for histamine intolerance have not yet been well studied, in addition those used for gut healing, several have shown promise, and have been quiet effective in my clinical practice. These include:

  • Quercetin and Freeze Dried Stinging Nettles: this is a natural antihistamine duet, often found as a combination product, that does not block DAO and is very effective in preventing histamine reactions and calming mild to moderate reactions. Dose: A combination product that provides 250 mg quercetin or isoquercetin three times daily; quercetin should not be used in pregnancy or if you have kidney disease.
  • Vitamin B6: 50 to 100 mg a day (do not exceed 100 mg/day)
  • Buffered Ascorbic Acid: 500 mg 2 to 4 times daily
  • Probiotics and Prebiotics: A daily combination of both a probiotic and a prebiotic helps to repair the intestinal wall, however, be avoid probiotics with Lactobacillus casei, a strain that may increase histamine.
  • Direct DAO supplementation is often recommended, however, I’ve not found nearly as effective as the above combination, and therefore rarely recommend it anymore.

 

Living with the symptoms of histamine intolerance can be annoying in the least, debilitating when severe. I hope this article gives you yet another tool to be a Root Cause Revolutionary and start to take back your health. If you’ve found this article helpful, please LIKE and SHARE it, and make sure to leave a comment in the comments section below if you’d like to dialogue with me or other readers. To learn more about healing your gut and resetting your adrenals, get a copy of my latest book, The Adrenal Thyroid Revolution. 

With love,

Dr. Aviva

 

 

 

 

 

References

Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May; 85(5):1185-96.

40 Comments

  1. This is a very interesting article. Thank you for posting. I have a gluten and processed sugar (also corn syrup, high fructose corn syrup, fructose, maple syrup) intolerance that I had to figure out on my own. Doctors weren’t able to diagnose. After years of taking antihistamines, it finally dawned on me that the symptoms may be food related. Sure enough. I stay away from all wheat and sugar products. I’m also allergic to all chemical sweeteners. Aspartame and sucrose make my hair fall out. Sugar alcohols give me terrible heart palpitations. My diet consists of 95% whole food. I make my own chocolate with honey, coconut oil and unsweetened cocoa powder and I’m okay with small amounts. I’ve dropped 2-3 sizes in clothes, work out regularly, stay hydrated and for the most part am happier and healthier than I’ve ever been.

  2. Wow, Dr. Romm, you have done it once again!!! I am always blown away by your brilliance and how clear it is that you just want to help people. As someone who has been healing from Chronic Lyme (I am talking…undiagnosed from childhood, and finally diagnosed at 31, six years ago…), histamine intolerance and overall sensitivity and over-reactivity has been a big issue for me. I know a lot of it has to do with gut integrity, but I just don’t know how to go about healing my gut. I have tried a lot of different things, but I react to so much, to it is a real challenge. I think I need to just make an appointment with you and get started (I live outside of Boston).

    I am so excited for your Facebook Live on this topic, and I will ask my questions there, if I can…but I thought I would put them here as well, in case they benefit someone reading this article. Since you mention histamine’s role in stomach acid production, would HCL be beneficial or counterproductive? I am also thinking about the neurotransmitter aspect and how that could be supported more (you mention B6), because I tend to have nightmares/sleep disorder increase (bruxism/apnea-type stuff) when I am in a flare (usually seasonally).

    Also, you mentioned Vitamin C, and I am wondering if a Vitamin C “Flush” might be beneficial. Something I find interesting is that you mention pineapple on the “avoid” list, yet some histamine supplements (like D-Hist) contain Bromelain from pineapples. I am also curious about probiotics, because mine contains Lactobacillus Paracasei, and I am reading up to see if it is essentially the same as Lactobacillus Casei. If it has the same impact on histamine, then I will switch.

    As someone who has been trying to navigate this for years it is very interesting to notice the seasonality of it all. For example, I could eat avocado a month ago, but tried to have a little over the weekend, and my tongue got itchy/bumpy. It’s that whole “rain bucket” idea…as you mentioned, it adds up. When you are getting stimulated by environmental allergens on top of the food you are eating there can be a lot of cross reactivity and histamine overload. Speaking of rain…drinking lots of water and staying well hydrated is so key!

    Thanks again, Dr. Romm. Obviously I geek-out to this stuff…which is why I am currently enrolled in the Functional Medicine Coaching Academy program! So exciting to help each other and put an end to people suffering and missing out on life! XO

  3. Does Histamine cause redness in the face and red, puffy eyes when crying? When I get emotional with tears my entire face gets very red, especially around my eyes and take hours to return to it’s normal coloring.

  4. Thank you for this article. I noticed that you mentioned dairy kefir and fermented vegetables in the list of foods to avoid. I am wondering if that would also include fermented drinks such as water kefir and kombucha.

  5. thank you sweet woman
    sound advice
    has homeopathy in your experience been succeddful in de- sensitizing
    last histmaine count (which i requested was 1023)
    dustmites originally- midgees /sandflie snow. am exhausted with the pain of these alone- plus other health issues
    there has to be a solution beyond this
    I cannot live on brown rice and water- this condition has caused me major malnourishment
    I am vego/vegan
    I will not support my life on the sufering of animals
    now due to the successive stress adrenal/cortical damage
    its better not to eat than burn from head to toe I cant go outside in my belovedgarden
    any advice would be substantially appreciated.
    i first contracted allergy whilst pregnant andnow believe it has contributed to spectrum disorder in offspring.
    Hari om
    love will follow you everywhere

    • Gosh, sounds like you’re having a bad time of it. I’m also vegan with leaky gut and suffer from fructose, sorbitol, mannitol and histamine digestive problems. I tested positive for mutated MTHFR gene, maybe you should get tested for that yourself?

      In terms of food, while I’m on the elimination diet I can handle carrots, broccoli, kale, a bit of cauliflower and zucchini. I have them either oven roasted with olive oil/coconut oil and some tahini, or have them in some coconut milk with ginger and turmeric – quite delish! Can serve with rice or rice noodles. And for breakfast I have seeds – pepitas (2T), sunflower seeds (1T), hemp seeds (2-3T) and coconut flakes (1/4 cup) in homemade hemp milk with stevia. Not the most adventurous, but it gets me through!

      Perhaps you’d benefit from a good naturopath to guide you too. 🙂

      Best of luck with it. I can also recommend Aviva’s book – it’s great.

  6. Okay…a couple more geeky points… I am also curious to learn more about the hormonal interplay. I find that when inflammation is up due to menstruation (and the added burden on the liver), I am less tolerant of histamine. Also, I have found with both myself and others I coach a connection between histamine issues (again, especially seasonally) and dental problems. Again, the way histamine impacts the swelling of tissue, and especially the gums, is significant. I believe this is why I have sleep apnea-type symptoms only when the pollen count is high, or I have had some sort of chemical exposure. Since I am in that pattern right now I think I will try a little activated charcoal to try to lower my overall burden and see if that helps.

    • In brief there does seem to be a connection between histamine intolerance and premenstrual migraines due to a natural dip and DAO prior to menstruation. I’ve not found much literature on this but the connections you describe make sense. I’m not a fan of activated charcoal for this though.

  7. Thank you for this, I’m wondering if there is any link between this and sulphite allergy? I have a fairly severe self-diagnosed sulphite allergy and have very bad reactions to things like wine and dried fruit. I see a number of the foods to avoid seem to overlap.

  8. Very interesting article! Never heard of this before. Seems a lot of things fall into the category of symptoms and it would be difficult to know if you really have this or not!

  9. I must take Methylfolate, B12, etc… because I have MTHFR. Is it safe for me to discontinue those supplements for a month or more? It seems that if those were causing me problems, I would still have to take them to prevent other sever health problems. Please advise. Thanks.

    • Sorry, would love to help, but can’t give direct health advice without seeing someone as a patient. Thanks for your understanding.

  10. Great article! I think it is important for people to know that Histamine Intolerance is a real condition and that it can be healed over time. There is a growing community with more and more support as more people suffer from this. It’s horrible to deal with and the anxiety that comes with it is very real and can be very debilitating if you allow it to be. I dealt with this 2 years ago and fortunately figured out what it was pretty quickly (on my own), but it still took a good 6 months to heal. But I’m still scared of certain foods!

  11. Wow, thank you so much! What a fascinating article and a topic I will certainly be exploring further for our whole family. We eat a lot of fermented foods, can you tell me if coconut yoghurt is as high in histamine as dairy yoghurt? Thank you so much!

  12. Amazing article. Couldn’t come at a better time. We’ve been trying to figure out my sons hives and stomach pain for over a month. All allergy testing came out negative. He’s been on the 4R diet with me so I thought the stomach pain was bc of all the high fiber gassy foods like cabbage but this makes so much more sense!!!!! Ty so much.

  13. Thank you so much for covering this topic! I was diagnosed nearly a year ago but have suffered with symptoms for years without answers. I was wondering if you had any recommendations for brands of pre/probiotics? I also wonder if you could provide a list of supplements or medications that should be avoided (that either create histamine or reduce DAO). Lastly, what are your thoughts about using an infrared sauna and if that poses any risk of inducing histamine reactions? I have been using one to help with stress, as well as to detox (and support my taxed liver). I don’t have onset histamine reaction during use (though hard to tell since I’m flushed!) but I’ve heard heat/cold intolerance could increase histamine in the body. Thoughts? Does the benefit still outweigh any risk? Thanks again! Sorry – lots of questions!

  14. Amen! I am that “pain in the ass” mom who knows that HIT is real even if our allergist says it’s not, so it’s nice to see you, a Yale-trained MD, speaking up about it. THANK YOU! THANK YOU! THANK YOU!

  15. Aviva my daughter has the skin and nasal reactions and has maybe 1 item on the list that is forbidden once in a while and still there is no change to her symptoms. What could I do to help her. I’ve taken most those things out at different times and still not noticed a difference. I’m at a loss.

  16. “Because it’s not a true allergic condition, allergy testing, including food allergy testing, is not useful.”

    Great article! Just wanted to mention that I have been allergy tested at the Environmental Health Center in Dallas. The first provocotive neutralization test given for all patients is for histamine. I am now on antigens for a whole host of things I reacted to, including histamine. This treatment has been incredibly helpful.

  17. Thank you so much Aviva! Before an herbalist friend referred me to you and your leaky gut protocol, I had heard of HIT, looked into it and did the diet for a while. While it helped, it wasn’t solving my issue. What really helped was your leaky gut protocol which I did for 9 weeks. Then I went off the wagon… and now I’m back on it -repair mode once again. Thank you for writing about histamine intolerance in such a way that people can understand it! I am a TCM practitioner and herbalist and am constantly referring patients to your website/book/you-ness! Inspiring and so so helpful. Big gratitude and love!!

  18. Aviva, thanks so much for this. More quality information from you! I am wondering if MTHFR mutations can also cause allergies due to inefficient detoxification pathways?? If a woman has a history of recurrent miscarriage and allergies but no lab results would you supp methylated bs first and see how she fares with her allergies? Thanks again, Penny

  19. Finally, more information about Histamine Intolerance! I’ve been working with this for the last year and most folks don’t know what I’m talking about. Can you talk about the link between HIT and Rosacea? I’ve realized I’ve had Rosacea all my life, but it has worsened from about age 30 onward (now I’m almost 50). All last year I thought my Rosacea symptoms where Histamine Intolerance, but now I’m wondering if the story is different. Any insight?

  20. Hi Dr. Romm,
    How would I dose my 3 year old daughter suffering from chronic eczema with the Freeze Dried Nettle Leaves and Quercetin? How about for the other supplements that you suggest? From my understanding, it’s good to halve adult dosages when dosing kids. Thanks again for this well-written article!

    • Hi Danielle, Excuse the promo – not meant to “sell you” on something – but my children’s course The Allergy Epidemic is specifically designed to help kids with chronic eczema – and I think you’ll find it most helpful and it will discuss supplements appropriate for children her age. It’s exactly why I created it. You can learn more at http://www.healthiestkids.com
      Warmly, Aviva

  21. Is quercetin ok when breastfeeding? I’ve been following the low histamine diet for my baby’s eczema and it has helped immensely. We both take nettles and I’ve just recently cut the B vitamins. I was thinking of trying quercetin to see if it would help her heal that final bit.

    • It is generally considered safe while BF’ing though studies haven’t been done specifically looking at this. It’s during pregnancy that’s the known problem.

  22. I just discovered your podcast and this is so interesting. I believe I have this – I get severe reactions, as described – went to the ER twice but they were useless so I know I’m better off riding it out at home. I’ve been tested by an allergist and he said I’m not allergic to food, but I have found I react to MSG, some other unknown additives, trace amounts of “other Tree nuts”, and Bree. Such an odd combo but it lines up with this article. Also, sometimes I can tolerate things more than others. I’ve also been suffering from constipation for about 18 months while I was pregnant and had an episode.
    I’ve made an appointment with my medical doctor – is there a lot of resistance to this condition (like do MDs / allergists believe in it)? Would you recommend going straight to the gut protocol or do I need to start over with the elimination diet?

    • Many allergists and rheumatologists are very well aware of it – and in Europe, a patient over there told me – it’s well recognized. Hopefully you’ll find that your MD gets it! OR can refer you to one who does. Let us all know! 🙂

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