A Guide to Italian, Spanish, French Menus with Histamine Intolerance

A Guide to Italian, Spanish, French Menus with Histamine Intolerance

A Tolerance Kitchen article

In Part One of our series on world cuisine we looked at low histamine options found in Chinese, Thai and Japanese menus. In Part Two we are going to stay closer to home and run our rule over three of Europe's most loved cuisine.

On paper Italian, Spanish and French menus should be easier to navigate, as there is far less reliance on fermented sauces and flavourings compared to the Asian dishes. Unfortunately however the elements of European cooking that make it so special, things like aged cheeses, cured meats and ripe tomatoes, are also some of the biggest natural sources of histamine (or histamine liberators).

Luckily these cuisines also have a strong tradition of fresh, simply cooked foods, which means that with a little bit of planning there should always be a low histamine option on the menu. At Tolerance we want people to be able to eat the food they enjoy with the people they love, and this article is designed to help you do just that.

A Reminder of The Three Main Triggers of Histamine Sensitivity 

Before we get started, let's quickly recap the three main ways food and drink can add to your histamine bucket:

  • High Histamine Content: These are foods where histamine has developed through processes like ageing, curing, or fermentation. Think aged cheese, cured meats, and wine
  • Histamine Liberators: These are foods that may trigger your body's own mast cells to release their stores of internal histamine. Common examples include citrus fruits, tomatoes, and chocolate
  • DAO Blockers: Certain compounds in food and drink, particularly alcohol, can inhibit the activity of your diamine oxidase (DAO) enzyme, reducing your ability to break down external histamine

Italian food is probably the most classic option when someone thinks of eating out. While it's built on beautiful and simple ingredients, there are a few staples that we need to be careful with.

The Challenges: The biggest challenges with Italian food are aged cheeses (especially Parmesan), cured meats (prosciutto, salami), and tomatoes. Red wine is also a common feature, both in the glass and in the cooking. It contains histamine and acts as a DAO blocker.

We have an article that looks specifically at how you can replace Parmesan cheese in your cooking. If you're eating in a restaurant, it's likely best to avoid the Parmesan altogether.

Safer Bets:

  • Pasta: Simplicity is generally key, and a dish like the classic aglio e olio (garlic and oil) with fresh parsley is a great choice. Many restaurants can prepare a simple butter or olive oil sauce with fresh vegetables or chicken, and any dish without a tomato-based sauce or Parmesan will be safer than one that has it
  • Risotto: A simple mushroom risotto can be a good option but it is worth asking if it is made with wine or a pre-made stock cube. A risotto made with fresh stock is a much safer bet, and again skip the Parmesan finish
  • Pizza: Look for a pizza bianca (white pizza), which is on that's made without the tomato base. Top it with fresh mozzarella or ricotta and simple ingredients like courgette, mushrooms or chicken. Skip the cured meats, anchovies and olives
  • Mains: Look for simple grilled fish or chicken (pollo alla griglia), served with a side of roasted vegetables or a simple salad (ask for olive oil and a pinch of salt instead of a vinaigrette)
  • Cheese: While hard, aged cheeses are a problem, very fresh cheeses like ricotta or fresh mozzarella may be better tolerated in small amounts by some people

Unfortunately the things that make Spanish cuisine so unique are the same things that make it challenging if you have histamine intolerance. More small plates means more dishes to check, while cured and preserved ingredients appear all over the menu.

The Challenges: Jamón and chorizo appear in everything from croquetas to paellas, while aged cheeses like Manchego, tinned and marinated fish (anchovies, boquerones in vinegar) and olives are all tapas staples. Tomato is also everywhere from pan con tomate to gazpacho, as well as being the sofrito base of many rice dishes. Sangria, red wine and sherry bring both histamine and alcohol's DAO blocking effect. A true minefield!

Safer Bets:

  • A la Plancha: This simply means cooked on a hot grill plate and it is often your safest section of the menu. Grilled chicken, fresh fish or prawns cooked with olive oil, garlic and salt are good choices. Ask for the lemon to be left off if citrus is a trigger for you
  • Vegetable Tapas: Pimientos de Padrón or padron peppers are a simple option, as are grilled vegetables like courgette and asparagus. Plain fried potatoes work well too, just ask for them without the bravas sauce which is tomato and chilli based
  • Tortilla Española: A classic Spanish omelette is made from just eggs, potato, onion and olive oil. Ask whether it is made fresh and check it does not contain chorizo
  • Paella: This one requires clear communication and carries a slightly higher risk. A chicken and vegetable paella is a better option than a seafood one, but ask whether the base is made with tomato, wine or a pre-made stock

French cooking is famous for its sauces and that is where most of the difficulty lies. The simpler bistro classics are a much easier place to start.

The Challenges: Wine is used heavily in the kitchen, in slow-cooked dishes like coq au vin and boeuf bourguignon as well as in many sauces. Stocks and reductions are often simmered for hours which gives histamine more time to develop. The cheese board is a clear one to avoid as ripened cheeses like Camembert, Brie, Roquefort and Comté are all high in histamine. Charcuterie (saucisson, pâté, rillettes) and salad dressings made with vinegar and mustard are also common.

Luckily, despite all the above, French actually offers some great low-histamine options

Safer Bets:

  • Grilled and Roasted Meats: Roast chicken (poulet rôti) or a simply grilled steak are bistro staples. Ask for them served plain with any sauce on the side, and check whether the steak has been dry-aged - if it has, stick to the chicken!
  • Fish: Look for simply grilled or pan-fried fresh fish (poisson grillé). A classic sole meunière is cooked in butter with parsley, ask for it without the lemon if citrus is a trigger for you
  • Omelettes: A freshly made omelette aux fines herbes is a simple and reliable choice at lunch. Skip the cheese and ham fillings
  • Sides: Green beans (haricots verts), steamed potatoes and a plain green salad are all good choices, just ask for olive oil instead of vinaigrette. A gratin dauphinois is traditionally just potatoes, cream and garlic, but many restaurants add cheese so it is worth checking with your waiter

Your Toolkit for a Successful Meal Out

Beyond specific menu choices there are a few general strategies that can make all the difference. You can read more about these in detail in our Guide to Eating Out with Histamine Intolerance.

  • Plan Ahead: Look at the menu online before you go. This gives you time to spot potential safe options without pressure
  • Call Ahead: Phone the restaurant during a quiet period (like mid-afternoon) to briefly explain your dietary needs. You will get a much better response than when you ask during a busy dinner service
  • Keep it Simple: The fewer ingredients in a dish, the lower the risk. Grilled meat or fish with vegetables and potatoes is a reliable fallback in almost any Italian, Spanish or French restaurant
  • Think About Your Drink: Wine is a big part of all three cuisines, but alcohol adds to your histamine load in more than one way. Sticking to water with your meal leaves more room in your bucket for the food itself
  • Consider Your Bucket: If you know you are eating out in the evening, you can be extra careful with your food choices during the day to ensure your histamine bucket has plenty of capacity
  • Support Your Digestion: For those with a diagnosed DAO deficiency, supporting your body's own enzyme activity can be a helpful part of your toolkit. A DAO supplement like our Aperitif is designed to be taken 15-20 minutes before a meal. One to three capsules can help with the digestion of histamine from food and drink. Do not exceed the maximum daily dosage of three capsules

With a little preparation and knowledge, you can still enjoy a plate of pasta, a table of tapas or a long bistro lunch. Remember, navigating histamine intolerance is a personal journey, and finding what works for you is a process of discovery.

Following a low histamine diet should always be done alongside a qualified dietitian. Your own unique intolerances may make you more susceptible to certain foods than others, and long term adherence can lead to deficiencies in other important nutrients. You can find a list of trusted histamine practitioners here, all of whom offer 1:1 online sessions to help you get started and work with you to create a personalised diet.
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