The aim of this paper is to provide a critical analysis of histamine intolerance (HIT) in children and adolescents, with a focus on proposed mechanisms, diagnostic limitations, and realistic therapeutic options. Symptoms attributed to HIT are nonspecific and therefore require a broad differential diagnosis, including functional and psychosomatic disorders, allergies, other food intolerances, and inflammatory diseases. Measurement of serum diamine oxidase activity has limited diagnostic utility. If dietary intervention is considered, it should be short-term and accompanied by an assessment of the risk of nutritional deficiencies and the potential development of pediatric feeding and eating disorders. The overarching goal should remain the maintenance of dietary diversity and the improvement of quality of life for the child and their family. This paper also highlights the need for high-quality research and effective patient and family education to reduce misdiagnosis and prevent unnecessary dietary restrictions.