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Plain English guide to Sensitivity to histamines and other vasoactive amines

Date issued: December 2021

Review date: December 2023 

Ref: C-474 

PDF:  Plain English Sensitivity to Histamines and other Vasoactive Amines final December 2021.pdf [pdf] 212KB

What is histamine?

Histamine is a chemical created in your body. It is released by white blood cells into the bloodstream when your body has an allergic reaction to something. Histamine release has many different effects on the body. Symptoms can include:

• Flushing of the face

• Itching

• Swelling of parts of the body

• Breaking out in a rash or hives

• Having a runny or blocked nose

• Sneezing or wheezing

• Irregular heartbeat

• A drop in blood pressure

• Abdominal pain, nausea, diarrhoea

• Headache

• Increased anxiety

It is likely that more than one of these symptoms will happen at the same time.

Pollen, insect bites and stings, mould, dust and certain foods can cause allergic reactions. What causes an allergic reaction is different for different people.

What is a Vasoactive Amine and how can it affect me?

Vasoactive amines are found naturally in food and drinks. The longer a food is stored or aged the more vasoactive amines will be made. Almost all food will contain some vasoactive amines but certain foods contain a lot more. Histamine is a vasoactive amine.

Some people can develop symptoms from having too much vasoactive amines in food and drinks. These symptoms are similar to those caused by histamine release during an allergic reaction. The reason for this is not fully understood. Symptoms can occur within 30 minutes of eating a meal but can also be delayed. This reaction is not called a ‘food allergy’ but a ‘chemical sensitivity’ because of how the immune system is involved. Your
immune system defends your body against substances it sees as harmful or foreign.


There are no reliable tests which can provide an accurate diagnosis of sensitivity or intolerance to vasoactive amines. The only way to diagnose this is to avoid foods that contain high amounts of vasoactive amines for 2-4 weeks to see if your symptoms improve.

It is important to eat foods during this time with little or no vasoactive amines and to replace avoided foods with alternatives to ensure you still have a balanced diet. It is very difficult to provide an accurate list of foods to avoid because the amount of vasoactive amines in foods is affected by many different things.

This booklet:

This booklet has been written to help guide you through what you can and can’t eat and is based on the best available information. You will find it helpful to keep a food and allergic symptom diary during this time. Your dietitian will talk to you about this.

Important things to know: 

• Any food which is aged, for example: mature cheese or hung meat, could contain high    amounts of vasoactive amines.
• Any food or drink which is fermented, for example red wine or  sauerkraut, could               contain high amounts of vasoactive amines
• Try to eat fresh food as much as possible.
• Avoid ready meals.
• If you cook a large portion of a meal and want to freeze the remains do this straight        away; do not keep it in the fridge for a few days before freezing.
• Cooking the food will not change the amount of vasoactive amines within the food.

The following pages:

The following pages will give you information about:

• The name of your dietitian
• Foods to avoid for the next 2-4 weeks
• Foods you can eat during the next 2-4 weeks
• Meal suggestions and alternative sauce recipes
• Antihistamines
• What happens after 2-4 weeks
• Useful contacts

My dietitian:
My dietitian is:
Their telephone number is:

Foods you can and can’t eat:

Foods to avoid

Meat and poultry
All fresh pork for example: roasting joints and chops

All cured meat and pork for
example: salami, pepperoni, bacon and sausages Offal for example: kidneys, hearts and liver
Aged steak
Game for example: rabbit, pigeon or pheasant

Vegetarian alternatives

Tempeh, tofu, Quorn


Fresh or tinned: tuna, sardines, mackerel, salmon, caviar or herring

Processed fish products for example: fish paste, fish pate, smoked/dried/pickled fish
Prawns, crab, lobster or squid

Milk and eggs

Blue cheese, parmesan, brie, camembert, emmental, gouda, cheddar, or any type of hard cheese including from goat’s or sheep. Cottage cheese, feta cheese, mascarpone, mozzarella, processed cheese slices, ricotta, soft goat’s cheese or soft sheep’s

Eggs which are boiled, fried, poached, scrambled or made into an omelette or quiche

Buttermilk, kefir, sour cream, yoghurt or long-life cream


Bananas, tinned figs, grapefruit, tangerines, oranges, limes, lemons, pineapple, grapes or strawberries

Aubergine, spinach, avocados, broad beans, pickled vegetables, olives, tomatoes or tomato based products

Fresh foods you can choose to eat

Meat and poultry

Fresh beef, chicken, lamb or turkey


Fresh white fish or fresh white fish that was frozen as soon as it was cleaned and prepared

Milk and eggs

Cheese spread

Eggs which are baked into foods for example: cake or biscuits

Milk (including goat and sheep), soya milk, rice milk, oat milk, hemp milk, coconut milk.
Fresh cream and ice cream


All other fruit not in the list

All other vegetables not in the list

Foods to avoid

Legumes including peanuts

All colours of lentils
Peas for example green peas, snap peas, snow peas, split peas, blackeyed
Beans for example kidney beans, butterbeans, fava beans, lima beans, adzuki beans

Tree nuts and seeds

All tree nuts for example: brazil nuts, cashews, almonds, hazelnuts, pecans, pistachios
and walnuts


Sourdough bread, yeast or marmite

Condiments and pickles

Fermented soya products such as Miso and soy sauce Fish sauce, Yeast extract
Vinegar and vinegar products for example: pickles, chutney or salad dressings

Hot drinks

Coffee, cocoa, hot chocolate or green tea

Cold drinks

Fresh fruit juice or smoothies made from fruit that need to be avoided

Alcoholic drinks

Wine, champagne, beer or cider

Sweet and savoury treats


Fresh foods you can choose to eat

Tree nuts and seeds


Linseeds, pumpkin seeds, sesame seeds and sunflower seeds


Rice, corn, wheat, rye, barley, oats, quinoa, cous cous, buckwheat, breakfast cereals,
flour, pasta and rice 
Bread unless you know you have a problem with it, try wraps or flatbread which do not contain yeast or crackers

Condiments and pickles

Salt, pepper, herbs and spices. Any other sauce not listed

Hot drinks

All other hot drinks including tea and fruit/herbal teas

Cold drinks

Water, Squash

Alcoholic drinks

Spirits for example: gin, vodka or whiskey

Sweet and savoury treats

Sweets, cakes, biscuits, sugar, syrup and crisps

Meal suggestions:

Suggestions below are made with ingredients from the foods you can eat
listed above.


• Cereal with milk or milk alternatives
• Porridge with milk or milk alternatives
• Pancakes with suitable fruit
• Toast and jam made from allowed fruit


• Chicken/beef/turkey/cheese spread sandwich or wraps with salad
• Soup made with allowed foods with bread or crackers


• Rice, pasta, potato, cous cous or quinoa
• Chicken, beef, turkey, lamb, white fish
• Salad or suitable vegetables

Snacks/treats in moderation:

• Allowed fruit
• Sesame seed bars
• Mixed seed bars
• Popcorn
• Crisps
• Cakes
• Biscuits

Alternative sauce recipes:

Option 1: bolognaise

6 carrots
1 small beetroot
I large onion
3 stalks of celery
1 whole bay leaf
350ml of water

1. Peel and dice the vegetables.
2. Put all of the ingredients into a sauce pan and bring to the boil.
3. Reduce heat and simmer until the vegetables are soft.
4. Remove the bay leaf and blend until smooth.
5. Add salt, pepper or any herbs or spices you like.

Option 2: Roasted pepper

1. Roast peppers under the grill under they start to go black. Keep
    turning them.
2. Peel and blend to a smooth consistency.

Option 3: Pesto sauce for pizzas or pasta

1. Toast sunflower and pumpkin seeds in a pan until they just start to
2. Blend with 1 garlic glove, a large handful of fresh basil and enough
     olive oil to make a smooth paste. Add salt and pepper

Option 4: alternatives to soy sauce

• Sesame oil and sesame seeds mixed with curry powder
• Tamarind paste with fresh coriander
• Five spice powder mixed with garlic oil and freshly grated ginger


Although allergic reactions are not usually life threatening they can be scary and unpleasant. Antihistamines may be helpful to relieve symptoms so it’s a good idea to carry some in your purse or wallet. You should also follow a management plan given to your by your doctor or dietician.

Some medications can exacerbate (worsen or intensify) histamine tolerance. You should continue to take any prescribed medication unless advised differently by your doctor whilst you make changes to your diet.

If you have asthma make sure it is well controlled and use your inhaler if certain foods make you wheezy.

After 2-4 weeks:

After 2-4 weeks you will be able to slowly reintroduce foods which contain vasoactive amines to determine your tolerance. Your dietitian will tell you when and how to do this.

Simple tips to help you reintroduce foods:

• Start with foods you have missed the most or foods that will make a difference to the       balance of your meals
• Do not try lots of new foods at the same time or on the same day
• If you experience symptoms try to think which food or quantity of food may have              caused them
• If you experience symptoms stop eating the food you have recently tried and wait until     your symptoms have gone before trying the next food.
• Make sure you keep your food and symptom diary up to date after each meal

You may:

• Find you can tolerate a certain level of foods with vasoactive amines in them
• Or can have certain foods throughout the week but not on the same day.
• You should consider retrying foods every so often to test this.

Useful contacts:

Allergy UK: a charity organisation providing support for people with
allergies and intolerances
Tel: 01322 619898

British Dietetic Association: fact sheets on food allergy and intolerance,
Autism and allergy testing
Tel: 0121 200 8080

NHS Choices: allergy and intolerance advice

This Plain English document is based on the BDA guide to Sensitivity to
Histamine and Vasoactive Amines produced by the BDA Food Allergy
Group and The Association of UK Dietitians.



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