Plain English guide to Sensitivity to histamines and other vasoactive amines
Date issued: December 2021
Review date: December 2023
Ref: C-474
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.
Diagnosis:
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
Seafood
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
cheese.
Eggs which are boiled, fried, poached, scrambled or made into an omelette or quiche
Buttermilk, kefir, sour cream, yoghurt or long-life cream
Fruit
Bananas, tinned figs, grapefruit, tangerines, oranges, limes, lemons, pineapple, grapes or strawberries
Vegetables
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
Seafood
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
Fruit
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
peas
Beans for example kidney beans, butterbeans, fava beans, lima beans, adzuki beans
Chickpeas
Peanuts
Tree nuts and seeds
All tree nuts for example: brazil nuts, cashews, almonds, hazelnuts, pecans, pistachios
and walnuts
Cereals
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
Chocolate
Fresh foods you can choose to eat
Tree nuts and seeds
Coconut
Linseeds, pumpkin seeds, sesame seeds and sunflower seeds
Cereals
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.
Breakfast:
• Cereal with milk or milk alternatives
• Porridge with milk or milk alternatives
• Pancakes with suitable fruit
• Toast and jam made from allowed fruit
Lunch/dinner:
• Chicken/beef/turkey/cheese spread sandwich or wraps with salad
• Soup made with allowed foods with bread or crackers
Tea/dinner/supper:
• 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
brown.
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
Antihistamines:
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
www.allergyuk.org
Tel: 01322 619898
British Dietetic Association: fact sheets on food allergy and intolerance,
Autism and allergy testing
www.bda.uk.com
Tel: 0121 200 8080
NHS Choices: allergy and intolerance advice
www.nhs.uk/conditions/food-allergy/
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.
