Angioedema and diet: Foods to eat and avoid

Last updated Nov. 26, 2024, by Lindsey Shapiro, PhD
Fact-checked by Joana Carvalho, PhD

For many patients, diet may play an important role in controlling angioedema, a disorder characterized by swelling in the deep layers of the skin and in mucus membranes.

There are several types of angioedema, each with a different underlying cause, but diet may play a role in managing any of them. For some, allergic reactions to specific foods directly cause angioedema and should be avoided. For others, while food is not the primary cause of angioedema, certain foods may trigger attacks or make them worse.

Although there’s no specific angioedema diet, following a well-balanced and nutritious diet while avoiding known trigger foods can help to prevent swelling attacks and support an active, healthy life.

How diet affects angioedema

While each type of angioedema has its own cause, they’re all characterized by inflammatory processes in the deep layers of the skin and mucous membranes that drive the disease’s hallmark symptom of swelling.

The most common type of angioedema is acute allergic angioedema, where an allergic reaction to a substance that’s usually harmless causes the immune system to release an inflammatory molecule called histamine, driving a swelling attack. Food allergens are a common driver of these attacks, and avoiding certain foods is a key aspect of managing acute allergic angioedema.

Beyond allergies, angioedema can have a number of other causes, including the genetic mutations that underlie hereditary angioedema (HAE). In such patients, certain foods may trigger or exacerbate swelling attacks.

While dietary modifications are not likely to completely prevent angioedema attacks in people whose disease isn’t caused by food allergies alone, eating a well-balanced diet that avoids known trigger foods can help reduce their frequency or severity.

Eating or avoiding certain foods also can help to lower inflammation in the body, easing the symptoms of angioedema.

As in the general population, a well-balanced and nutritious diet can bring numerous benefits to people with angioedema. These include higher energy levels, lower stress levels, better mental health, and a reduced risk of developing other health problems, such as high blood pressure, diabetes, and cardiovascular disease.

Dietary tips for managing angioedema

Each person with angioedema will have different dietary needs, and in general, there’s no particular angioedema diet plan that’s prescribed or foods that absolutely should be avoided.

It’s recommended that patients work with their doctors, and in some cases with a nutritionist, to develop an individualized plan that works for them. Nonetheless, there are a few dietary tips for people with angioedema to keep in mind.

Avoid allergens and trigger foods

For people with allergic angioedema, the No. 1 tip for managing the condition is to avoid any foods or food additives that caused a previous attack. Even if past reactions were mild, future attacks triggered by the same food allergen could be more serious, affecting the airways and becoming life threatening. Therefore, patients should take every precaution to avoid known food triggers.

Common food allergens that may cause an allergic reaction and lead to angioedema include:

• nuts
• seafood
• eggs
• milk
• legumes, such as peanuts and soy
• berries
• chocolate.

With other forms of angioedema, if patients have identified any food that seems to trigger or make swelling attacks worse, it’s a good idea to avoid it or limit its intake.

Consider an inflammation-reducing diet

Inflammation is a common factor across all angioedema types. Ample research indicates that chronic inflammation in the body can contribute to serious health complications, increasing the risk of cardiovascular disease, mental health issues, cancer, and many other illnesses.

It’s been proposed that a diet that limits the intake of inflammation-promoting foods, such as those with high levels of histamine, may be of benefit in angioedema.

Foods known to be high in histamine include:

• fermented and pickled foods
• certain fruits, including pineapples, bananas, papaya, strawberries, and citrus fruits
• certain vegetables, including tomatoes, eggplant, and spinach
• aged or fermented cheese
• processed or aged meats
• canned fish and shellfish
• beans
• alcohol.

Avoiding pseudoallergens — substances that can cause inflammatory reactions similar to a true allergic reaction — may also help. These include medications like nonsteroidal anti-inflammatory drugs (e.g., ibuprofen), salicylates found naturally in fruits, as well as certain food additives commonly found in processed foods, such as flavor enhancers, food colorants, and preservatives.

Instead, a well-rounded, low histamine diet full of fresh and lean proteins, fresh fruits and veggies, and whole grains is generally considered safe. Staying hydrated also is an important aspect of angioedema care. Proper hydration can help to flush toxins and reduce inflammation.

Identify triggers

In some cases, and regardless of angioedema type, a person may not know the exact cause of an angioedema attack. There are a few steps one can take, in collaboration with a healthcare provider, to identify specific triggers if food is a suspected culprit.

• An allergist can perform skin allergy testing to identify if a person is allergic to any common food allergens. This test usually involves pricking the skin of the arm with a tiny amount of liquid containing the suspected allergen. A skin reaction is a sign of an allergy.
• Keep a food diary. Writing down the foods and beverages that have been ingested throughout the day, in addition to tracking when angioedema symptoms start, can help to identify any trigger foods.
• With an elimination diet, a doctor will recommend completely removing a group of foods from a person’s diet for a set period of time, usually at least a couple of weeks. If angioedema symptoms ease during that time, it’s likely one or several of those foods is a trigger. One-by-one, these foods slowly will be added back into the diet. If symptoms worsen after a specific food returns, it might be a trigger.

Patients should never try an elimination diet for angioedema without first talking with their healthcare providers, as they’ll be able to guide them through the process and decide which foods make sense to eliminate. They’ll also closely monitor to make sure the patient doesn’t have other serious health problems, and that nutritional deficiencies do not arise as a result of an elimination diet.

Foods that may trigger HAE attacks

In the most common types of HAE, genetic mutations cause a C1 inhibitor deficiency that results in the overproduction of an inflammatory molecule called bradykinin. Patients experience recurrent episodes of swelling, which can appear almost anywhere, throughout their life. Swelling in the lining of the intestines, for instance, can lead to gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting.

Food is not among the most common triggers for HAE attacks, but it can act as one. While no foods are universally known to trigger HAE attacks, some patients have reported that certain foods make their angioedema worse.

A small, 2018-published study showed foods linked to abdominal HAE attacks were not related to an allergic reaction, but rather appeared to be a food intolerance driven by histamine. Foods in that report linked to HAE attacks in more than one person included:

• fish
• fruits, including apples, pineapples, strawberries, and citrus fruits
• onion and garlic
• chili peppers
• milk and cheese.

Foods that were the suspected cause of an attack in one person included tomatoes, bananas, kiwi, leeks, green salad, shrimp, bread, nuts, chicken, chamomile, and alcohol. Another report found a similarly wide range of foods linked by individuals to their swelling attacks.

Importantly, while these foods have been associated with HAE attacks in a small number of patients, there is not enough evidence to indicate that specific foods should be universally avoided in people with HAE. Every patient is different, and trigger foods for one person will not necessarily cause problems in another. The best strategy is to keep a food diary in order to identify one’s own food triggers.

Recommended foods for managing HAE

No specific diet is recommended for people with HAE, as everyone’s trigger foods may be different, if they have any at all. That said, HAE has been linked to an increased risk of heart disease, so a heart-healthy diet, such as the Mediterranean diet, could be of benefit. This diet is among those that align with dietary guidelines from the American Heart Association to improve heart health across the general population.

Components of a Mediterranean diet include:

• plenty of fresh fruits and veggies
• whole grains
• lean sources of proteins, such as chicken and turkey
• beans, nuts, and seeds
• moderate amounts of dairy
• healthy fats, such as fish, olive oil, avocado, and nuts.

Limited research has been conducted into the benefits of specific vitamins and minerals with HAE. In general, doctors will recommend taking certain supplements or multivitamins based on each person’s individual needs.

Angioedema News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.