Angioedema and diet: Foods to eat and avoid

Diet often plays a crucial role in managing angioedema, a condition characterized by swelling in the deep layers of the skin and mucus membranes. For some, allergic reactions to specific foods directly cause angioedema and should be avoided. For others, food is not the primary cause of angioedema, but certain foods may trigger attacks or make them worse.

There is no one specific angioedema diet that will work for everyone, but following a well-balanced and nutritious meal plan while avoiding known trigger foods can help to prevent swelling attacks and support an active, healthy life.

How diet affects angioedema

There are several types of angioedema. While each has a different underlying cause, they’re all characterized by inflammatory processes in the deep layers of the skin and mucus membranes that drive the disease’s hallmark symptom of swelling, which can occur in various parts of the body. Diet may play a role in managing any type of angioedema.

The most common type of angioedema is acute allergic angioedema, where an allergic reaction to a usually harmless substance causes the immune system to release an inflammatory molecule called histamine, driving a swelling attack. Food allergens are a common trigger of these attacks, and avoiding specific 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 specifically caused by food allergies, eating a well-balanced, anti-inflammatory diet that avoids known trigger foods can help ease the symptoms of angioedema.

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

Foods to avoid with 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.

Still, certain foods may need to be avoided or eaten with caution in some patients. 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.

Allergens and trigger foods

For people with allergic angioedema, the number one tip for managing the condition is to avoid any foods or food additives that have 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 linked to angioedema include:

• tree nuts
• seafood
• eggs
• milk
• legumes, such as peanuts and soy
• wheat
• sesame

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.

Inflammation-promoting foods

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

There are no specific guidelines on an anti-inflammatory diet for angioedema, and few studies have focused specifically on the swelling disorder. However, because inflammation is an underlying driver of swelling, it has been proposed that limiting the intake of inflammation-promoting foods, such as those with high histamine levels, may be beneficial.

Examples of high-histamine foods to avoid or eat in moderation with a low-histamine diet 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, or NSAIDs (e.g., ibuprofen), salicylates found naturally in fruits, as well as certain food additives, 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 is also crucial for flushing toxins and reducing inflammation throughout the body.

Identifying triggers

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

• Get tested for allergies: A skin allergy test can identify if a person is allergic to any common food allergens. An allergist will prick 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.
• Try an elimination diet: 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. If angioedema symptoms ease during that time, it’s likely one or more of those foods is a trigger. One by one, the foods will be added back into the diet. If symptoms worsen after consuming a specific food again, it may be a trigger.

Patients should never attempt an elimination diet for angioedema without first consulting their healthcare provider, as they’ll be able to guide them through the process and determine which foods are best to eliminate. They’ll also closely monitor them to ensure that no other health complications arise or worsen as a result of the 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 lives. Swelling in the intestinal lining, 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 study showed that 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 that were 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

Several other foods were the suspected cause of an HAE attack in one person.

In a small 2024 study, a third of HAE patients reported an association between food intake and HAE attacks, noticing an aggravation of symptoms after eating legumes, stone fruit, wheat-containing products, spicy or acidic foods, or milk.

Other studies have similarly found a wide range of foods linked by individuals to their swelling attacks.

Importantly, there is still insufficient evidence to indicate that specific foods should be avoided by all individuals with HAE. Every patient is unique, and trigger foods that cause problems for one person may not have the same effect on 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, may be beneficial. 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 protein, 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.

Key takeaways

If a person with any type of angioedema suspects that food may be a cause or trigger for their swelling attacks, there are a few key steps to take:

• Identify food-related triggers: Patients should keep a detailed diary about when swelling occurs, along with what they’ve eaten and done each day. This will help them and their healthcare team pinpoint what might be triggering swelling attacks.
• Communicate with the healthcare team: Patients should talk with their doctors if they suspect a food-related trigger for their angioedema. Depending on the situation, they may be referred to an allergist who can test for food reactions. A dietitian or nutritionist may also be brought on board to guide an elimination diet for identifying triggers and to help develop a dietary plan that avoids known triggers or allergens.
• Look for other triggers: Even if a certain food triggers a person’s angioedema sometimes, there are a variety of other factors that can also cause swelling attacks for that same person. Patients should inform their doctor if they notice any other factors that may be triggers and work together to develop a plan to avoid them.

Ultimately, every person with angioedema will have different needs. The key to living the healthiest possible life with the swelling disorder is to keep a close eye on which foods or other factors are linked to their attacks and promptly communicate this information with the healthcare team.