If you’ve been living with hereditary angioedema (HAE), you may have a good idea of what causes symptoms to flare up for you. Stress, for example, is a big trigger, as are minor injuries and infections. But for a subset of people, food can be another offender — one that often goes overlooked.
Even if food isn’t a direct trigger, eating large meals or the stress around eating may also worsen symptoms, says Inderpal Randhawa, MD, a board-certified allergist and immunologist and the founder of the Food Allergy Institute in Long Beach, California.
While there’s no exact diet designed specifically for people with HAE, says Dr. Randhawa, there are ways to shore up your eating habits to help prevent an attack or feel a bit better in the midst of one.
It was once believed that eating certain foods could trigger an allergic reaction in people with HAE and cause angioedema symptoms to flare up. During an allergic reaction, the body releases antibodies that attack allergens. But newer research has found that people who experience an HAE attack after eating a trigger food often don’t test positive for these antibodies in follow-up blood tests. This has led researchers to conclude that a food intolerance — not an allergy — may be the link between diet and HAE.
This is an important distinction, because food allergies affect the immune system, whereas a food intolerance affects the digestive system.
A food intolerance can cause an increase in bloating, which may put stress on the intestines. This is also one possible reason people with HAE tend to have abdominal swelling after eating a trigger food. People with HAE who are lactose intolerant, for example, tend to report milk as a trigger for HAE.
There’s no known list of foods that have been proved to cause flare-ups of HAE. But some research has found that the following foods may be linked to an increase in symptoms:
Other research has found that acidic and spicy foods have been linked to an increase in HAE symptoms.
Still, what triggers an HAE attack for one person may not trigger an attack for someone else. So your best bet is use a journal or app to track how certain foods affect you, and adjust your diet accordingly.
Many foods that may cause HAE symptoms contain histamine, a chemical released by the body’s immune system that can cause inflammation.
It’s worth noting, though, that histamine intolerance is more of a theory than a verified fact. It isn’t officially recognized as a condition by the American Academy of Allergy, Asthma & Immunology. But it’s thought that some people’s bodies can’t digest histamine very well, causing an increase in symptoms such as nausea, swelling, and skin rashes.
For that reason, some people may find it helpful to eat foods that contain lower levels of histamine, even though there’s no direct evidence showing this will improve HAE symptoms. Foods that are low in histamine include:
Rather than overhauling your diet, though, you may simply want to stick to the basics: Avoid any known trigger foods and focus on eating nutritious foods. “Staying hydrated and eating balanced, simple meals may reduce attack risk or discomfort,” says Randhawa.
Symptoms of an HAE attack include abdominal pain, diarrhea, nausea, and vomiting — all of which can make it difficult to eat. If you’re experiencing abdominal swelling, “Stick to bland, easy-to-digest options like clear broths, plain rice, bananas, or electrolyte drinks,” says Randhawa. “Avoid greasy, spicy, or heavy foods until symptoms pass.”
No matter what food choices you make, be sure to eat a nutritious diet. When in doubt, aim for a heart-healthy eating plan. Some research has found an increased risk of heart disease in people who have HAE — including higher rates of high blood pressure (hypertension) — possibly linked to low-grade inflammation in the body.
A Mediterranean diet, for example, has been shown to be good for heart health. It also happens to include some low-histamine foods, such as almonds, olive oil, and salmon.
Need help bolstering your diet or have questions about which foods you should eat more of or avoid? Ask your doctor for help or a referral to a dietitian, who can help you develop a well-balanced meal plan that works for you.
Certain foods, especially ones that are acidic or spicy, may trigger a flare-up of hereditary angioedema (HAE) symptoms, although it’s not clear why.
Some research suggests a food intolerance may also trigger HAE symptoms, including abdominal swelling.
Consider tracking how certain foods affect you and taking steps to avoid potential food triggers. And follow a balanced eating plan, such as a Mediterranean diet, to help manage HAE.
