Sensitivity to Histamine and Other Vasoactive Amines
Vasoactive amines (also known as biogenic amines) are chemicals that naturally occur in certain types of food and drink and include histamine, tyramine and phenylethylamine.
Although high levels of vasoactive amines can make anyone feel unwell, most people can tolerate the amount found in a normal diet. Some people, however, will experience a reaction to ‘normal levels’, which may be due to a reduced ability to break them down in their digestive system. It is believed that this is the result of a lack of the enzyme diamine oxidase. After consuming food or drink containing high quantities of vasoactive amines, individuals may suffer ‘allergy-like’ symptoms such as headaches, rashes, flushing, itching, swelling, runny or blocked nose, irregular heartbeat, diarrhoea, nausea, vomiting or abdominal pain. Symptoms may occur 30 minutes or longer after consumption and level of tolerance will vary from person to person. There are no reliable tests to diagnose vasoactive amine sensitivity, but true food allergies should be ruled out by an experienced clinician before experimenting with your diet.
Once food allergy or other causes have been ruled out, the best way to establish if vasoactive amines are causing symptoms is to try avoiding them for 2-4 weeks. Symptoms need to be monitored by keeping a food and symptom diary; then by reintroducing foods gradually, you can see how much can be tolerated and how often. It is best to embark on this plan with the support of an experienced Dietitian, particularly if other foods are being avoided, to ensure the diet remains well balanced.
Foods and drinks that are particularly high in vasoactive amines include:
- Champagne, wine, beer, cider
- Coffee, cocoa, chocolate
- Fermented soya products including miso and tempeh
- Blue cheeses, parmesan cheese, camembert, emmental, old gouda, cheddar and other hard cheeses, fresh and hard sheep and goat cheeses
- Cured meat especially pork products e.g. sausages and other processed meats (ham, salami, pepperoni, bacon)
- Fresh or canned tuna, sardines, mackerel, salmon, herring, processed fish products e.g fish pastes, smoked or dried pickled fish
- Tomatoes, pickled cabbage (sauerkraut), broad beans, aubergine, spinach
- Peanuts, tree nuts
- Oranges, tangerines, bananas, pineapple, grapes, strawberries
Taking an antihistamine may help to relieve any symptoms so it is a good idea to carry them with you. Also ensure that any asthma is well controlled.