About Food Allergy:
Food allergies have become extremely common nowadays. You are bound to know someone or yourself suffer from some or the other type of food intolerance or allergy. People with food allergy have an immune response to certain proteins found in some foods. The immune system starts attacking these substances as if they are foreign invaders like bacteria or viruses. According to estimates by the National Institute of Allergy and Infectious Diseases, around five percent of children and four percent of adults in the United States suffer from a food allergy of some sort. This is a whopping 20 percent increase in childhood food allergies over the last 20 years. Furthermore, it is believed that over 250 million to 550 million people worldwide have food allergies.1,2
According to the US Centers for Disease Control and Prevention, four to six percent of children and five percent of adults have food allergies. Nearly 20 percent of people worldwide are likely to be suffering from food intolerance, with many being unaware of this.3,4
Of course, the best way of avoiding the symptoms or flare-up of your food allergy is to avoid the allergens themselves. However, in order to have well-rounded and balanced nutrition, it is essential that you follow a healthy diet full of fruits and vegetables that can help with such food allergies. One of the first things to do when you have food allergies is to follow the elimination diet.
What is the Elimination Diet and How Can It Help In Food Allergies?
When we discuss about food allergy diets, the gold standard for identifying food sensitivities, allergies, and intolerances through diet is the elimination diet. Elimination diet work by removing certain foods that are known for causing allergic symptoms and then reintroducing the same foods at a later point in time while simultaneously looking out for signs of an allergic reaction.
Registered dietitians and allergists have been using and recommending the elimination diet for decades now to help people with food allergies and intolerances pinpoint the foods that are the culprits and not tolerated well by them.5,6
To follow the elimination diet, you will first remove certain foods from your diet that you believe your body is not tolerating well. These foods will later be reintroduced, one by one, while looking for any signs and symptoms of an allergic reaction.
The elimination diet lasts for only five to six weeks and is especially helpful for people who have a sensitive gut, food allergy, or food intolerance, identify the foods that are causing the reaction or symptoms.7,8
In this manner, an elimination diet for food allergy can help provide relief from gas, bloating, constipation, diarrhea, nausea, and any other symptom you experience as a result of a flare-up of your food allergy or intolerance.
There are many types of elimination diets, all of which involve removing or including specific kinds of foods. However, if you suspect or know that you have a food allergy, you should only follow an elimination diet under the supervision of your doctor or a registered dietitian/nutritionist. This is because reintroducing a potential food allergen can lead to a dangerous condition known as anaphylaxis, which may prove to be fatal if medical help is not given immediately.9,10,11,12
This is why it is crucial that if you suspect you might be allergic to certain foods, you must check with your doctor before you start the elimination diet.
Some of the common symptoms of a food allergy include:13
- Difficulty breathing
- Stomach cramps
- Persistent cough
- Hoarse or tight feeling in the throat
- Trouble swallowing
- Swelling of the tongue, to the extent that it affects the ability to breathe or talk
- Feeling faint
- Weak pulse
- Pale or blue coloring of the skin
- Shock or circulatory collapse
Anaphylaxis – a potentially life-threatening allergic reaction that may impair your breathing and may send the body into shock. Anaphylaxis reactions may also affect different parts of the body at the same time, for example, you may experience a stomachache and a rash together.14
How Does The Food Allergy Elimination Diet Work?
An elimination diet for food allergies is divided into two parts. First is the elimination part, and the second is the reintroduction phase.
The Elimination Phase
During the elimination phase, you will slowly remove any foods you suspect could be triggers for your symptoms. This is only done for a short period of time, usually around two to three weeks.
While any food can cause a potential adverse reaction, there are eight types of food that account for almost 90 percent of all food-related allergic reactions.14 These include:
- Tree nuts
Certain types of seeds, such as mustard and sesame seeds, are also known to be common food allergy triggers and, in some countries, are considered to be a major allergen.
During the elimination phase of the food allergy diet, you will stop having foods that you think your body does not tolerate well. At the same time, you will also eliminate foods that are typically associated with causing allergic symptoms, such as nuts, soy, corn, citrus fruits, wheat, nightshade vegetables, and foods containing gluten, eggs, seafood, and pork.15
The elimination phase will help you determine if the uncomfortable symptoms you were experiencing were due to the foods you eliminated or due to something else. If you find your symptoms still persist after stopping the specific foods for two to three weeks, you should inform your doctor about the same.
The Reintroduction Phase
The second phase of the elimination diet is the reintroduction phase, during which you slowly reintroduce or bring back the eliminated foods into your diet.
As you reintroduce each food group, you have to introduce them individually over two to three days and not altogether on the same day itself. After introducing each food group, you need to look out for any signs and symptoms of a reaction. Some of the symptoms you should look out for include:
- Skin changes and appearance of rashes
- Joint pain
- Changes in breathing
- Difficulty sleeping
- Migraines or headaches
- Changes in bowel habits
- Abdominal cramps or pain
- Nausea and/or vomiting
If you do not experience any symptoms during the immediate time period after reintroducing a particular food group, you can assume that the food item is safe to eat and move on to reintroducing the next food group. However, if you experience any adverse reaction or symptoms like those discussed above, this means you have successfully identified your trigger food group and should now remove it from your diet.
The entire process, including elimination and reintroduction, should take around five to six weeks. However, if you feel you might be allergic to more than one food group or have identified several food groups, then you must seek advice from your dietitian or doctor before eliminating those food groups. This is because eliminating too many food groups will also mean you are removing those nutrients from your diet, thus and may eventually lead to a nutritional deficiency.16,17
Can You Eat Anything You Want On An Elimination Diet?
It’s not possible to eat anything you want while following an elimination diet. The best elimination diets are those that have the most restrictions. This is because the more foods you remove during the first phase of the diet, the more likely it will be that you will find out which foods trigger an allergic reaction or cause any type of adverse symptoms.
Foods that are typically removed during the elimination phase of the diet are as follows:18
- Nuts and Seeds: You will need to cut out all nuts and seeds.19
- Starchy Foods: You need to restrict the intake of wheat, barley, corn, oats, rye, spelt, and bread. You will also need to avoid any foods that contain gluten.
- Citrus Fruits: Citrus fruits such as grapefruits, lemons, and oranges will have to be avoided.
- Legumes: You will need to eliminate all legumes, including lentils, peas, beans, and any soy-based products.
- Nightshade Vegetables: Nightshade vegetables such as tomatoes, eggplant, white potatoes, paprika, cayenne pepper, and peppers should be avoided.20
- Meat and Fish: Eliminate processed meats, chicken, cold cuts, beef, pork, shellfish, and eggs.
- Fats: Eliminate margarine, butter, mayonnaise, spreads, and hydrogenated oils.
- Spices and Condiments: Avoid having all types of sauces, mustard, and relish.
- Dairy Products: You will have to eliminate all dairy products, such as milk, yogurt, cheese, and even ice cream.21,22
- Sweets and Sugar: Eliminate both white and brown sugar, maple syrup, honey, corn syrup, and high-fructose corn syrup, agave nectar, chocolate, desserts, cookies, and cake.
- Beverages: Eliminate alcohol, black tea, coffee, soda, any type of carbonated drinks, and any other caffeinated drinks.
If you feel that there are some other foods that are not on this list, but they make you uncomfortable and cause some types of symptoms, you should go ahead and remove them as well.
So if you have to eliminate so many food groups, what is it that you can eat on an elimination diet? Let’s take a look.
What is Included in an Elimination Diet?
Even though a food allergy elimination diet is very restricting, there is still plenty of variety you can choose from to make your meal healthy and delicious.
Some of the foods you can eat while on an elimination diet include:
- Vegetables: All vegetables except nightshades can be included.
- Fruits: Apart from citrus fruits, you can go ahead and have all other fruits.
- Meat and fish: You can include lamb, turkey, wild game, cold-water fish like salmon, and other fatty fish like sardines, trout, tuna, etc.
- Grains: Buckwheat and rice can be had.
- Fats: You can include coconut oil, flaxseed oil, and cold-pressed olive oil.
- Dairy substitutes: You can have unsweetened rice milk and coconut milk. Other dairy products must be avoided.
- Spices, condiments, and other items: You can have fresh herbs, black pepper, apple cider vinegar, and all spices except paprika and cayenne pepper.
- Beverages: You can have water and herbal teas. However, avoid adding lemon or other citrus fruits to flavor your water. Also, avoid sparkling or carbonated water.
Being such a restrictive diet, it becomes difficult to follow an elimination diet for five to six weeks. This is why to remain motivated during this duration, you should try coming up with new recipes and experimenting with different spices and herbs to add a dash of flavor to your dishes.
Other Types of Food Allergy Diets
Apart from the conventional elimination diet, we have just discussed, there are many other types of food allergy diets that also work on the concept of eliminating certain foods from your daily diet.
Here are some other types of food allergy diets:
FODMAP stands for fermentable oligo-, di-, monosaccharides, and polyols.23 These are all scientific terms used for the classification of groups of carbohydrates that are known for triggering various gastrointestinal symptoms like gas, bloating, and abdominal pain or cramps. FODMAPs can be found in a wide variety of foods in different amounts. While some foods contain only one type of FODMAP, others can have several. Here are the major dietary sources of the four groups of FODMAPs:
- Oligosaccharides: This group of carbohydrates includes rye, wheat, legumes, and certain fruits and vegetables such as onions and garlic.
- Disaccharides: This group includes milk, soft cheese, and yogurt. Lactose is the primary carbohydrate in this group of foods.
- Monosaccharides: The primary carbohydrate in this group is fructose. Various fruits such as mangoes and figs fall in this category. Sweeteners like agave nectar and honey are also part of this group.
- Polyols: Certain vegetables and fruits like lychee and blackberries are part of this group, along with low-calorie sweeteners.
Many people are no able to digest FODMAPs, due to which they experience digestive issues. Studies had found that symptoms like stomach pain and bloating significantly decreased when people switched to a low-FODMAP diet.24,25 Many other studies have also found that a low-FODMAP diet can further help manage diarrhea, constipation, and flatulence.26
Fasting Elimination Diet
The fasting elimination diet requires you to follow a strict schedule of drinking water for up to five days and then reintroducing the food groups. This type of diet, though, is only carried out with the permission of your doctor as it can prove to be dangerous to your health.
Few Foods Elimination Diet
This type of food allergy diet involves eating a combination of certain foods that you won’t eat regularly. For example, having the lamb and pears diet, which is quite popular in the US. This is an uncommon combination because you won’t usually be combining lamb with pears.
There is also the sugar-free diet, lactose-free diet, gluten-free diet, and the wheat-free diet that are all used to identify food allergies and intolerances.
There are many types of food allergy diets, but the best diet helps you identify your food trigger is the elimination diet. The elimination diet enables you to understand which food group your body does not tolerate well, and thus you can remove it from your daily diet. However, elimination diets should not be done without consulting a dietitian or your doctor. Children, especially, should never try the elimination diet unless prescribed by their doctor. Also, remember that elimination diets should only be carried out for a short time as in the long run, it may lead to nutritional deficiencies.
- Niaid.nih.gov. 2020. The Page You’Re Looking For Isn’T Available | NIH: National Institute Of Allergy And Infectious Diseases. [online] Available at: <http://www.niaid.nih.gov/topics/foodallergy/Pages/default.aspx> [Accessed 14 October 2020].
- Branum, A.M. and Lukacs, S.L., 2008. Food allergy among US children: trends in prevalence and hospitalizations.
- Nelson, M. and Ogden, J., 2008. An exploration of food intolerance in the primary care setting: The general practitioner’s experience. Social Science & Medicine, 67(6), pp.1038-1045.
- Gupta, R.S., Warren, C.M., Smith, B.M., Jiang, J., Blumenstock, J.A., Davis, M.M., Schleimer, R.P. and Nadeau, K.C., 2019. Prevalence and severity of food allergies among US adults. JAMA network open, 2(1), pp.e185630-e185630.
- Pastorello, E.A., Stocchi, L., Pravettoni, V., Bigi, A., Schilke, M.L., Incorvaia, C. and Zanussi, C., 1989. Role of the elimination diet in adults with food allergy. Journal of allergy and clinical immunology, 84(4), pp.475-483.
- Grimshaw, K.E., Maskell, J., Oliver, E.M., Morris, R.C., Foote, K.D., Mills, E.C., Margetts, B.M. and Roberts, G., 2014. Diet and food allergy development during infancy: birth cohort study findings using prospective food diary data. Journal of Allergy and Clinical Immunology, 133(2), pp.511-519.
- Nature.com. 2020. Official Journal Of The American College Of Gastroenterology | ACG. [online] Available at: <http://www.nature.com/ajg/journal/v108/n5/full/ajg201377a.html> [Accessed 14 October 2020].
- Meyer, R., Godwin, H., Dziubak, R., Panepinto, J.A., Foong, R.X.M., Bryon, M., Lozinsky, A.C., Reeve, K. and Shah, N., 2017. The impact on quality of life on families of children on an elimination diet for Non-immunoglobulin E mediated gastrointestinal food allergies. World Allergy Organization Journal, 10(1), p.8.
- Waserman, S. and Watson, W., 2011. Food allergy. Allergy, Asthma & Clinical Immunology, 7(S1), p.S7.
- David, T.J., 1984. Anaphylactic shock during elimination diets for severe atopic eczema. Archives of Disease in childhood, 59(10), pp.983-986.
- Keet, C.A. and Wood, R.A., 2007. Food allergy and anaphylaxis. Immunology and allergy clinics of North America, 27(2), pp.193-212.
- Bock, S.A., Muñoz-Furlong, A. and Sampson, H.A., 2001. Fatalities due to anaphylactic reactions to foods. Journal of Allergy and Clinical Immunology, 107(1), pp.191-193.
- Sicherer, S.H. and Sampson, H.A., 2014. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. Journal of Allergy and Clinical Immunology, 133(2), pp.291-307.
- Muraro, A., Werfel, T., Hoffmann‐Sommergruber, K., Roberts, G., Beyer, K., Bindslev‐Jensen, C., Cardona, V., Dubois, A., Dutoit, G., Eigenmann, P. and Fernandez Rivas, M., 2014. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy, 69(8), pp.1008-1025.
- Cdc.gov. 2020. Food Allergies | Healthy Schools | CDC. [online] Available at: <http://www.cdc.gov/healthyyouth/foodallergies/> [Accessed 14 October 2020].
- 2020. [online] Available at: <https://www.foodallergy.org/file/facts-stats.pdf> [Accessed 14 October 2020].
- Noimark, L. and Cox, H.E., 2008. Nutritional problems related to food allergy in childhood. Pediatric Allergy and immunology, 19(2), pp.188-195. Mehta, H., Groetch, M. and Wang, J., 2013. Growth and nutritional concerns in children with food allergy. Current opinion in allergy and clinical immunology, 13(3), p.275.
- Denton, C., 2012. The elimination/challenge diet. Minnesota medicine, 95(12), p.43.
- Comstock, S.S., DeMera, R., Vega, L.C., Boren, E.J., Deane, S., Haapanen, L.A. and Teuber, S.S., 2008. Allergic reactions to peanuts, tree nuts, and seeds aboard commercial airliners. Annals of Allergy, Asthma & Immunology, 101(1), pp.51-56.
- Race, S., 2012. Change your diet and change your life: food intolerance and food allergy handbook. Sharla Race.
- Fleet, G.H., 1990. Yeasts in dairy products. Journal of applied bacteriology, 68(3), pp.199-211.
- Bordoni, A., Danesi, F., Dardevet, D., Dupont, D., Fernandez, A.S., Gille, D., Nunes dos Santos, C., Pinto, P., Re, R., Rémond, D. and Shahar, D.R., 2017. Dairy products and inflammation: A review of the clinical evidence. Critical reviews in food science and nutrition, 57(12), pp.2497-2525.
- Gibson, P.R. and Shepherd, S.J., 2005. Personal view: food for thought–western lifestyle and susceptibility to Crohn’s disease. The FODMAP hypothesis. Alimentary pharmacology & therapeutics, 21(12), pp.1399-1409.
- Marsh, A., Eslick, E.M. and Eslick, G.D., 2016. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. European journal of nutrition, 55(3), pp.897-906.
- Staudacher, H.M., Lomer, M.C., Anderson, J.L., Barrett, J.S., Muir, J.G., Irving, P.M. and Whelan, K., 2012. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. The Journal of nutrition, 142(8), pp.1510-1518.
- Böhn, L., Störsrud, S., Liljebo, T., Collin, L., Lindfors, P., Törnblom, H. and Simrén, M., 2015. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology, 149(6), pp.1399-1407.