Is it safe for a patient with oral allergy syndrome and multiple food allergies to incorporate foods that cause nausea into her diet while undergoing eating disorder treatment?

From the Guidelines

It is not safe for a patient with oral allergy syndrome and multiple food allergies to incorporate foods that cause nausea into their diet during eating disorder treatment without proper medical supervision and evaluation. The patient should work closely with both an allergist and eating disorder specialist to develop a safe, individualized meal plan. Foods that trigger allergic reactions, including those causing nausea, should be avoided until proper testing confirms which foods are truly allergenic versus which might be safe to gradually reintroduce 1. Oral allergy syndrome (also called pollen food allergy syndrome) typically causes immediate symptoms like itching, tingling, or swelling of the mouth when eating certain raw fruits, vegetables, or nuts that cross-react with pollen allergies. Forcing consumption of trigger foods could lead to potentially dangerous allergic reactions ranging from mild symptoms to severe anaphylaxis, which would undermine eating disorder recovery.

Key considerations in managing this patient's condition include:

• The use of oral food challenges, such as double-blind placebo-controlled food challenges (DBPCFCs), to diagnose food allergies and determine which foods are safe to consume 1.
• The importance of avoiding foods that have caused severe allergic reactions in the past, particularly if they have resulted in life-threatening reactions 1.
• The need for medical supervision during oral food challenges, as they can pose a risk of severe allergic reactions 1.
• The role of antihistamines and other medications in managing non-severe food-induced allergic reactions, but not as a substitute for allergen avoidance 1.

Instead, the treatment team should focus on finding nutritionally adequate alternatives that don't trigger allergic responses while addressing the psychological aspects of the eating disorder. Gradual exposure to feared foods should only occur after allergic triggers have been clearly distinguished from eating disorder-related food aversions through proper medical evaluation. This approach will help ensure the patient's safety and support their recovery from both the eating disorder and the management of their food allergies.

From the Research

Oral Allergy Syndrome and Food Allergies

• The patient has oral allergy syndrome and confirmed allergy to Birch pollen, with positive skin tests to various foods including corn, soybean, pea, almond, peanut, and hazelnut 2, 3.
• The patient reports reactions to foods that cross-react with Birch pollen, including apple, cherry, peach, pear, strawberry, carrot, nuts, tomato, berries, grapes, and pineapple, even when heated or cooked.

Incorporating Foods that Cause Nausea into the Diet

• There is no clear evidence to support the incorporation of foods that cause nausea into the diet of a patient with oral allergy syndrome and multiple food allergies, especially during eating disorder treatment 4, 5.
• Oral immunotherapy has shown promise in inducing tolerance to food allergens, but it is still an experimental method and should be conducted in a highly controlled setting 6.
• The safety and efficacy of incorporating foods that cause nausea into the diet have not been established, and further research is needed to determine the best approach for patients with oral allergy syndrome and multiple food allergies.

Considerations for Eating Disorder Treatment

• Patients with eating disorders require a comprehensive treatment plan that addresses their nutritional and psychological needs 3, 5.
• The incorporation of foods that cause nausea into the diet may exacerbate eating disorder symptoms and should be approached with caution.
• A multidisciplinary team of healthcare professionals, including an allergist, dietitian, and therapist, should be involved in the patient's care to ensure a safe and effective treatment plan.