Does dietary elimination cause food hypersensitivity?

From the Guidelines

Eliminating foods does not cause food allergies, and current medical evidence suggests that early introduction of potentially allergenic foods to infants may actually help prevent food allergies in some cases. Food allergies develop when the immune system mistakenly identifies certain food proteins as harmful and produces an abnormal immune response. Avoiding specific foods doesn't create this immune sensitivity; rather, genetics, environmental factors, and early exposure to allergens play significant roles in allergy development.

Key Points to Consider

• The timing and manner of food introduction, particularly during early childhood, appears more important than elimination in the development of food allergies 1.
• For those with existing food allergies, strict avoidance of trigger foods is necessary to prevent reactions, but this management approach doesn't cause additional allergies to develop 1.
• Elimination diets can lead to nutritional deficiencies if not properly managed, highlighting the importance of consulting a dietitian when implementing such diets 1.
• The decision to eliminate foods should be based on a thorough diagnosis and under the guidance of a healthcare professional to avoid unnecessary dietary restrictions and potential nutritional deficits 1.

Recommendations for Practice

• Maintain a diverse diet unless a diagnosed allergy or intolerance exists.
• For infants, consider early introduction of potentially allergenic foods under the guidance of a healthcare professional.
• For existing food allergies, adhere to strict avoidance of trigger foods to prevent reactions.
• Consult a dietitian when implementing elimination diets to ensure nutritional adequacy and minimize the risk of deficiencies.

From the Research

Dietary Elimination and Food Hypersensitivity

• Dietary elimination is a common approach to managing food allergies, involving the removal of offending foods from the diet 2, 3
• This approach can lead to significant anxiety and costs for patients and caregivers, and may increase the risk of inadequate nutrient intake, particularly in children with multiple food allergies 2, 3
• However, there is no direct evidence to suggest that dietary elimination itself causes food hypersensitivity 2, 4, 3, 5, 6

Food Allergy Diagnosis and Treatment

• Diagnosis of food allergy typically involves a detailed medical history, serum immunoglobulin E testing, and skin prick testing 2
• Treatment options are currently limited to avoidance of the offending food and emergency treatment with epinephrine and antihistamines in the event of an allergic reaction 2, 4
• Oral immunotherapy (OIT) is an experimental treatment that involves gradually increasing consumption of the offending food to induce desensitization, but it carries significant risks and its long-term efficacy is not yet established 5, 6

Prevention and Management of Food Allergies

• Preventative strategies, such as early introduction of potentially allergenic foods to high-risk infants, may help reduce the risk of developing food allergies 4
• Multidisciplinary management of food allergies is crucial to ensure adequate nutrition and prevent potential deficiencies resulting from food allergen avoidance 3