Avoiding risk of elimination diet - AAAAI

The symptoms of food allergy may be delayed or chronic so it will be hard to diagnose non IgE mediated or even mixed IgE and non IgE mediated food allergy

Skin Prick test and specific IgE are not useful in diagnosing non IgE mediated food allergy

short term elimination are effective in diagnosing if symptoms relieved

after that food challenge can be used

some times clinical Hx and elimination of diet only are effective in diagnosis especially in cases of FPIEC as food challenge may be difficult

Should cross reacted food also avoided?

it depends:

if milk ... mostly other mammalian milk cause the same allergy

most patients with egg or milk allergy tolerate them in baked form .... so food challenge can determine that.

foe wheat allergy :

other gluten containing cereals may or may not cause allergy so individual assessment is essential

Soy.. products containing soy sometimes do not cause allergy like refined soy oil and soy lecithen

allergy from peanuts may need to avoid also tree nuts because of cross reactivity and cross contamination but also individual assessment is better than blanket avoidance, unneceesary avoidance may lead to food allergy later on.

the patient should be reevaluated, the symptoms may disappear and the food may be reintroduced again, milk and eggs allergy resolves in late childhood, peanut and tree nuts mostly persistent but also should be periodically evaluated.

Food allergy is more common in children than adults, milk,eggs, soy, wheat, peanut

all contain essential nutrients may trigger nutritional risk for children

children on restricted diet, have lower growth, micro and macronutrients than normal children. especially those who have allergy to more than one type of food.

How can health professionals minimize exclusion of multiple foods?

taked a detailed clinical HX

avoid testing for tolerated foods

remove only food which are for sure allergic

elimination of more than one type of food in children affect growth

a large number of food allergies due to deficient nutrient intake

advantages of elimination diet:

improve nutritional statues dt absence of GI symptoms

disadvantages of elimination diet:\

nutritional def

behavioral and psycological problems such as refusal of food, picky eating

Cow's milk:

source of Ca and Vit D, also protein and fat in children.

supplemental substitute formal is recommended over the cow's milk substitue in children leass than 2 years

when adequate volumes are not taken euther from the formula or the milk substitute, may lead to def. Ca, vit D. selenium etc

Wheatsources of Energy, riboflavin , thiamin and niacin

also whole wheat is source of fiber so aonstipation may occur

although micronutrients are important, the most common complications are protein and energy malnutrtion

use rice or almond milk without sufficient amount may cause hypoalbuminemia

adults with food allergy may not hve nutritional def like children but should be screened and supplemented with vit D , B vitamins , calcium and omega 3 fatty acids

to follow up with lab tests and see if there are any nutritional def from elimination diet: 

CBC

Comprehensive metabolic panel ( Albumin, total ptn, electrolyts, blood urea nitrogen and creatinine)

Vit D serum (25 hydroxy Vit D) 

serum ferritin, iron and total iron binding capacity 

the dose of vit and mineral supplement depends on whethrt it is prescribed to mmet needs or to correct def

make sure that they are from from allergens

To calculate DRI of any nutrients for any person:

https://fnic.nal.usda.gov/fnic/dri-calculator/