Dietary Management

Dietary Approaches

Dietary management serves as the primary approach for managing non-IgE-mediated allergies. It has two main objectives: preventing allergic reactions and maintaining adequate nutrition. Achieving the former involves avoiding allergens, often through elimination diets, while the latter involves introducing substitute foods to fulfil nutritional needs. For instance, individuals allergic to milk can opt for fortified plant-based milk alternatives to maintain calcium and vitamin D levels. However, it is important to be cautious, especially with infants. Milk and soy have a high co-reactivity; therefore, the transition to soy formula as a plant-based option is not recommended, and both foods should be avoided. In infants with milk or soy Food Protein-Induced Enterocolitis Syndrome (FPIES), solid foods should be introduced starting from less allergenic options such as fruits and vegetables, gradually progressing to include all foods within the first year of life. High-risk foods such as grains, rice and fish associated with atypical FPIES should ideally be introduced one at a time, with at least a few days in between.

The success of an elimination diet depends on several factors, including food availability, family resources, cooking skills, diet duration and the number of allergens that have to be avoided. Understanding food labels, recognizing hidden allergens, and effectively communicating food allergies to others, such as school staff, restaurant personnel and friends all have an influence on the patient’s ability to avoid an allergen. Following a strict elimination diet can be difficult. It is important to note that patients typically do not need to avoid foods with precautionary allergen labeling unless there's a history of severe reactions to trace amounts. Additionally, some children allergic to milk and egg can tolerate these components if they have been previously subjected to high heat.