Dietary Changes Could Unintentionally Cause New Allergic Reactions

Dietary Changes Could Unintentionally Cause New Allergic Reactions

In recent years, elimination diets have gained popularity as a means of identifying food allergies and managing sensitivities. However, new research suggests that these diets may inadvertently increase the risk of developing food allergies, particularly for individuals with pre-existing conditions such as eczema or a history of food allergies.

One of the key concerns with elimination diets is their potential impact on oral tolerance, a process that suppresses immune responses to ingested food proteins, thereby preventing harmful reactions like food allergies. By removing certain foods from the diet, elimination diets can disrupt oral tolerance and instead promote sensitization through skin exposure or other routes. This risk is particularly pronounced in those with eczema, as their impaired skin barrier can allow allergen sensitization through the skin rather than oral tolerance through ingestion.

Children with moderate to severe eczema are more likely to develop food allergies. However, current expert advice discourages empiric elimination diets since most eczema is not directly caused by foods. Instead, early introduction of allergenic foods is now recommended to help build oral tolerance and protect against food allergies.

Strict elimination diets without careful reintroduction protocols carry the risk of missing or delaying the introduction of allergenic foods, which may raise allergy risk rather than reduce it. Rotation diets and carefully monitored reintroduction protocols may help manage sensitivities with less risk, but they require professional guidance.

In some cases, completely cutting out a food isn't necessary. Keeping small, tolerable amounts in the diet may help maintain oral tolerance while still easing discomfort. Regular, ongoing exposure to foods is also crucial for maintaining oral tolerance throughout life.

Research on children with eczema on elimination diets found a significant increase in the risk of allergic reactions upon reintroduction of eliminated foods. In one study, 19% developed new immediate allergic reactions, and 30% experienced severe reactions classified as anaphylaxis. Similarly, a separate study found that 70% of adults who developed allergies to foods they had previously tolerated had been on elimination diets beforehand, with half experiencing anaphylaxis and the vast majority having pre-existing allergic conditions.

For individuals at higher risk, consulting with a healthcare professional before starting an elimination diet is strongly advised. This is particularly important for children and those with pre-existing allergy conditions. Expert medical supervision is also essential for children following elimination diets to ensure nutritional adequacy and healthy growth.

In summary, while elimination diets can be useful for identifying specific allergens, unsupervised or prolonged elimination can increase the risk of developing new food allergies by interfering with the natural development of oral tolerance, especially if allergenic foods are delayed or avoided early. Expert consultation is strongly advised before undertaking such diets.

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