Intolerance

Related Terms

Allergies, diet, elimination diet, food allergy test, food hypersensitivity, hypoallergenic diet, low allergy, oral allergy syndrome, rotation diet, sensitivity, intolerance.

Background

A low allergen diet eliminates foods and food additives that may trigger an allergic reaction. By removing the triggers, symptoms associated with the food allergy may be relieved. A low allergen diet is typically used as a diagnostic tool, rather than a cure, in individuals with suspected food allergies.
Common symptoms of allergic reactions may include itchy, watery eyes; sneezing; headache; fatigue; postnasal drip; runny, stuffy, or itchy nose; sore throat; dark circles under the eyes; an itchy feeling in the mouth or throat; abdominal pain; diarrhea; and the appearance of an itchy, red skin rash. Life-threatening allergic reactions may include trouble breathing and difficulty swallowing.
It is important to note that food intolerance or sensitivity is not the same as a food allergy. Allergic reactions are responses triggered by the immune system to a particular food, inhalant (airborne substance), or chemical. The terms "allergies" and "sensitivities" are often used interchangeably even though many sensitivities are not true allergies. "Sensitivity" is a general term and may include true allergies, reactions that do not affect the immune system, and reactions where the cause has not been established yet.
Detecting allergies and other sensitivities and then eliminating or reducing exposure to the sources may be a time-consuming process and the support of an expert is often necessary. Other methods of identifying food reactions include the scratch test, AST/MAST/PRIST/ELISA (tests that measure immunoglobulins), cytotoxic testing, and clinical ecology (provocation-neutralization; end-point titration).
Available high-quality studies evaluating the allergen free diet as an effective diagnostic tool are lacking. There has been some study of the low allergen diet as a possible treatment for asthma, chronic fatigue syndrome, and environmental hypersensitivity. One human study found that adopting a low allergen diet might be helpful in lactating mothers of colicky infants. More high-quality trials are necessary before any firm recommendations can be made.

Theory / Evidence

A low allergen diet is usually suggested for individuals with symptoms of food allergies. This diet is used primarily as a diagnostic tool; it does not cure food allergies; rather it may reduce symptoms due to elimination of allergen triggers. Avoiding these foods for a period of time (usually months or years) may result in the foods no longer causing the allergic reactions.
There are two types of allergic reactions to food, cyclic and fixed. The most common allergy is cyclic, meaning that the allergy generally goes away after long-term avoidance of the offending food. Fixed allergies are those that cause an allergic reaction regardless of the time period the food has been avoided.
Based on a double-blind, randomized, placebo controlled study of colicky infants for 1-week, Hill et al (1996) suggested that a period of dietary modification with a low allergen diet and appropriate nutritional support may help healthy infants with colic. In this study, all mothers of breast-fed infants were started on an artificial color-free, preservative-free, additive-free diet and also randomized to an active low allergen diet (milk-, egg-, wheat-, nut-free) or a control diet. Infants of mothers on the low allergen diet had a significantly higher rate of improvement than those on the control diet.
Other studies have investigated the low allergen diet as a possible treatment for asthma, chronic fatigue syndrome, and environmental hypersensitivity. More high-quality trials are necessary before any firm recommendations can be made.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Hill DJ, Hudson IL, Sheffield LJ, et al. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol. 1995 Dec;96(6 Pt 1):886-92.
Hill DJ, Hosking CS. The cow milk allergy complex: overlapping disease profiles in infancy. Eur J Clin Nutr. 1995 Sep;49 Suppl 1:S1-12. Review.
Michelet L, Loof-Pougnault. [The low-allergen diet in the treatment of asthma] Clinique (Paris). 1965 Sep;60(610):521-3.
Morris DH, Stare FJ. Unproven diet therapies in the treatment of the chronic fatigue syndrome. Arch Fam Med. 1993 Feb;2(2):181-6.
Krop JJ. Treatment and prophylaxis for patients suffering from environmental hypersensitivity disorder. Folia Med Cracov. 1993;34(1-4):159-72.

Diet outline

This diet eliminates foods and food additives considered to be common allergens and usually continues until a reaction to allergenic food or foods has been detected or eliminated. However, the length of time a low allergen diet is used varies from person to person, and may last from 5 days to 3 weeks. Many experts believe that a 2-week trial is normally sufficient enough for the purpose of diagnosing food reactions. Once the food reactions have been identified, only those foods that are causing a reaction are avoided. All the other foods that had previously been eaten are added to the diet again.
Once identified, food allergies are often treated by avoiding the food responsible for a set period of time, followed by a "rotation" diet, in which problem foods are only eaten every 3 to 4 days, instead of on a daily basis. In theory, a child who is allergic to a particular food or class of foods may not show a reaction if those foods are spaced out over a 3-day period.
Most common allergens/sensitivities: Corn, eggs, milk (dairy), soy, wheat, yeast.
Frequent allergens: Alcohol, apple, bacon, bean (dried), beef, berry, buckwheat, carrot, cheese, chocolate, cinnamon, coconut, coffee, fish, grape, mustard, nuts, onion, orange (citrus), peanut, pea, pork, potato, raisin, rye, shrimp, tomato.
Occasional allergens: Alfalfa, amaranth, banana, barley (malt), celery, cherry, chicken, chile, clove, cottonseed, garlic, lettuce, lobster, melon, mushroom, oat, oyster, pear, pepper, pineapple, plum/prune, quinoa, rice, sesame seed, spices, spinach, strawberry, sunflower, turkey, vinegar.
Rare allergens: Apricot, beet, cranberry, honey, lamb, peach, rabbit, salmon, salt, squash, sweet potato, tapioca, taro root, tea, vanilla.