Elimination Diet
Description
An allergy-free diet has two components: the identification of specific food allergens in the diet, and thereafter the allergen-free maintenance of the individual on a day-to-day basis.
To identify the allergy-inducing foods, an elimination, or avoidance, diet is begun. Once the offending foods are identified, the maintenance diet can be designed.
What is an elimination diet?
The elimination diet is an important diagnostic tool for food allergies. To begin the elimination diet, omit the following common allergens from the diet for a period of two weeks: milk, eggs, wheat, sugar (both sugarcane and beet sugar), corn, citrus, chocolate, coffee, additives, preservatives and food colorings.
If symptoms decrease or disappear with the omission of all these items, foods can be added back at the rate of a food item a day until the causes and symptoms of the food allergies are identified. If symptoms persist even after several weeks of eating only the foods allowed on the elimination diet, then each "allowed" food needs to tested individually for its allergenicity.
Beginning the elimination diet
Here are some guidelines to help you begin the elimination diet:
1. Before starting this diet, get a physician's approval. It is also good to inquire about guidelines for taking medications, as antihistamines may sometimes mask allergic reactions.
2. Create a food diary. Use the diary for writing down everything eaten throughout the day. Also, use the diary for recording the appearance of symptoms and the time(s) when they occur. The food diary is a crucial part of the elimination diet.
3. Page through the hypoallergenic recipes in this program and use a few to create menus that are appetizing. Sample menus are included in this elimination diet. Remember: food preparation time is minimized, and patient compliance increased, if the entire family participates in this diet.
4. After menus are developed, create a detailed grocery list. When first shopping for allergy-free foods, allow extra time for reading labels and finding substitute ingredients at the supermarket.
5. A health-food store owner may know of acceptable food sources or might be able to special-order certain foods.
6. The diet should be followed for at least two to three weeks in order to become symptom-free. This is because allergens of previously eaten foods may remain in the body for one or more weeks.
7. It is extremely important to remember ingesting a slight amount of the allergenic food can produce symptoms, so do not deviate from the diet thinking "it won't hurt to have just a taste". If the allergenic food is accidentally ingested, continue with the diet. However, stay on the diet for two to three weeks more from the date of the ingestion of the suspected allergen. Don't become discouraged since this happens to almost everyone!
8. Don't forget that simply inhaling the odors of some foods can cause allergic symptoms in very sensitive patients.
Testing foods for allergenicity
Once allergy symptoms disappear, add foods back to the diet one at a time to see which ones produce reactions.
To test a food, for instance corn, eliminate corn in all forms for three weeks. Then eat increasing amounts of pure corn, such as corn on the cob or corn flakes, for three consecutive days. On the first day, eat a small amount (such as 1 serving of corn flakes) and eat a larger portion on the following days. If allergic symptoms develop, stop eating the corn immediately.
If allergic symptoms do not develop, one can probably assume corn is acceptable. Thus, continue to eat corn while the next suspected allergen is tested in the same manner. Wait 3 days before introducing a new food since a delayed reaction to corn may occur. Continue recording the foods ingested and any symptoms which may occur.
When an allergy-provoking food is identified, check the biological classification of that food. Sensitivity to one item in a food class indicates the possibility of a cross-reaction with another items listed under the same category. For example, if one is allergic to wheat, one may also be allergic to other members of the grain family, such as corn, rye, barley, etc. Test each related foods separately.
A proven food allergen may be reintroduced into the diet after several months. If symptoms reappear, avoid the food for several more months. If no symptoms recur, add the food back into your diet, eating it only once every few days or weeks to avoid redevelopment of the allergy.
Sample Menu
MENU SUGGESTIONS FOR AN ELIMINATION DIET
Please customize these menus according to the individual's particular food allergies or dietary requirements. Most of the recipes can be found under Allergy-free Recipes' Menu.
| -- Breakfast -- | -- Meal planning tips -- |
| Fresh Cantaloupe | Make up plenty of granola |
| Apple Cinnamon Crunchy Granola | and freeze extra. |
| Nut Milk | |
| Sliced Fresh Peaches | Squeeze pineapple juice |
| Blueberry Muffin with | onto the peaches to keep |
| Peanut Butter Spread | them from turning brown. |
| Pancakes | Instead of a pancake, pour |
| Pure maple syrup | batter (with 1 extra tbls. |
| Turkey Burgers | baking powder added) into |
| greased pan, and sprinkle | |
| with fruit. Bake in 350 | |
| degree oven for 40 min. | |
| Oatmeal Sprinkled with Maple Sugar | |
| Cantaloupe and Watermelon Balls | |
| Strawberries and Orange Sections | Make your own sausage by |
| Bean Soup | using plain ground pork and |
| Pure Pork Sausages | seasonings such as salt, sage, |
| Biscuits | black pepper - ground. |
| Fresh Apricot Juice | Use pure maple syrup or |
| or Apricot-Apple Shake | homemade blueberry syrup. |
| Waffles with Maple Butter Spread | |
| or Blueberry Syrup | |
| Pure Apple Juice | Sprinkle bananas with lemon |
| Sliced Bananas | juice. Add seeds or coconut. |
| Potato Pancakes | Grate potatoes the night |
| Pork sausage | before and store in container |
| filled with water. This | |
| prevents the potatoes from | |
| turning brown. | |
| -- Lunch -- | -- Meal planning tips -- |
| Homemade Bread with | Cook fresh turkey; do not |
| Sliced Turkey and | use packaged lunch meat. |
| Homemade Mayonnaise | Make bread and slice. Put |
| Apple Juice | wax paper in between slices, |
| Pecan Balls | wrap and freeze. |
| Chef Salad w/Sliced Chicken, | If packing a lunch, store |
| Tomato, Carrot & Sunflower Seeds | dressing in a small container. |
| Oatmeal Bread | Pour over salad just before |
| French Dressing | serving. |
| Banana Ade | |
| Avocado Stuffed with | Buy potato chips processed |
| Tuna & homemade Mayonnaise | with safflower oil. |
| Toasted Rice Cakes | Make your own homemade |
| or Potato Chips | applesauce in a few minutes. |
| Applesauce | |
| Sparkling Mineral Water | |
| Rice Minestrone Soup | The minestrone soup tastes |
| Carrot and Celery Sticks | better after a day or so. |
| Waldorf Salad | |
| Oatmeal Crackers | |
| Fruit Slush or Rice Nectar | |
| Chicken Salad on Bed of Lettuce | |
| Radishes & Olives | |
| Pineapple and Banana Salad | |
| Rye Krisp | |
| Sliced Pineapple and Orange Sections | |
| Tuna Salad on Avocado Half | |
| Fresh Cantaloupe Shake | |
| Split Pea Soup | Make soup in a crockpot the |
| Sliced Chicken Breast | night before. |
| Apple Nut Salad | |
| Muffins | |
| -- Dinner -- | -- Meal planning tips -- |
| Crispy Oven Fried Chicken | |
| Potato Salad | |
| Gelatin | |
| Almond Cookies | |
| Fruit Punch | |
| Sloppy Joes | Mix all the dry ingredients |
| Baking Powder Biscuits | together for the biscuits and |
| Asparagus | cut in vegetable shortening. |
| Baked Pears | Store in refrigerator until |
| ready to bake, then add liquid. | |
| Pineapple Pork Chops | Peel enough carrots for another |
| Baked Sweet Potatoes | meal. Make carrot-raisin salad |
| String Beans | first and steam carrots later. |
| Celery and Carrot Sticks | |
| Chicken Supreme | Wrap extra cooked Chicken |
| Green Beans with Almonds | Supreme with sauce in individual |
| Banana Cake | portions and freeze or make up |
| "TV" dinners. All these foods | |
| freeze well. | |
| Bean Soup | Make up your own dressing |
| Fried Onion Rings | of oil and vinegar; add |
| Fried Fish with Tartar Sauce | your favorite seasonings. |
| Hash Brown Potatoes | |
| Toss Salad with Oil and Vinegar | |
| French Onion Soup | Freeze extra soup in ice cube tray |
| Baked Sweet Potatoes Casserole | & store in plastic bag. Take out |
| Roast Cornish Hen with Stuffing | several cubes & heat for a cup. |
| Quick Savory Meat Loaf | |
| Mashed Potatoes | |
| Steamed Carrots | |
| Watermelon Sherbet | |
| Baked Pears | |
| Roast Wild Duck | |
| Brown Rice | |
| Fried Zucchini | |
| Grapefruit, Avocado, Persimmon Salad | |
| Tomato Soup | Press wheat-free dough |
| Broiled Burgers w/Homemade Catsup | into pie pan instead of |
| Stuffed Mushrooms | rolling dough. |
| Mashed Potatoes | |
| Key Lime Pie | |
| Vegetable Juice | |
| Roast Beef w/Potatoes, Carrots, Onions | |
| Rice Pudding | |
| Watercress Salad w/Pineapple Honey Dressing | |
| Vegetable Beef Soup | |
| Roast Loin of Pork | |
| Mashed Parsnips | |
| Sunflower Salad | |
| Baked Chicken with Tomato Rice | |
| Baked Acorn Squash | |
| Mixed Vegetable Salad | |
| (Cauliflower, String Bean, and Carrots) | |
| Apple Tapioca Supreme | |
| Roast Chicken w/Mushroom Stuffing | |
| Carrots and Peas | |
| Brown Rice | |
| Fresh Raspberries | |
| Lemon and Herb Baked Chicken | |
| Potato and Onion Soup | |
| Barley and Mushroom Pilaf | |
| Green Beans with Almonds |
Food Exchange List
Included are suggestions of allowed foods used in your elimination diet. Food tolerances and allergies are specific to the individual; select foods with these in mind.
Baking products
| Baking powder (corn-free) | Baking soda |
| Carob | Gelatin (beef) |
| Gelatin (pork) | Kelp |
| Miso, a fermented soy product | Raisins |
| Tapioca, instant | Tapioca, pearl |
| Vanilla |
| Almond nut milk | Apple juice (100% pure) |
| Apricot juice (100% pure) | Bottled spring water |
| Carrot juice (100% pure) | Celery juice (100% pure) |
| Cow's Milk and buttermilk | Goat's milk |
| Grape juice (100% pure) | Grapefruit juice (100% pure) |
| Orange juice (100% pure) | Pear juice (100% pure) |
| Pineapple juice (100% pure) | Tomato juice (100% pure) |
Flours, grains and thickeners
| Agar | Amaranth flour |
| Arrowroot starch | Barley flour |
| Buckwheat flour | Buckwheat groats |
| Chick-pea flour | Corn flour |
| Corn meal | Cornstarch |
| Millet flour | Oatmeal |
| Oat flour | Potato flour (cooked) |
| Potato starch (uncooked) | Rice |
| Rice flour | Rye flour |
| Soy flour | Tapioca starch flour |
| Wheat flour | Xanthan gum |
Nuts and seeds
| Almond | Brazil nut | Cashew |
| Filbert | Macadamia nut | Peanut |
| Pecan | Pine nut | Pistachio (undyed) |
| Pumpkin seed | Sesame seed | Sunflower seed |
| Walnut |
Fruits and vegetables
| Alfalfa sprout | Apple | Apricot |
| Artichoke | Avocado | Bamboo shoot |
| Banana | Bean sprouts | Beet |
| Blackberries | Black-eyed pea | Blueberry |
| Broccoli | Brussels sprout | Cabbage |
| Cantaloupe | Carrot | Cauliflower |
| Celery | Cherry | Chick pea |
| Coconut | Collard greens | Corn |
| Cranberries | Cucumber | Currant |
| Eggplant | Endive | Fig |
| Garlic | Grapefruit | Grape |
| Green beans | Green pea | Bell Pepper |
| Kidney bean | Kiwi | Lamb's Quarter |
| Leeks | Lemon | Lentil |
| Lettuce | Lima bean | Lime |
| Mango | Mushroom | Muskmelon |
| Navy bean | Nectarine | Onion |
| Orange | Papaya | Parsnip |
| Pea (dried) | Peach | Pear |
| Pepper | Persimmon | Pineapple |
| Plum | Potato | Pumpkin |
| Radish | Raspberry | Rhubarb |
| Rutabaga | Spinach | Squash |
| Strawberry | Sweet potato | Swiss chard |
| Tangerine | Tomato | Turnip |
| Water chestnut | Watermelon | Yam |
| Zucchini |
Meat, eggs, poultry and fish
| Beef | Chicken | Crab |
| Duck | Egg | Fish |
| Frog legs | Goose | Lamb |
| Lobster | Pheasant | Pork |
| Quail | Rabbit | Salmon |
| Shrimp | Turkey | Tuna (water-packed) |
| Venison |
Oils and fats
| Almond oil | Apricot oil | Avocado oil |
| Butter | Coconut oil | Corn oil |
| Cottonseed oil | Margarine | Olive oil |
| Peanut oil | Safflower oil | Sesame oil |
| Soy oil | Sunflower oil | Walnut oil |
| Barley malt | Beet sugar | Cane sugar |
| Corn sugar | Corn syrup | Date sugar |
| Honey | Maple sugar | Maple syrup |
| Sorghum | Molasses | Rice syrup |
Miscellaneous
| Applesauce | Cashew butter | 100% Peanut butter |
| Rice cakes | Rice crackers | Rice sticks |
| Vinegar, apple | Vinegar, grape | Vinegar, distilled |
References
Butkus S.N., L.K. Mahan. Food allergies: immunological reactions to food, a review. J Am Diet Assoc. 1986 May. 86(5). P 601-8.
Cant, A.J. Food allergy in childhood, a review. Hum Nutr Appl Nutr. 1985 Aug. 39(4). P277-93.
Halpern, G.M., J.R. Scott. Non IgE antibody mediated mechanisms in food allergy, a review. Ann Allergy. 1987 Jan. 58(1). P14-27.
Panush, R.S., E.M. Webster. Food allergies and other adverse reactions to foods, a review. Med Clin North Am. 1985 May. 69(3). P 533-46.
Taylor, S.L., R.K. Bush, & W.W. Busse. Avoidance diets--how selective should we be? New Eng Reg Allergy Proc. 1986 Now-Dec (7) 6. p 527-32.
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