Allergy

Elimination Diet

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Elimination Diet

  • Disclaimer
  1. Elimination Diet is medically controversial
  2. Should not delay or replace standard medical approach
    1. Consider if conservative management fails
  3. Does no harm
  4. Many patients anecdotally respond (Placebo Effect?)
  • General
  1. No specific food allowed more than twice per week
  2. Eliminate foods for 7-10 days
    1. Anticipate symptom clearing 4-5 days
    2. Anticipate initial worsening of symptoms
      1. Withdrawal symptoms
    3. Anticipate weight loss during elimination time
  3. Reintroduce foods one per day
    1. Eliminate offending food for 6 weeks
    2. May re-challenge at 6 week mark
  4. Keep Food diary
    1. Time and amount of food eaten
    2. Time symptoms began or cleared
    3. Length of time symptoms lasted
    4. What they did to clear symptoms
  • Specific Eliminations for symptoms
  1. Headache: Tyramine Elimination
  2. Arthritis: Nightshade Elimination
  • Foods allowed
  1. Meats
    1. Beef, Pork, Veal
    2. Turkey, Chicken
    3. Fish (trout, salmon, tuna, sardines)
  2. Vegetables (no corn)
    1. Green peas, Beans, and other Legumes
    2. Sweat potatoes
    3. Cabbage, Lettuce, Spinach
    4. Carrots, Squash, Asparagus, Cauliflower
    5. Onions, Radishes, Celery
    6. Cucumbers, Brussels sprouts, broccoli
  3. Fruits (no citrus)
    1. Bananas, Apples, Grapes
    2. Peaches, Pears, Pineapple
    3. Prunes, Raisins
    4. Cantaloupe, Watermelon
    5. Figs, Dates, Cherries
  4. Apricots, Nectarines
  5. Grains
    1. Breads not containing wheat (homemade)
    2. Rice crackers and cakes
    3. Oat, Rice or Potato flours
  6. Nuts (except peanuts)
  7. Honey, pure maple syrup
  8. Peanut butter
  9. Safflower oil or sunflower oil
  • Foods to avoid
  1. Common Adverse Reactions
    1. Milk
      1. Cheese, butter, margarine, ice cream
      2. Cream soup, Luncheon meats, processed foods
      3. Breads, crackers, Cookies, cakes, candies
    2. Wheat
      1. Breads, cookies, candies, crackers, soups
      2. Cereals, Luncheon meats, pancake mixes
      3. Salad dressings, gravies
    3. Corn
      1. Candies, breads, pastries, batters, cereals
      2. Ketchup, peanut butter, bacon
      3. Corn oils, starches, sugars
    4. Citrus
      1. Orange, Grapefruit, lemon, limes, Sprite
    5. Tomato
    6. Sugar and sweeteners
      1. Cane and beet sugars
    7. Peanut
    8. Chocolate and Cola containing foods
    9. Egg
      1. Custard, cakes, cookies, ice cream, pies, macaroni
      2. Salad dressings, noodles, pancake mixes
    10. Soy
  2. Other Adverse Reaction Foods to avoid
    1. Coffee, Tea, Alcohol
    2. Spices
    3. Yeast
      1. Breads, wine, vinegar, mushrooms, Vitamins
      2. Dried fruits, fruit juices
    4. Processed foods with coloring, flavoring, additive
      1. Cereals
      2. Soft drinks
      3. Ketchup, mustard
      4. Hot dogs, luncheon meats
  • Reintroduce Foods in pure form (one new food per day)
  1. Day 1: Citrus (Orange)
  2. Day 2: Wheat (Cream of wheat, shredded wheat)
  3. Day 3: Egg (Boiled Egg)
  4. Day 4: Food coloring
  5. Day 5: Chocolate
  6. Day 6: Corn (Corn on the cob)
  7. Day 7: Sugar
  8. Day 8: Milk (Glass of milk)
  • References
  1. Sicherer (1999) Am Fam Physician 59(2): 415-24 [PubMed]
  2. Crook (1995) Tracking Down Food Allergy