ABSTRACT
Clinical Questions .................................................................................................. 165 Introduction ............................................................................................................ 166 Label Reading ........................................................................................................ 166 Nutrition ................................................................................................................. 171
Pediatric Nutrition ............................................................................................. 171 Adult Nutrition .................................................................................................. 171
Nutrition Assessment ............................................................................................. 172 Medical History and Laboratory Indices........................................................... 172 Dietary History .................................................................................................. 172
Macronutrients ....................................................................................................... 173 Protein .................................................................................................................... 173 Fat .......................................................................................................................... 174 Carbohydrate .......................................................................................................... 175 Micronutrients ........................................................................................................ 176 Anthropometric Measurements in Children ........................................................... 177 Food Elimination Diets .......................................................................................... 179
Milk Elimination ............................................................................................... 179 Wheat ................................................................................................................ 181 Egg, Soy, Peanut, Tree Nuts, and Seafood ........................................................ 182
Conclusions ............................................................................................................ 183 Clinical Pearls ........................................................................................................ 184 References .............................................................................................................. 184
Currently, the treatment of food allergy requires, among other things, the prescription of an elimination diet. The United States National Institute of Allergy and Infectious Diseases (NIAID) Food Allergy Guidelines recommend that individuals with documented food allergy avoid their identified allergen(s).1 The prescription of an elimination diet is, however, more complex than simply advising a patient to avoid the trigger food(s). Patients prescribed an elimination diet will need to know how to read labels on manufactured products, cook without their allergen, substitute for the nutrition in the eliminated food(s), and manage the elimination diet while continuing to participate in daily activities. Allergen elimination diets have broad implications for the patient and the patient’s family with potential social, psychological, financial, and nutritional burdens.2,3 Therefore, an elimination diet should be prescribed only for the treatment of a diagnosed food allergy or for a specified period of time ( typically between 2 and 6 weeks) when used as a trial for diagnostic purposes.1,4 The use of an elimination diet for diagnostic purposes is supported by the NIAID guidelines as well as the United Kingdom’s National Institute of Health and Clinical Excellence (NICE) Food Allergy in Children and Young People Guidelines.1,4 However, due to the potential broad implications of allergen avoidance for patients, avoiding potentially allergenic foods as a means of managing atopic dermatitis, asthma, or eosinophilic esophagitis in individuals without documented or proven food allergy is not advised.
