What role do elimination diets play in the diagnosis and management of food intolerances, and how should they be implemented?

Role of elimination diets: Elimination diets are used primarily in the diagnosis and management of non-IgE-mediated food allergies and intolerances. They help identify the suspected allergen by removing it from the diet for a trial period, typically between 2 to 6 weeks, followed by reintroduction to observe if symptoms recur. This process aids in confirming the diagnosis when clinical history suggests a non-IgE-mediated reaction.

Recommended approach for implementation: The implementation of elimination diets should be guided by a healthcare professional with appropriate competencies, ideally involving a dietitian to ensure nutritional adequacy and proper timing of elimination and reintroduction phases. Before starting, an allergy-focused clinical history must be taken to identify suspected allergens and assess the patient's symptoms and context.

Patients and carers should be provided with clear information about which foods to avoid, how to interpret food labels, alternative nutritional sources, the duration of the elimination diet, and the safety and limitations of the diet and subsequent food reintroduction or oral food challenge procedures. For infants suspected of cow's milk protein allergy, specific advice on breastfeeding and formula options should be given.

Referral to secondary or specialist care is recommended if symptoms persist despite a single-allergen elimination diet, or if there are severe or systemic reactions, faltering growth, or complex allergy presentations.

Alternative diagnostic tests such as serum-specific IgG testing, vega test, applied kinesiology, and hair analysis are not recommended.

Overall, elimination diets are a diagnostic tool within a broader clinical assessment and should be carefully managed to avoid nutritional deficiencies and ensure accurate diagnosis.

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