Browse the corpus

Elimination diets are commonly employed when diagnosing and treating food allergies, intolerances, and other disease processes in which a systemic reaction to a particular food product is assumed or proven. Many elimination diets exist, but almost all are based on the concept of removing a food or foods from the diet for some time and reintroducing foods while monitoring symptomatology. Most elimination diets are indicated when symptoms are present, but a formal diagnosis has not been made; the exception is the gluten-free diet in established celiac disease or gluten enteropathy. With most elimination diets, removal of all or a subset of the most commonly implicated food allergens is recommended; these allergens include animal milk, eggs, soy, wheat, nuts, including tree nuts and peanuts, and fish, including shellfish. Instituting an elimination diet before arriving at a formal diagnosis frequently facilitates the ongoing evaluation by identifying trigger foods and guiding further serological and procedural assessment. This activity reviews the steps in implementing commonly utilized elimination diets, their clinical significance, and the potential adverse effects of dietary restrictions, and highlights the role of the interprofessional team in improving outcomes for patients with gastrointestinal or food-related pathologies that benefit from introducing an elimination diet. Objectives: Differentiate the specific recommendations of commonly utilized elimination diets. Select patients who may benefit from an elimination diet based on their clinical history and evaluation. Identify and treat the commonly encountered adverse effects of elimination diets. Develop and implement effective interprofessional team protocols to ensure patients following an elimination diet achieve symptom control in a safe and cost-effective manner. Access free multiple choice questions on this topic.

An elimination diet is a commonly utilized dietary approach in which a particular food or group of foods is removed from the diet. Elimination diets can be employed to identify and treat food intolerances, food allergies, and other disorders, such as urticarial disease, eosinophilic esophagitis, irritable bowel syndrome, or migraine headaches.[1][2][3][4] The specific protocol that guides each elimination diet is dictated by the presenting symptoms or established disease process. The elimination process can either be directed by food allergen testing or instituted empirically.[5][6] Highly regimented elimination diets exist, including the gluten-free diet and the low-FODMAP (Fermentable Oligo-, Di-, Monosaccharides, and Polyols) diet. For severe food-related reactions, such as anaphylaxis, other diagnostic avenues, including skin prick tests, serum-specific IgE measurements, or component-resolved diagnostics, can be employed before an elimination diet with oral food challenges is pursued.[7] Elimination diets have proven efficacy in symptom control and patient satisfaction in various disease processes and are backed by various randomized control trials and observational studies.[8][9][10] This activity reviews commonly utilized elimination diets, the disease processes they may help identify and treat, the limitations of such diets, and the optimal approach to improving patient outcomes through their implementation.

Achieving desirable results with an elimination diet is best accomplished with an interprofessional approach. Patients with food allergies or gastrointestinal complaints frequently present to the primary care practitioner, who should obtain a comprehensive medical history and perform a thorough physical examination. The medical history must include a detailed account of the present illness, past medical and surgical history, family history, current medications, and social determinants of health. Guideline-directed medical care should be implemented according to the needs of each patient. Pathologies mimicking the presenting symptoms should be ruled out before assuming a food allergy or intolerance. An elimination diet can be a powerful diagnostic and treatment tool but cannot replace a comprehensive, guideline-directed evaluation. Clinicians must understand the limitations and appropriateness of elimination diets and how to avoid pitfalls that can lead to failure. Once an elimination diet is prescribed, ensuring the patient understands the specific instructions and goals of the regimen is essential. Registered dieticians can improve patient education by assessing understanding and offering comprehensive dietary instructions. Dieticians can instruct patients on how to read food labels, which specific foods to avoid, and how to avert nutritional deficiencies. The clinical nursing and support staff are also integral to the success of an elimination diet by gathering valuable information about patient compliance, at what elimination or reintroduction stage or step the patient is currently in, and changes in symptomatology. Social workers are essential in cases where barriers to compliance with prescribed elimination diets must be addressed, including socioeconomic status, restricted access to necessary food resources and information, and harmful perceived attitudes toward elimination diets.[14] Elimination diets can be complicated for patients, who may struggle to follow the recommendations. An interprofessional team approach to each patient can optimize treatment, improve outcomes, and provide long-term symptom relief.