Moving towards a food-focused approach in adult food allergy and hypersensitivity care

A recent editorial published in Clinical & Experimental Allergy highlights the limitations of current adult food allergy and hypersensitivity services, which are often fragmented due to a focus on organ systems or immunological mechanisms (e.g., IgE-mediated vs non-IgE-mediated) rather than on the foods themselves. This fragmentation can result in repeated investigations, conflicting advice, and unnecessary dietary restrictions, ultimately compromising patient care and quality of life. 

Adverse food reactions often affect multiple organ systems and present with overlapping symptoms, leading patients to consult several specialists. While specialisation improves care, it can also result in fragmented approaches and missed underlying causes. This issue is particularly evident in the diagnosis and management of food allergy and hypersensitivity, where patients may undergo numerous tests and receive conflicting advice or turn to unreliable sources, such as social media or peers. 

The value of a food-focused diagnostic approach 

A food-focused diagnostic approach, which begins by identifying the suspected food(s) rather than the mechanism, offers a more holistic and effective evaluation. This is particularly important for adults who may experience overlapping IgE-mediated, non-IgE-mediated, or non-immune-mediated reactions, and benefit most from personalised dietary management. 

Many adults may have never had their symptoms evaluated from a dietary perspective. Taking an allergy-focused diet history could help address this. This process consists of three components¹ : 

• questioning and linking – gather information by asking the patient about their allergy history, usual dietary habits, nutritional status, and any relevant co-factors. 

• interpretation of history – interpret responses by using gathered information and provided tools to guide diagnostic decisions and next steps. 

• tests and diagnosis – begin appropriate testing and/or refer the patient to a specialist allergy centre, gastroenterologist, or specialist dietitian as needed. 

This approach often reveals that many adults have adopted unnecessarily restrictive diets, increasing their risk of nutritional deficiencies (such as protein, calcium, iron, zinc, iodine, and B vitamins) and psychological impacts like anxiety or fear around food. 

Management and follow-up 

Developing an effective treatment plan typically requires multiple consultations. The initial focus is on reviewing current dietary restrictions and supporting the safe reintroduction of foods that may not need to be avoided. Follow-up appointments assess adherence, symptom improvement, and the patient’s ability to maintain the diet long-term. 

Importantly, the food-focused approach also addresses the psychological impact of restrictive eating, enabling tailored support and referrals to psychological services when needed. 

The need for multidisciplinary expertise 

Implementing a food-focused approach requires healthcare professionals with expertise in both nutrition and immunology-such as specialist dietitians, allergy nurses, or clinicians with additional nutrition training. These professionals can bridge gaps between specialties, ensuring holistic care that addresses both nutritional and psychological needs. 

Learning from paediatric models 

The editorial highlights that multidisciplinary, food-focused care is standard in paediatric allergy services but is less commonly seen in adult care. Lessons from paediatrics can inform adult services, ensuring that adults receive comprehensive, personalised dietary management that supports both symptom control and long-term health. 

Key takeaways  

• Adopt a food-focused approach: start with the suspected foods and the patient’s diet, not just the mechanism. 

• Assess nutrition and mental health: monitor for nutritional deficiencies and psychological impacts of restrictive diets. 

• Work across disciplines: collaborate with dietitians, psychologists, and other specialists to provide holistic care. 

• Advocate for comprehensive adult services: adults with food allergy and hypersensitivity deserve the same level of multidisciplinary, food-focused care as children. 

Read the full editorial here.

References 

1. Skypala IJ, Venter C, Meyer R, deJong NW, Fox AT, Groetch M, Oude Elberink JN, Sprikkelman A, Diamandi L, Vlieg-Boerstra BJ. (2015) The development of a standardised diet history tool to support the diagnosis of food allergy: Clinical and Translational Allergy. doi: 10.1186/s13601-015-0050-2. PMID: 25741437; PMCID: PMC4349299.