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Elimination Diet

What Is an Elimination Diet?

An elimination diet is a meal plan that avoids or removes certain foods or ingredients so you can find out what you might be sensitive to or allergic to. 

It isn’t about weight loss. You aren’t out to delete unneeded calories or drop some extra pounds. 

The most common reason for an elimination diet is because you and your doctor think certain foods may be the reason for your allergy symptoms. You’ll need to partner with your doctor on this and make sure that you still get all the nutrients you need.

Don’t do it if you have a serious food allergy or have had a severe allergic reaction called anaphylaxis. If you have, you need to know your trigger food as soon as possible so you can avoid it. Talk with your doctor about that. Blood and skin tests can identify some food allergies. You may need them before you can safely try an elimination diet on your own.

How Does an Elimination Diet Work?

There are two parts to an elimination diet: 

  • The elimination (avoidance) phase
  • The reintroduction (challenge) phase

Elimination phase

The first step is to stop eating the suspicious foods. You’ll need to read food labels carefully and ask how foods are prepared at restaurants. Keep a food diary and write down everything you eat, and note how you feel after you eat them. Your doctor will watch you for a few weeks while you try this.

Foods to consider avoiding while on an elimination diet: 

  • Citrus
  • Milk
  • Eggs
  • Wheat and gluten, which includes rye, barley, and malt vinegar
  • Shellfish
  • Soy

Remember to consider food additives. Some are known to trigger allergy symptoms in some people: 

  • Things that end in -amine (histamine, tyramine, octopamine, and phenylethylamine)
  • Artificial food colors (tartrazine and dyes derived from coal tar)
  • Aspartame (artificial sweetener)
  • Butylated hydroxyanisole and butylated hydroxytoluene (preservatives)
  • Lactose and other disaccharides
  • Monosodium glutamate (flavor enhancer)
  • Nitrate and nitrites (preservatives)
  • Sulfites, benzoates, and sorbates (preservatives)
  • Tragacanth or agar-agar (thickeners or stabilizers) 

You may not need to avoid all these foods at the same time. If you suspect you feel bad after eating dairy products, you might just start with avoiding those. 

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Make sure you eat other foods that provide the same nutrients as the food you need to avoid. For example, if you're supposed to eliminate dairy products temporarily, you'll want to look for foods that are fortified with calcium. (Soy can be a good source, but check to see if it's allowed on your plan.) A dietitian can help you make your shopping list.​​​​​​​

Reintroduction (challenge) phase

After you’ve eliminated possible food allergy triggers, you’ll slowly add back suspicious foods, one at a time. This process helps you know exactly which foods are a problem.

In your food diary, note any symptoms that you get as you add each food back in.

If you bring back a food and you have any of the following symptoms, get emergency medical help and stop the elimination diet until your doctor says it's safe to resume: 

  • Throat swelling
  • Immediate rash or hives
  • Trouble breathing

The last step is to once again stop eating the problem foods, one at a time. The list should be smaller this time. The goal is to see if your symptoms clear up for good.

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Keep in mind that you could be sensitive to a food but not allergic to it. Still, the elimination diet can help you know which foods you’re better off avoiding.

If your symptoms disappear after you stop eating a specific food or ingredient, your doctor should order blood or skin tests to confirm the food allergy diagnosis.  Some, but not all, food allergies can be diagnosed this way. 

Types of Elimination Diets

There are several types of elimination diets. Your doctor can design one that’s right for you. 

Some common types are: 

Simple (modified) diet. This basic elimination diet involves avoiding just one food or, sometimes, the two most common food allergy triggers: wheat (including gluten items) and dairy. Instead, eat gluten-free foods and brown rice, millet, buckwheat, or quinoa. 

Moderate intensity diet. You’ll avoid several groups of food all at one. On this diet, you stop eating or drinking:

  • Alcohol
  • All animal and vegetable fats
  • Certain fruits and veggies
  • Chocolate
  • Coffee, tea, soft drinks
  • Dairy
  • Eggs
  • Legumes
  • Nuts
  • Wheat
  • Yeast products

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Ask your doctor what foods you need to stay healthy. If you don’t want to skip animal protein entirely, try lamb or poultry, which are considered low-allergy risk. 

Strict, few foods diet. This is the strictest type of elimination diet. You can only eat a selected group of foods. It isn’t a nutritious diet, so you don’t want to follow this plan for long. The only foods allowed on this level 3 strict elimination diet are: 

  • Apples or apple juice
  • Apricots 
  • Asparagus 
  • Beets 
  • Cane or beet sugar 
  • Carrots 
  • Chicken 
  • Cranberries 
  • Honey 
  • Lamb 
  • Lettuce 
  • Olive oil 
  • Peaches 
  • Pears
  • Pineapple
  • Rice (including rice cakes and cereal)
  • Safflower oil
  • Salt
  • Sweet potatoes
  • White vinegar

No matter what type of elimination you choose, remember to drink lots of water to stay hydrated. 

Benefits of an Elimination Diet

An elimination diet can make you aware of your specific food allergens -- the ingredients you’re sensitive to -- and may help identify a specific food allergy. 

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Elimination diets can help uncover the cause of symptoms such as persistently dry, itchy, skin (dermatitis) and stomach discomfort.

Knowing your food triggers and staying away from them is the safest way to manage a food intolerance or allergy. Carefully following an elimination diet with your doctor’s help can allow you to create a healthy, safe, personal meal plan. 

Risks of an Elimination Diet

Adding foods back to your diet might be risky if you are allergic to them. Sometimes, small amounts of a food might be OK but larger portions could cause problems. You might have a severe food allergy reaction. If you eat a type of food and immediately get a rash or have throat swelling or breathing trouble, seek medical help right away. 

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on July 30, 2020

Sources

SOURCES:

American Academy of Family Physicians: "Summary of the NIAID-Sponsored Food Allergy Guidelines." 

Asthma and Allergy Foundation of America: "Food Allergies."

Cleveland Clinic: "Food Challenge Test."

National Jewish Health: "Food Allergy: Diagnosis."

University of Wisconsin School Integrative Medicine Department of Family Medicine: "Elimination Diet."

Academy of Nutrition and Dietetics: ““What is an Elimination Diet?”

National Institute of Allergy and Infectious Disease: “Guidelines for the Diagnosis and Management of Food Allergy in the United States.”

UW Integrative Health: “The Elimination Diet.”

Environmental Working Group: “EWG’S Dirty Dozen Guide To Food Additives.”

Mayo Clinic: “What is MSG? Is it bad for you?”

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