Elimination diet
An elimination diet is a method of diagnosing idiopathic food intolerance (see p. 74) and certain other
forms of food sensitivity where indirect tests, such as skin tests, are unhelpful. The principle of the
elimination diet is very simple. It begins by removing from the body every food that could possibly
cause a reaction, and seeing if this produces a symptom-free state. If it does, the elimination diet
then presents the body with different foods, each in its pure form, to see which ones cause symptoms.
While the principle is simple, the practicalities of the elimination diet can be much more complex, and
it is vital to understand the details fully before you start. There is absolutely no room for
‘cheating’ with this diet – one mouthful of cake is enough to ruin the whole thing. You need forward
planning and a lot of self-discipline, backed up by a good stock of the permitted foods for moments
when hunger overcomes you. Some cooked foods, stored in the freezer in individual portions for quick
defrosting, are a great help.
Doing an elimination diet incorrectly is not just a waste of time. Some people acquire new
sensitivities during the diet, which may make it very much more difficult to do a second elimination
diet. So plan ahead and get it right first time.
The planning stage
First of all, start an accurate symptom diary. This will give you a precise picture of how bad things
are now, before you try any dietary measures. A detailed daily symptom record, covering a period of
about two weeks, can be very useful, whether or not you actually do an elimination diet. It can serve
as a baseline against which to judge the effects of any future treatment.
Before you begin an elimination diet, you must see your doctor and ask if it is safe for you to do the
diet. Read through the next four pages first – the more you know about elimination diets, before
talking to your doctor, the better.
There are some conditions where, although an elimination diet can be very helpful, it should not be
attempted without full medical supervision. Two main causes for concern exist:
• For people who are undernourished to start with, the elimination diet may be too demanding – it
is difficult to eat enough calories during the first few weeks of the diet, unless an elemental diet is
used as a supplement (see box on p. 196). If you are underweight, or have rheumatoid arthritis or
Crohn’s disease, the possible use of elemental diets is something you should discuss with your doctor.
• With certain diseases (see list that follows), the testing stage may induce severe symptoms.
Sometimes these can be life-threatening and need immediate medical attention.
Medical supervision during food testing is recommended for anyone with these conditions:
• Crohn’s disease – testing can bring on a prolonged relapse. Very small amounts of food should
be tested initially, and the quantity slowly increased.
• Brittle asthma – after a period of avoidance, a culprit food can bring on a severe and possibly
life-threatening asthma attack.
• Atopic eczema – the risk of reactions is higher if skin tests are positive (see p. 198).
• Chronic urticaria – occasionally there is an immediate reaction to an offending food. It is
advisable to test foods in very small portions oust a mouthful) at first. If there is no reaction
whatever after four hours, a normal portion can be tested.
Note that an elimination diet is not suitable for anyone with true food allergy (see p. 62). If you
have ever had an immediate reaction to any food, or any symptoms in the lips or mouth, testing foods
can be dangerous. Caution is also necessary if you have ever reacted to a food with violent vomiting
and/or diarrhoea some hours after eating. This could be due to an infection, of course, but such
symptoms can also, very rarely, result from true food allergy (see p. 64). Finally, if you have ever
suffered anaphylaxis from any cause – not just food –the testing phase of an elimination diet might be
risky. Ask your doctor’s advice.
Once you have your doctor’s permission to try the diet, work out how the stages of the diet will fit in
with your life over the weeks or months ahead. Until it is over, eating food made by other people is
virtually out of the question. When eating away from home, you must either take prepared food with you,
or just eat very simple foods – such as permitted fruits or nuts. Think about the practicalities of
carrying food for meals away from home.
Finally, devise the diet you will follow during the exclusion phase (see right), locate shops that sell
the more unusual foods, and stock up on everything required.
You will continue to eat a lot of these foods for the first few weeks of the testing stage, so you may
want to buy extra stocks and refrigerate them for
longer storage, especially if the sources of supply are some distance from your home.
Note that food ingredients in medication could interfere with the results of the elimination diet. For
example, if you are very sensitive to maize (corn), the cornflour that is added to many antihistamines
and other drugs could create much confusion. Food-free medicines are available – talk to your
pharmacist about this initially, then to your doctor if you need a different prescription.
The exclusion phase
During the first part of an elimination diet, you exclude all the foods that you normally eat, plus any
closely related foods. For example, if you normally eat oranges, you should avoid all other citrus
fruits, including lemon, limes and grapefruit, even though you do not normally eat these. If you
normally eat plenty of broccoli, you should omit all its relatives, such as cabbage, kale, spring
greens and cress.
The best way to conduct the exclusion phase is not to follow a set menu, such as the well-known
‘Iamb-and-pears’ diet, but to draw up your own list of permitted foods. This can include foods that you
have never eaten before, and those you eat rarely.
The list should run to at least ten items. One problem with an exclusion phase that consists of only
two foods (as in the ‘Iamb-and-pears’ diet) is that you are bound to eat a huge amount of these foods.
This is asking for trouble if you have a tendency to food intolerance, because you can quite quickly
become sensitive to new foods if eating them in large amounts.
Your list of permitted foods should include:
Some starchy items. These are essential for keeping hunger at bay: try some of the more exotic root
crops, such as sweet potatoes, yams, dasheen and cassava. These are available in large supermarkets and
in small shops catering to Indian, African, Chinese and Caribbean communities. (Cook them as you would
potatoes. In the case of cassava, it must be boiled, not baked.) You can also eat parsnips, turnips,
chestnuts and pumpkin. Tapioca, sago, buckwheat, millet, quinoa and sorghum are other possibilities: a
health-food shop is a good source of some of these. Use rice if it is not normally part of your diet.
Do not include sweetcorn or maize meal, even though you do not normally eat these –corn products are
very widely used in packaged food, and sensitivity to corn is not uncommon.
Several fruits and vegetables that you don’t normally eat. Exotic produce such as mangoes and okra can
help a lot in keeping the diet tasty. Avocados, which are very rich and nutritious, can be included if
you don’t eat them often.
Some protein items. For carnivores, this is the easy part – any meat that you don’t normally eat is
suitable. Consider turkey, rabbit, pigeon or game, for example. (Soak rabbit meat in salt water
overnight to get rid of the strong taste, if you dislike this.) Strict vegetarians have more problems
here, since goat’s milk, sheep’s milk and all birds’ eggs are disallowed – their proteins are much too
similar to those of normal milk and eggs. Soya products such as tofu should definitely be avoided, as
should other pulses initially, because sensitivity to these is a possibility among vegetarians. Quorn,
or mycoprotein, could affect anyone sensitised to yeast, and should not be included. Fortunately the
exclusion phase is fairly brief, so a low intake of protein will not be disastrous. Including some nuts
on your list of permitted foods will help, as these contain protein. If nuts are part of your normal
diet, you may have to resort to rarely eaten kinds such as macadamias, cashews or pistachios.
Elemental diets
An elemental diet is a powder that contains all the nutrients the human body needs but is free from the
substances in food that provoke allergic and intolerance reactions. It is mixed with water to create a
complete substitute for food. Originally designed for space travel, this totally synthetic form of
sustenance is also known as ‘the astronaut’s diet’.
Used alone during the exclusion phase, elemental diets are the basis for the ultimate – and
theoretically foolproof – elimination diet. They sustain you through the exclusion phase, and continue
to provide your basic diet during the testing phase.
For anyone with multiple food sensitivity, using an elemental diet circumvents the problem of finding
ten or more safe foods with which the elimination diet can begin.
Those who are underweight can also benefit from using an elemental diet, simply as a calorie-boosting
supplement during the exclusion phase and testing phase.
Unfortunately, elemental diets taste fairly unpleasant and are quite expensive. You
may need a prescription, so talk to your doctor. Ideally you should get an elemental diet that does not
contain sucrose (sugar).
Some items that make good snacks. Nuts, pumpkin seeds, sunflower seeds, fresh fruit and dried fruit are
all useful for times when you are away from home, or feel hungry between meals. At the outset of the
diet, use only unsulphured dried fruit –available from health-food shops. At a later stage, you can
test ordinary dried fruit (all of which is treated with sulphur preservatives – see box on p. 207).
A cooking oil, preferably one that you have not used much in the past. Use this fairly liberally, to
keep the calorie content of your diet at a reasonable level
Note that this is a very plain diet – you eat the permitted foods and absolutely nothing else. You
cannot use spices, herbs or other flavourings. Salt is allowed, but sugar is out, as are tea, coffee,
alcohol and all soft drinks. You must drink only mineral water and pure juices from permitted fruits.
Don’t use canned or packaged versions of the permitted foods. Buy raw food and cook it yourself. The
idea is to avoid food additives and other contaminants, such as those from the linings of cans.
Throughout this phase, and the next, you must be very careful not to eat too much of any one food.
Never eat any food every day, and stay away from any food that you begin to develop a real passion for
– this is always a bad sign in people with food intolerance. It is better to go a little hungry
(assuming you are not underweight to start with) rather than binge on any of the permitted foods.
Acquiring new sensitivities is all too easy.
Assuming you do have food intolerance, and you have excluded all the foods that affect you, there
should be a complete clearance of symptoms within 7-10 days. The response is usually unmistakable. A
partial or slight response is probably just a coincidence, and should be discounted, except for those
with rheumatoid arthritis (see below).
Be warned that you may feel a great deal worse before you get better. For those who do have idiopathic
food intolerance, the first 5-6 days of the diet can be very unpleasant – usually they suffer the same
symptoms as before the diet, but far more severe.
Some conditions, such as Crohn’s disease and rheumatoid arthritis, may require a longer exclusion
phase, but there is no point in continuing beyond three weeks. Bear in mind that long-term structural
damage to arthritic joints may prevent a complete recovery. A partial but sustained improvement in the
joints, accompanied by a distinct improvement in general health, suggests that food could well be
playing a part in causing the disease, and that it is worth going on to the testing phase.
Symptoms that are only intermittent, such as chronic urticaria or migraine, pose a special problem. You
need to decide, before starting the diet, how long the exclusion phase should continue in order to give
you a clear sign that your state of health is improved. A symptom diary is vital here. If, for example,
your symptom diary shows that you sometimes have a week that is symptom-free but you never get through
two weeks without an attack, then your exclusion phase should continue for two weeks.
You should only go on to the testing phase if you improve during the exclusion phase. If you do not
improve, you have excluded the possibility of food intolerance, and can give up the diet.
The testing phase
This part of the diet, which is sometimes called the reintroduction phase, takes about eight weeks. It
requires careful observation of your symptoms, and constant self-discipline about everything you eat.
You should not stop or delay the testing unless you are ill – it is vitally important to complete it as
quickly as possible.
Foods have to be reintroduced one at a time, with a space between in which symptoms can be observed. It
sounds simple, but this is where errors can easily occur.
During this phase, as well as noting your symptoms daily, you should also record absolutely everything
you eat.
For the first 2-3 weeks you should test foods that are unlikely to cause symptoms. Start by testing
fruits, vegetables and meats that you do not eat very often normally, but which you do like. If they
pass the test, you can use them to vary your diet. This will make life much easier and reduce the risk
of developing new sensitivities.
Next test foods that you do eat reasonably often, but not every day. Leave the most likely culprits –
the foods you eat very regularly, such as wheat and milk products – until you have established a safe
diet that contains at least 25 different foods. This safe and relatively varied diet should be the
backdrop against which you test staple foods.
The testing procedure changes over time, because your sensitivity may decline as the diet progresses.
During the first eight weeks, you should test one food each day, eating a normal-sized portion for
lunch or supper. A reaction to the food might occur quite soon after the meal, or some hours later. Any
symptoms that occur within the following 24 hours should be provisionally attributed to that food.
Unfortunately, bowel symptoms can sometimes take longer to develop – up to 48 hours. This can confuse
things when a new food is being tested every day.
There may also be uncertainty about intermittent conditions such as chronic urticaria. You may not be
absolutely sure that the problem really responded to the exclusion phase. If so, when the symptoms
recur during the testing phase, this may be due to a food, or it may just be coincidence.
Should there be any doubt about which food caused a particular set of symptoms, cut out all the suspect
foods for now, and retest them after a couple of weeks, using a three-day testing procedure (see
below).
When a reaction does occur to a food, stop all testing and go back to the safe diet until you feel
completely better. But don’t wait too long before resuming testing. You need to get through most of the
testing within eight weeks because, for some people, intolerance to the foods begins to fade after
that.
This does not mean that the intolerance has been ‘cured’, unfortunately. A period of eating the food
regularly will soon bring the problem back.
If you are still testing foods after eight weeks, you must change to three-day testing – eat a normal
portion of the food every day for three days, stopping only if you get symptoms. Should you have no
reaction to the food by the end of the fourth day, you can consider it safe. (But leave it out of your
diet for at least another four days.)
There are some special procedures for testing certain foods:
• When you test wheat, even if it is quite early on, use the three-day test procedure (see
above). Reactions to wheat can be very slow. (If you have rheumatoid arthritis, you should spend a full
five days testing wheat, and eat it at least twice a day.) Don’t use bread to test wheat because this
also contains yeast and other ingredients. Use a pure wheat cereal such as Shredded Wheat – moisten it
with fruit juice if you cannot have milk. Note that some people who react to whole-wheat are sensitive
to the wheat germ, and can tolerate refined wheat, as in white bread and flour. For others only white
flour is a problem – they are usually reacting to additives in the white flour. Careful testing will
sort out these issues.
• Test milk before cheese and butter. You may react to one but not the others. If you react to
fresh milk, wait a few weeks, then test evaporated milk. Later, you can test goat’s milk and then
sheep’s milk. Some people can tolerate these, but must be very careful not to consume too much of them.
• You can test yeast using Marmite or yeast-based B-vitamin tablets. Do this before you test
mushrooms, • At some point, test a canned food. This is to check for reactions to the lining
material used on cans. Choose something that contains no other ingredients or additives, such as
carrots. Test it first in a frozen or fresh form, so that you are sure you don’t have a reaction to the
food itself.
• Throughout the testing period, continue with cooking all your own food from scratch. At a
fairly late stage in the testing, when you have tested most foods, spend three days eating packaged
food. The idea is to eat a wide range of different food additives all at once. Read the labels
carefully (see p. 172) to check that all the food ingredients are ones which you have already tested
and found safe. You are unlikely to react to these packaged foods, but if you do, you should then
conduct tests with all the individual food additives. You may need some help from a dietitian for this
(see p. 201).
Testing becomes more and more uncertain after 12 weeks. If you
have not completed it by then, reintroduce all the untested foods.
Should your symptoms come back, cut out all those foods again,
then test them individually.
What next?
For anyone who recovers during an elimination diet, and successfully identifies their problem foods, a
period of complete abstinence from those foods follows. After about a year, it is worth testing the
foods again, as the sensitivity may have subsided. (Don’t do this if you have rheumatoid arthritis –
see p. 23.)
If, after a year or two, you find that a food no longer makes you ill, don’t go back to your old ways –
remember that you must only eat the food occasionally. Once every three or four bays is a good rule of
thumb for a food to which you were previously intolerant. You might get away with having it slightly
more often than this, but never go back to eating it daily. If it starts to become your ‘favourite
food’ again – the thing you fancy more often than anything else – watch out.
Good nutrition is an important issue for anyone avoiding certain key foods. If you have cut out all
milk products, for example, you should probably be taking a calcium supplement, unless you eat a lot of
other calcium-rich foods. Ask your doctor to refer you to a dietician or nutritionist if you feel you
need help.
An elimination diet for children with eczema
Before putting your child on any kind of restrictive diet, it is vital that you talk to your doctor.
The risks of malnutrition are far higher for children, and there can be serious long-term consequences,
such as stunted growth or impaired intelligence. You must therefore have medical consent and
supervision for an elimination diet.
For young children with atopic eczema, there is rarely any need for a stringent elimination diet, such
as that described on pp. 194-7. Children are usually sensitised to only one or two commonly eaten
foods.
In the case of recently weaned infants, it is enough to simply cut out individual foods, one at a time.
Avoid each food for two weeks, while observing symptoms carefully.
For older children a simple elimination diet, with an exclusion phase which avoids just the most likely
culprits, works well. The foods that you should exclude at the outset are:
• any food which has given a positive skin-prick test (see p. 69)
• any food which you think may have caused digestive symptoms, such as diarrhoea, either now or
in the past
• eggs, milk and all milk products
• beef and chicken
• citrus fruits (oranges, lemons etc.)
• food additives.
If the child’s skin is no better after a week of this diet, cut out the following foods as well:
• peanuts and other nuts
• soya
• fish
• wheat and maize (corn)
• tomatoes
• lamb.
If there is no response after another week, food is unlikely to be contributing to the eczema.
For the testing phase, use three-day testing, as described on p. 197, if you have fewer than ten foods
to test. Use one-day testing if you have more than ten foods to test.
You should begin by testing a very small amount of the food. Wait ten minutes for any symptoms (not
just skin symptoms – the mouth or stomach may also be affected) then give a little more if nothing has
happened. Build up gradually to testing a normal portion of the food.
A more cautious approach is required for children who give positive skin-prick tests to foods, or have
a history of symptoms in the mouth or digestive tract. They are more likely to suffer severe symptoms
in the lips, mouth and throat – the type of reaction associated with food allergy. Emergency medical
treatment may be needed. You can see if there is any likelihood of a severe immediate reaction to foods
by starting with a test on the face, and then the outer lip (see box on p. 23). If nothing happens, it
is probably safe to go on to the next stage – giving the child a very small amount of the food to eat.
However, you should have medical supervision for Rare reactions
Very occasionally, atopic eczema sufferers on milk-avoidance diets develop a sensitivity reaction to
calcium supplements. There is no scientific explanation for this, but it has been very well documented
in two children. Should you encounter this problem, the answer may be some alternative natural source
of calcium: sardines or other small fish, eaten whole, are one possibility, assuming your child will
eat fish. A dietician can advise on how much is needed per day.
There has also been one well-documented report of a child reacting to mineral water. When the water she
usually drank was changed to another brand, her eczema cleared up. This is very unlikely to be a common
problem.
this procedure in the case of foods that gave positive skin tests. If your child has both severe eczema
and additional symptoms (such as nettle rash, or symptoms in the mouth or digestive tract) it may be
advisable to have medical supervision when testing all foods.
Bear in mind that atopic eczema naturally fluctuates a great deal. To observe the effects of trying out
a food, you need the child’s skin to be in a steady state. That means being absolutely consistent about
applying steroids and moisturisers, avoiding (for the period of testing) any stressful situations that
could provoke a flare-up, not exposing the skin to sudden doses of irritants or airborne allergens, and
keeping scratching under control. Be aware of other factors that could muddy the waters by provoking a
flare-up of eczema – such as teething, or a cold (see p. 44).
If certain foods are identified as provoking eczema symptoms, and you decide to cut the food from your
child’s diet, a nutritional supplement may well be needed. Ask your doctor to refer you to a
nutritionist or dietician.
Other diagnostic diets
These diets are not used by (or even known to) the majority of doctors. While some, such as the
low-nickel diet, have been subjected to rigorous scientific testing and have shown their worth, others
have not been tested scientifically. The evidence in favour of them is purely anecdotal – in other
words, doctors have used these treatments repeatedly and observed good results with some of their
patients. That is not hard science, but it is how innovations in medicine often begin.
There are few risks with any of these diets – the number of foods to be avoided is small, and you are
most unlikely to become malnourished. Your doctor should not object to you trying any of these diets,
however sceptical he or she may be about its possible benefits.
Low-nickel diet
This diet is sometimes of benefit to adults with eczema. There are various pointers which indicate that
the diet may help, as described on pp. 55-6.
Make sure that you have absolutely no contact with any nickel (e.g. in jewellery, jeans studs, watches
or hair clips) throughout this diet, and for at least two weeks before starting it.
Ideally you should also stop treatment with steroids or antihistamines a week or so before starting the
diet. This allows any improvement to be easily observed. Obviously you should get your doctor’s
permission to do this.
The diet could take anything from six weeks to six months to take full effect. Some people have a
complete clearance of their eczema, while for others there is a partial but distinct improvement.
The foods with a high nickel content, which should be avoided as far as possible, are:
• shellfish
• green beans and peas
• beansprouts and lucerne sprouts
• dry beans and lentils (pulses) of all kinds; soya protein and products containing it (e.g.
vegetarian sausages and burgers)
• spinach and kale
• lettuce, leeks
• wheat bran (avoid bran cereals and other products; replace wholemeal bread with white bread, or
eat it in moderation only – you can get plenty of fibre from fruits and vegetables; do not eat
multi-grain breads at all)
• oatmeal, millet and buckwheat
• raspberries, prunes, pineapple, figs
• chocolate and cocoa
• tea from drinks dispensers (restrict intake of other tea and coffee, and don’t make them too
strong)
• peanuts, hazelnuts, almonds and marzipan
• liquorice
• sunflower seeds, linseed
• baking powder, in large amounts
• vitamin or mineral preparations that contain nickel (check the label carefully), Nickel is also
found in drinking water, and absorbed from certain cooking utensils, so:
• Do not use items plated with nickel (e.g. tea balls, some tea strainers, egg beaters). The
extremely shiny appearance of nickel makes these easy to recognise.
• Do not cook acid fruits in stainless steel pans, since the acid leaches some nickel out of the
stainless steel. An enamel cooking pot is safe.
• Minimise the amount of tinned food that you eat.
• In the morning, run off the first litre of water from the tap, as this may contain nickel
released from the tap itself.
Several other foods and drinks seem to aggravate the skin of nickel-sensitive people, even though the
foods are not rich in nickel. These foods and drinks should also be avoided:
• beer, wine
• herring, mackerel, tuna
•tomatoes, carrots, onions, apples; oranges and other citrus fruits, including their juices.
Low-chromium and low-cobalt diets
Skin sensitivity to chromium or cobalt can, very occasionally, result in a tendency to react to these
same metals when consumed in food or drink (see pp. 56).
Unfortunately, both chromium and cobalt are essential for good nutrition, so avoiding them is fraught
with problems. You would need the help of a really good dietician, or a doctor with a particular
interest in nutritional problems, to guide you through a diet of this kind.
The only measure you can safely take at home is to cut down on excessive consumption of these metals,
for three weeks only, to see if this produces any improvement in your symptoms. If it does, that should
encourage you to seek expert help for a more thorough avoidance diet.
In the case of cobalt sensitivity avoid:
• all canned and bottled beer.
In the case of chromium sensitivity avoid:
• beer, wine and cider
• yeast extract and yeast tablets
• black pepper
• calf’s liver
• wheatgerm and wholemeal bread
• cheese.
If you also have nickel sensitivity, avoid nickel-rich foods (see p. 199) at the same time.
Low-histamine diet
Histamine in food is mostly produced by bacterial action. The majority of people can break down any
histamine they eat, as long as the amount is not excessive (see box on p. 67).
Temporary susceptibility to histamine may accompany viral hepatitis or other liver conditions.
A permanently impaired ability to detoxify histamine is relatively unusual. When it does occur it can
result in symptoms such as chronic urticaria, migraine or recurrent headaches. A low-histamine diet may
help in these cases. All of the following should be avoided:
Very high histamine content:
• red wine, champagne
• tuna, sardines
• Emmenthal and Camembert cheeses.
High histamine content:
• beer, white wine
• anchovies
• Gouda, Roquefort, Stilton and all other well-matured cheeses
• salami and other well-matured sausages, Westphalian ham
• sauerkraut
• spinach
• tomato ketchup.
If you improve only partially on this diet, this may indicate that you are on the right track
(histamine is indeed the problem) but that the bacteria in your gut are undermining your efforts with
the additional histamine which they generate. You can investigate this possibility by trying a
low-carbohydrate diet, as described on p. 53.
Low-amine diet
Naturally occurring substances called amines, found in many different foods, can have a drug-like
effect on the blood vessels, making them open up a little and so increasing the blood flow. The effect
is usually small, but some people are more susceptible than others. A low-amine diet is worth trying if
you have chronic urticaria or migraines, and have not improved with other treatments. A low-amine diet
can also be useful in atopic eczema: amines in food are not a basic cause of eczema, but they can
aggravate the rash by increasing blood flow to the skin. To begin with, cut out all foods listed below:
Very high amine content:
• all cheeses except cottage cheese
• dark or plain chocolate
• yeast extract (Marmite etc.), miso, tempeh, tomato paste, tandoori spice mix, stock cubes,
ready-made sauces • cola drinks, orange juice, tomato juice
• any dried, pickled or smoked fish
• sausages, pies and smoked meats, beef liver, chicken skin
• broad beans, spinach
• sauerkraut
• almonds.
High or moderate amine content:
• milk chocolate
• soy sauce
• beer, wine and cider
• pork, including bacon and ham, salami, chicken liver, offal
• all fresh or tinned fish, except white fish
• all nuts except chestnuts and cashews
• sesame seeds, sunflower seeds
• avocados, aubergines, mushrooms, tomatoes, broccoli, cauliflower
• olives and olive oil
• oranges, lemons and other citrus fruits
• pineapples, bananas, raspberries, strawberries, pineapples, plums, grapes, dates, figs, kiwi
fruit, passion fruit.
Continue for at least three weeks, and longer if your symptoms are normally intermittent. if you
improve, you can then experiment with reintroducing small portions of foods from the second list, three
or four times a week. Gradually build up to a higher intake, but cut back if your symptoms return.
Organic diet
The objective here is to avoid pesticides, i.e. chemical sprays applied to kill fungi and insect pests.
This may be helpful for people with chemical intolerance (see p. 84).
`Chemical-free’ or ‘unsprayed’ food (crops grown without pesticides) will do just as well as 100%
organic food (which is grown without either pesticides or artificial fertilisers).
The highest intake of pesticides is from fresh fruit and vegetables, so if your budget is tight,
concentrate on buying organic or chemical-free versions of these. If you have a garden, growing some of
your own food will reduce the cost.
You can also reduce the pesticide content of ordinary fruits and vegetables by:
• Storing them for as long as possible before using them, because the pesticides break down quite
quickly
• Always peeling them. With difficult-to-peel items such as peaches and tomatoes, pour boiling
water over them and leave them to stand for a few minutes first, as this loosens the skin. Rinse in
cold water, then peel.
• If peeling is not possible, washing them very well with soap or detergent, then rinsing them
thoroughly
• Cooking them, as this drives off some of the pesticides; avoid inhaling the steam and ventilate
the kitchen well while doing this.
You should drink mineral water from a reputable source, or use a very high-quality water filter (not a
jug filter).
Additive-free diet
Food additives are occasionally the culprit in chronic urticaria (see p. 53). At the same time as
avoiding additives, people with chronic urticaria should cut out other potential culprits – alcohol,
spices and all aspirin-like drugs (see box on p. 151).
An additive-free diet may also be of value for some people with chemical intolerance (see p. 84).
In the case of children with Attention Deficit Disorder (ADD), also called Hyperkinetic Syndrome, the
role of additive-free diets is a contentious issue (see p. 81).
An additive-free diet is very healthy but quite hard work. It means making all your own food from 100%
fresh, unmodified produce (you cannot have bacon or ham, and even things like cooked chicken and
ready-to-eat salad can contain some additives; so does most restaurant food). Note that wines, beers
and other alcoholic drinks can contain many additives without declaring them on the label. (German
bottled beer is an exception here.) Baked goods sold unwrapped can also contain many additives without
declaring them.
Stop using toothpaste unless it is an additive-free brand. You can buy such toothpaste from a
health-food shop – or use sodium bicarbonate powder instead. Drink mineral water or filtered water (you
need a good-quality filter for this, not a jug filter).
Medicinal drugs can contain colourings and other additives, so you should try to get additive-free
versions. Talk to your pharmacist about this initially.
Assuming the symptoms clear up, testing can begin, but you will probably need medical help to work out
exactly which additives are at fault. It is difficult to organise these tests at home, because most
foods contain such a mixture of additives.
With chronic urticaria, there is the possibility of quite severe reactions on testing, so medical
supervision is desirable. You can undertake cautious testing with small amounts of tap water, spices
and alcohol at home, but make sure you are in a position to get emergency medical help if you need it.
Aspirin or aspirin-like drugs should not be tested at home. Life-threatening reactions are common in
sensitive individuals, and temporary avoidance can heighten your reaction.
smoke, they have a far greater chance of developing allergies and/or asthma when exposed to an allergen in the air.