To enable clients to identify any foods that cause their symptoms to inform and structure a nutritionally adequate diet that excludes them and alleviates symptoms.

This is a short-term programme that necessitates nutritional inadequacy and necessitates comprehensive and skilful dietetic guidance throughout both in supporting the use of the diet and structured reintroduction of foods as well as knowing when to stop the diet when it is not effective

The target group will know that the diet should be strictly adhered to, to identify any food allergy or intolerances.

With the guidance of the dietitian the target group will know how to plan the diet including:

• What foods to include/exclude
• That the diet should be undertaken at quiet social times
• That keeping a food and symptom diary is essential to successfully identify foods that cause symptoms

The target group will know that they must work closely with their dietitian to reintroduce foods to identify if/what foods are causing their symptoms.

There is limited evidence supporting the use of elimination diets where multiple foods are removed from the diet at the same time and that the advice is therefore based predominantly on experience in practice and is used at the discretion of the professional.

• Carroccio A et al, Oligo-Antigenic Diet in the Treatment of Chronic Anal Fissures. Evidence for a Relationship Between Food Hypersensitivity and Anal Fissures. The American Journal of Gastroenterology, May 2013, Vol.108, 825-832
• Denton C. The elimination/ challenge diet. Minnesota medicine (2012) 95;12:43-4
• Kattan J. Nowak-wegrzyn A. Oral food challenges in routine clinical practice, Current Allergy and Clinical Immunology 2013; 26(3): 122-129
• National Institute for Health & Care Excellence March 2016: Quality standard QS118: Food Allergy
• Skypala I. Adverse food reactions—an emerging issue for adults. Journal of the American Dietetic Association, 2011;111:1877–1891.
• Whelan K, Martin LD, Staudacher HM, Lomer MCE The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. Journal of Human Nutrition and Dietetics. 2018 Jan 15. doi: 10.1111/jhn.12530.