By Allergen Bureau

Most adults with food allergy don’t follow doctor’s orders

In the world’s first known study of its kind, most adults diagnosed with food allergy were found to not follow the dietary advice they had been given by a health professional. Several underlying reasons were found, offering health professionals an insight into what more they should consider when giving advice and guidance about allergy-related dietary restrictions.

After testing positive to a food challenge, adult patients participating in the study were given dietary advice based on sensitivity and severity of symptoms and their personal history. Dietary advice given fell into one of three options:

  1. Strict avoidance of the allergenic food and ingredients [including products with precautionary allergen labelling (PAL)].
  2. Avoidance of the allergenic food and ingredients but products with PAL allowed.
  3. Small amounts of the allergenic food or ingredients allowed with dose adjustment and regular evaluation [only in case of mild (mainly oral allergy) symptoms during food challenge and/or mild reaction to only a high dose].

Participants were asked 6 months later to fill in a questionnaire. Among information recorded, they were asked to describe what dietary advice they thought they had received from their health team, whether they had experienced allergic reactions since receiving dietary advice and, where relevant, any reasons for consciously choosing not to follow the dietary advice they had been given.

Only one third of the participants adhered to the dietary advice. The reasons for failing to follow the doctor’s orders include mis-remembering dietary advice, impaired health‐related quality of life (HRQL) on domain “Emotional impact’’, and the need to make significant dietary changes in order to follow the advice.

Of those not following the advice, more than one third reported that this was a conscious choice. Most of those who made this conscious choice has received advice to strictly avoid the food but found it led to too many dietary restrictions or because they expected products with PAL to be safe.

Knowing that dietary change is difficult, healthcare professionals should make greater use of known strategies to improve dietary adherence. The Allergen Bureau believes more work is also required to communicate the risks that underpin PAL. Visit our industry guidance page for more information.

Reference: Versluis et al. 2022. Journal of Allergy and Clinical Immunology. DOI:

Open Access publication