Diagnostic Elimination Diet and Food Reintroduction/

The elimination of food/s that appear to trigger the allergic reaction is followed by the food challenge, or the reintroduction of those food/s back into the child’s diet (or mum’s diet if breastfeeding), while monitoring the symptoms.

The food challenge helps to confirm if the reaction is allergic in nature. It is used in practice when the IgE tests and/or the reaction history is not 100% clear, or when you want to determine if a child has outgrown their food allergy. 

How it Works

Child's hands holding a glass of hypoallergenic dairy-free formula.

Diagnostic Elimination
Diet 2-6 weeks

The elimination diet is as intuitive as it sounds – cow’s milk protein (CMP) (all sources) is completely eliminated from the infant’s diet for 2-6 weeks. This includes eliminating CMP (all sources) from the mother’s diet, if they are breastfeeding.

If, after the elimination period, the symptoms do not improve, you can be confident that CMPA is highly unlikely. If symptoms do improve, an oral food challenge is usually performed. This is when CMP-based foods are re-introduced, in a controlled way, into the child’s diet to confirm the diagnosis of CMPA.

Once CMPA has been confirmed, a therapeutic elimination diet entirely free from CMP (dairy) will be required. Ideally this should be supervised by a clinically trained specialist dietician/nutritionist.  

The specialist dietician/nutritionist is advised to provide the parent/caregiver with as much information as possible. This might include, for example, a complete list of the foods containing the proteins the child should avoid, or mum needs to avoid if breastfeeding. A symptom tracking chart or daily diary is also helpful, enabling the parent/caregiver to monitor symptoms while the child is on the elimination diet.  

Serum IgE-specifc test

Serum IgE-
specifc test

Skin prick test

Skin Prick Test (SPT)

GOLD STANDARD Elimination diet followed by food challenge

Diagnostic Elimination Diet and Food Reintroduction/Challenge

IgE-mediated CMPA Use. Use. Use.
non-IgE-mediated CMPA Not use. Not use. Use.

Guidelines for Diagnosis and
Management of CMPA

You can find more detailed information about the diagnosis and management of CMPA in the different Guidelines that have been published including:

ESPGHAN Vertical Icon

ESPGHAN Updated - Position Paper 20231

ESPGHAN Guidelines

GA2LEN Vertical Icon

Managing Food Allergy: GA2LEN guideline 20222

GA2LEN Guidelines

EAACI Vertical Icon

EAACI guidelines on the diagnosis of IgE-mediated food allergy 20233

DRACMA Guidelines