Vegan diets from an allergy point of view – Position paper of the DGAKI working group on food allergy

Abstract

Vegan diets are currently attracting a great deal of attention. However, avoiding animal-based foods restricts the diet and is associated with risks, the extent and medical implications of which are at present not sufficiently understood. Elimination diets represent the usual therapeutic long-term management in the presence of food allergy. In order to understand the risks of vegan diets and to discuss these critically from the perspective of food allergies, the expertise of a nutritionist/dietitian with expertise in this area is indispensable. This position paper deals with the incentives behind and the benefits of a plant-based diet. The knowledge required to cover macro- and micronutrient dietary requirements is presented. Using the avoidance of cow’s milk as an example, the challenges of adequately meeting nutritional needs are identified and (so-called) milk alternatives are evaluated from an allergy and nutritional point of view. Finally, other plant-based (substitute) products are evaluated from the same perspective, as significant protein sources in vegan diets (e.g., legumes, nuts, and seeds) are at the same time potential and potent triggers of allergic reactions. However, the allergic potential of many substitute products cannot be fully assessed at present due to gaps in research. Wheat as the most important trigger for anaphylaxis in adults is also evaluated. Finally, the increase in ultra-processed products in the (vegan) food sector and their potential consequences for the immune system are discussed.

“Climate-friendly” diets from an allergy point of view

“…A diet which excludes animal foods cannot meet requirements without supplements and is therefore associated with high risks to health if critical nutrients are not adequately covered. This fact and the difficulty of meeting protein requirements, which is often underestimated, have already been discussed in detail in the position paper of the DGAKI Food Allergy Working Group “Vegan diets from an allergy point of view” [ 19 ]. However, people who do not completely exclude animal foods but consume them only in small amounts, are also at great risk of not meeting their needs.…”

“…Comparisons between different dietary patterns clearly show that protein intake decreases on average when less animal-based foods are eaten [ 20 , 21 ]. This observation is all the more alarming as the protein requirement increases the more plant-based the diet becomes (see also [ 19 ]). A (too) low protein intake often results from replacing milk and dairy products with plant-based “alternatives”, which not only reduces the protein quality of the diet (except for soy drinks), but also the intake of calcium and iodine [ 24 ].…”

“…With the ambition to transform the global food system from animal to plant-based protein sources, the development of ultra-processed plant-based foods has increased dramatically [ 19 , 32 ]. Ultra-processed foods (UPF) are often characterized by high levels of starch and sugar, refined fat, salt, and a lack of nutrients.…”

“…The replacement of animal food or protein sources with plant-based sources entails a number of risks for people affected by allergies, which have already been presented and discussed in detail in the position paper of the DGAKI Food Allergy Working Group “Vegan diets from an allergy point of view” [ 19 ] and will therefore only be outlined here.…”

“…With increasing age, food allergies are increasingly elicited by plant foods: in fact, wheat, legumes, nuts, and celery are the leading anaphylaxis triggers in adulthood alongside shellfish [ 38 ]. The fact that only some legumes (soy and lupine) and seeds (sesame) are subject to mandatory labeling and therefore need to be highlighted in the ingredient list, is particularly problematic [ 19 , 39 ]. In particular peas, which have been increasingly used as a source of protein in recent years due to their diverse technological properties are not subject to mandatory labeling.…”