Our role statement was developed by Accredited Practising Dietitians (APDs) working in Adverse Food Reactions.

It defines the role an APD may fulfil when working in the area of adverse food reactions.

Importance of APDs in Adverse Food Reactions

Adverse Food Reactions is a broad term that describes a wide range of immune-mediated (allergy) and non-immune mediated (intolerance) reactions to foods. In the case of food allergy, reactions such as anaphylaxis may be life-threatening. Other adverse food reactions, while not life-threatening, can adversely affect physical, mental, and social health, as well as nutrition and overall wellbeing. APDs possess expert knowledge and skills in providing tailored education to help minimise reactions, optimise nutrition, prevent deficiencies and enhance quality of life.

What all APDs in Adverse Food Reactions can do

Entry level competencies ensure all APDs can conduct assessments, diagnose nutrition issues and develop, monitor and evaluate interventions. This applies to individuals, groups, communities, organisations and population and systems levels. Dietitians in Adverse Food Reactions have specific skills to:

• manage patients with uncomplicated nutrition needs (such as single food allergy, no growth compromise, no other illnesses), within the multidisciplinary team, including consultation with an appropriate medical practitioner
• recognise the clinical features of adverse food reactions and understand the typical presentation of the wide range of associated conditions and diseases¹
• consider relevant cofactors and non-dietary triggers (such as exercise, alcohol, medications) when determining the likelihood of foods/food compounds (such as allergens, gluten) triggering food-related symptoms
• take and interpret a clinical history – dietary intake, body measurements (including growth in children and weight changes in adults), symptoms, triggers, medical, family, genetic tendency to develop allergic disease, ethnicity, co-factors and social factors
• consider the evidenced-based and non-evidenced based diagnostic tests available,² including their use, interpretation, associated risks and contraindications, when conducting a nutrition assessment and developing a plan
• apply diagnostic information and knowledge of the evidence base to guide prescription, implementation and evaluation of a safe and appropriate, nutritionally sound, individualised exclusion diet and supplement recommendations (if required). Contraindications as well as impact on quality of life and long-term health is also considered.
• provide education, including label reading and making appropriate food substitutions, to ensure nutritional adequacy
• provide nutrition advice appropriate for age and stage when working with children and their families – including breastfeeding, maternal diet manipulation, infant formulae, and suitable milk substitutes for infants and children including their indications and contraindications.

Note this list has been adapted from the European Academy of Allergy & Clinical Immunology.³

What APDs with greater experience in Adverse Food Reactions can do

As APDs gain experience and expertise in their area of practice, they can take on more complex tasks. Check with an APD if they have further training and an extended scope of practice. Dietitians experienced in Adverse Food Reactions may:

• manage patients with complex nutrition needs (for example, multiple food allergies, growth compromise, multiple illnesses), within the multidisciplinary team, including consultation with an appropriate medical practitioner
• undertake research contributing to the evidence-base in nutrition and adverse food reactions.

What APDs in Adverse Food Reactions don’t do

Dietitians work closely with other professionals to ensure the best outcomes for the people they work with. However, dietitians don’t always provide the same services as non-dietitian colleagues.

Dietitians in Adverse Food Reactions don’t:

• diagnose immune mediated adverse food reactions (for example, food allergy, coeliac disease)
• provide medical management, including conducting supervised food allergen challenges.

For more, download the full role statement.The full statement includes a list of document references.