# Sustainable Plant-Based Diets and Food Allergies: A Scoping Review Inspired by EAT-Lancet
## 3 Results
### Core Dietary Determinants of Allergy Prevention and Management Within Sustainable Eating Models
#### 3.4.1 Food Processing and Allergy: Preventive and Symptom-Modulating Perspectives  
Food processing techniques play a dual role in allergic disease: they can either enhance sensitization or reduce allergenicity, depending on how they alter the structure, digestibility, and immunogenicity of dietary proteins. This complex relationship is detailed in Table 11 (preventive effects) and Table 12 (symptom modulation), which synthesize key findings from both experimental and clinical-level evidence. Minimally processed diets--such as those recommended by the EAT-Lancet Commission--tend to preserve fermentable fibers, antioxidant bio \begin{table}
\begin{tabular}{p{56.9 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline
**Author and Year** & **Level of Evidence (CEBM 2009)** & **Study Population and Design** & **Main Findings** \\ \hline [PERSON] et al., 2023 [8] & Level 5 & Narrative review on food processing and allergy pathways. & Minimally processed diets maintain barrier integrity and promote immune tolerance. Industrial processing may increase sensitization risk. \(p\)-values not applicable. \\ \hline [PERSON] et al., 2019 [7] & Level 5 & Review on SCFA production via fermentable fibers and its impact on immunity. & Processing that retains fiber integrity supports SCFA generation, critical for allergy prevention. Refined foods reduce this benefit. \(p<0.01\). \\ \hline [PERSON] et al., 2023 [10] & Level 5 & Review on processing-induced changes in allergen structure. & Polyphenol binding and fermentation reduce allergenicity and epithelial permeability. Benefits observed in food allergy prevention. \(p<0.01\). \\ \hline [PERSON] et al., 2022 [29] & Level 5 & Review on allergen–polyphenyl conjugation in processed foods. & Conjugation of polyphenols to food proteins reduces antigenicity and IgE reactivity. Preventive effects in sensitization models. \(p<0.05\). \\ \hline \end{tabular}
\end{table} 
Table 11: Processing methods and their role in the primary prevention of food allergies. \begin{table}
\begin{tabular}{p{56.9 pt} p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline
**Author and Year** & **Level of Evidence (CEBM 2009)** & **Study Population and Design** & **Main Findings** \\ \hline [PERSON] et al., 2017 [21] & Level 5 & Review on Maillard reactions, enzymatic hydrolysis, and allergenicity in food proteins. & Processing methods can increase or reduce allergenicity. Some thermal treatments expose IgE epitopes; enzymatic hydrolysis tends to reduce symptom potential. \(p<0.01\). \\ \hline [PERSON] et al., 2015 [22] & Level 5 & Review on digestion models and allergenic potential of processed foods. & Simulated digestion and Caco-2 assays show altered allergenicity after processing. Impact depends on food matrix and type of processing. \(p\)-values not applicable. \\ \[PERSON] et al., 2024 [23] & Level 3b & Experimental study on soy protein treated with transglutaminase and lactic fermentation; \(n=36\). & Combined enzymatic and microbial processing significantly reduced IgE-binding and \(\beta\)-sheet structure in soy protein. \(p<0.01\). \\ \hline [PERSON] et al., 2017 [24] & Level 3b & In vitro and ex vivo evaluation of fermented soy milk proteins. & Fermentation reduced immunoreactivity of \(\beta\)-conglycinin and glycinin. Potential application in hypoallergenic food formulations. \(p<0.05\). \\ \hline \end{tabular}
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Table 12: Food processing techniques and their effects on allergic symptom modulation. structures in forms that promote mucosal tolerance and immunological homeostasis. Two reviews [7,8] highlight how industrially processed plant foods, often stripped of fiber and micronutrients, can impair the production of short-chain fatty acids (SCFAs) by the gut microbiota. This results in decreased regulatory T cell (Treg) induction and weakened epithelial barrier integrity, both of which increase the risk of allergic sensitization.