# Sustainable Plant-Based Diets and Food Allergies: A Scoping Review Inspired by EAT-Lancet
## 1 Introduction  
Food allergies are IgE-mediated immune responses to specific dietary proteins, causing symptoms ranging from mild reactions to life-threatening anaphylaxis. They affect up to 8% of children and 3% of adults, with rising prevalence in industrialized countries [1, 2]. Accurate diagnosis is essential to distinguish them from non-immune food intolerances [3]. The global rise in food allergies--particularly among children--has prompted increasing scientific attention to the role of diet not only as a therapeutic strategy but also as a modifiable determinant of immune tolerance and allergic sensitization. In parallel, plant-based dietary models have gained prominence for their dual relevance to human and planetary health. Characterized by an emphasis on vegetables, legumes, fruits, whole grains, nuts, and seeds and a reduction or exclusion of animal-derived products, these diets align with the ecological priorities outlined in the EAT-Lancet Commission's framework [4, 5]. While definitions of plant-based diets vary (e.g., vegan, vegetarian, and semi-vegetarian), the selected studies converged on shared sustainability goals and dietary structures that distinguish them from Western dietary models [4, 5]. The EAT-Lancet dietary model promotes a predominantly plant-based eating pattern designed to optimize both human and planetary health. It prioritizes the consumption of whole grains, legumes, vegetables, fruits, nuts, and unsaturated fats, while minimizing intake of animal products and ultra-processed foods [6]. Transformation to healthy diets by 2050 will require substantial dietary shifts, including a greater than 50% reduction in global consumption of unhealthy foods, such as red meat and sugar, and a greater than 100% increase in the consumption of healthy foods, such as nuts, fruits, vegetables, and legumes. However, the changes needed differ greatly by region [6]. In the context of food allergies, this model presents multiple potential benefits. First, it contributes to the reduction or elimination of common allergens such as cow's milk, eggs, and shellfish, facilitating dietary management for sensitized individuals [1, 2]. To contextualize the clinical relevance of such dietary considerations, Tables 1 and 2 summarize the most prevalent allerggenic foods in pediatric and adult populations, respectively, and highlight key targets for dietary exclusion or substitution in plant-based frameworks. \begin{table}
\begin{tabular}{l l} \hline \hline
**Allergen** & **Prevalence** \\ \hline Milk & One of the most common early childhood allergies; tolerance typically develops by age 5–10. \\ Eggs & Frequently seen in young children; many outgrow it with age. \\ Peanuts & Highly persistent allergy with a low likelihood of resolution. \\ Tree nuts & Common allergens, including walnuts, hazelnuts, almonds, and pistachios; often lifelong. \\ Soy & More prevalent in young children, with many developing tolerance. \\ Wheat & Less common than celiac disease; often resolves during childhood. \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Pediatric food allergy epidemiology. Second, the high content of fermentatable fibers and polyphenols supports a resilient gut microbiota, promotes short-chain fatty acid (SCFA) production, and enhances epithelial barrier function--all mechanisms associated with reduced allergic sensitization and improved oral tolerance [4; 5; 7]. Additionally, the emphasis on minimally processed plant foods over ultra-processed alternatives aligns with lower systemic inflammation and more favorable immune regulation [8]. These characteristics make the EAT-Lancet model a promising dietary framework for integrating environmental goals with the prevention and management of allergic diseases through dietary strategies grounded in immune resilience and nutritional adequacy.