# Sustainable Plant-Based Diets and Food Allergies: A Scoping Review Inspired by EAT-Lancet
## 3 Results
### Overview of Included Studies
For example, [PERSON] and colleagues and [PERSON] and colleagues [12; 14], analyzing a combined total of over 80 studies, identify that widespread use of nuts, legumes, and seeds in plant-based products--particularly in vegan and vegetarian processed foods--can inadvertently increase allergen exposure, especially in unsupervised individuals. These authors emphasize the importance of robust food labeling practices and regulatory oversight. The observational cohort study by [PERSON] and colleagues [16], involving 2431 adult endurance athletes (vegans, vegetarians, and omnivores), reported no statistically significant difference in allergy prevalence between groups. However, the vegan subgroup displayed more restrictive dietary patterns and higher frequency of micronutrient monitoring, highlighting the potential need for closer dietary oversight in plant-based populations. Cross-sectional data from [PERSON] & [PERSON] [15], involving 62 allergic children on vegan diets, and [PERSON] and colleagues [3], assessing 43 vegetarians with legume hypersensitivities, point to an increased risk of accidental allergen exposure and nutritional imbalance in these cohorts. These studies support the concept that it is not the absence of animal products per se, but the nutritional quality, variety, and biofunctional composition of plant-based diets that determine their preventive efficacy. Several mechanistic reviews [4; 19], link these effects to the modulation of microbial metabolites, particularly butyrate, propionate, and acetate, which enhance mucosal barrier function and suppress pro-inflammatory cytokine cascades. In sensitized individuals, evidence from reviews and cross-sectional studies indicates that plant-based diets--when planned to ensure adequate micronutrient intake and minimize allergen contamination--may help reduce symptom burden. [PERSON] and colleagues [1] emphasized the role of such diets in symptom management through both dietary exclusion and promotion of anti-inflammatory and antioxidant-rich plant components, analyzing a diverse population across pediatric and adult cases. [PERSON] and colleagues [2], in a position paper grounded in expert consensus and ~50 references, argue for the potential of vegan diets in reducing the recurrence of symptoms in patients allergic to dairy and eggs, provided substitution strategies (e.g., tolerated seed-based alternatives) are employed. The emphasis is placed on structured diagnostic protocols and clinician-supervised reintroduction or exclusion pathways to prevent novel allergen exposure. [PERSON] and colleagues [3] documented that vegetarians with legume hypersensitivity may suffer from more frequent or severe allergic reactions if appropriate protein alternatives are not selected. Clinical dietetic support was associated with improved symptom control and reduction in unintentional allergen consumption. [PERSON] and colleagues [17], in a narrative synthesis of strategies for nut allergy management, reported that tree nut exclusion within plant-based diets is effective in reducing allergic episodes. However, nutritional adequacy must be ensured through inclusion of tolerated seeds (e.g., pumpkin, sunflower, and hemp), which provide protein, zinc, vitamin E, and omega-6 fatty acids, supporting both symptom control and immune resilience. The Mediterranean diet, characterized by a high intake of vegetables, fruits, legumes, whole grains, and olive oil, also demonstrates favorable outcomes. [PERSON] and colleagues [18], in a systematic review involving allergic adults with asthma and allergic rhinitis, reported clinical improvements in symptom control across multiple included studies. These outcomes were linked to the diet's anti-inflammatory and antioxidant profile--especially its richness in omega-3 fatty acids, flavonoids, and vitamin C--which is capable of modulating mucosal immune responses and downregulating allergic inflammation. Importantly, these therapeutic benefits are not solely attributable to allergen avoidance.