Allergist, nutritionist or dietician?

The Pediatric Insider

© 2012 Roy Benaroch, MD

Anthony wrote in, “My son has a lot of allergies, and I’m not sure what is safe to feed him. Should I see an allergist or a nutritionist?”

Anthony, the first step is to figure out exactly what foods are truly allergic triggers. Many people have the impression they’re allergic to things for a variety of reasons, but they really aren’t. The best way to know for sure is by the history– what reaction occurs when your son eats that food? Though allergy testing is available, it isn’t exact, and doesn’t always show what the true allergies are. Even people who test positive for allergies might not really be allergic.

However, if your son really has food allergies, it is important to avoid those food triggers. You should work with either a pediatrician or allergist to determine what foods need to be avoided. There seem to be many “alternative practitioners” in the world of allergy these days, and they sometimes offer non-standard or genuinely quacky testing. Beware. Work with someone who’s board-certified and knows what they’re doing. Your pediatrician should be able to offer you a referral.

Kids with multiple food allergies can be challenging at mealtimes. If you’re having trouble coming up with a good, well-balanced, and safe diet, working with an expert in nutrition is a very good idea. Again, you need to be careful. A “nutritionist” can be anyone. That word doesn’t have any legal meaning, and there are no educational requirements or certifying authority for nutritionists. Basically, anyone can call themselves a nutritionist, and some of them may have no idea what they’re talking about. A genuine authority on feeding and nutrition is called a “dietician”. Requirements vary by state, but to call yourself a dietician means that you’ve met educational and practice guidelines. Working with a dietician is a very good idea for families with kids who have multiple allergies or other dietary issues. Working with a nutritionist may be a waste of money, or worse.

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4 Comments on “Allergist, nutritionist or dietician?”

  1. Cal Says:

    I am dealing with a similar issue, although I am still at the beggining and I am not sure exactly what is up.
    My toddler consistently has the same reaction to cows milk: rash and foul diarrhea. Is this a true sign of an allergy or just an intolerance because he cannot properly digest it yet? And is allergy testing even valid at this age (16m) or we should just wait for it to wane?


  2. Kay Says:

    Head straight to the allergist. We seemed to have multiple allergy issues of sorts. It turned out to be a cryopyrinopathy syndrome. Nothing was going to eliminate the rash but a correct diagnosis and medication to combat the underlying chronic inflammation.


  3. Dr. Roy Says:

    Cal, if your child has the same uncomfortable reaction to milk exposure, you ought to avoid milk. It may or may not be a true “allergy” (that is, mediated by a truly allergic mechanism)– but in any case it’s a consistent adverse reaction to a specific food, or a food intolerance. A pediatrician or allergist could probably make that determination from the history, perhaps accompanied by photographs of the rash. With a clear-cut history, no “testing” is needed.


  4. Cal Says:

    Thank you Dr. Roy for your input. I appreciate it.


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