A diet low in antigenic items was used to treat 63 children with epilepsy refractory to medication at the Depts of Neurology, Immunology, and Dietetics, The Hospital for Sick Children, Great Ormond Street, and the Institute of Child Health, London, England. The authors had previously reported beneficial effects of the “oligoantigenic” diet in the treatment of migraine (Lancet 1983;2:865) and the hyperkinetic syndrome (Lancet 1985 ;1: 940 ) . The diet consisted of 2 meats (lamb and chicken), 2 carbohydrates (potatoes and rice), 2 fruits (banana and apple), vegetables (cabbage, sprouts, cauliflower, broccoli, cucumber, celery, carrots, parsnips), water, salt, pepper, pure herbs, and calcium and vitamins for 4 weeks. Patients who responded (no seizures or migraine for the last 2 weeks) were reintroduced to essential foods (eg. milk, cheese, wheat) at the rate of one a week. If symptoms were provoked, soy-based or goat milk products, rye or oats were substituted. Setbacks were avoided by first giving foods least likely to be antigenic (eg. beef, oats, peaches, or grapes). Of 45 children who had epilepsy with recurrent headaches, abdominal symptoms, or hyperkinetic behavior, 25 had no seizures and 11 had fewer seizures during diet therapy. Foods most likely to provoke seizures when reintroduced were cow milk and cheese, citrus fruits, wheat, tartrazine and benzoic acid food additives, eggs, tomato, pork, and chocolate. In double-blind, placebo-controlled provocation studies introducing cow milk, orange juice, wheat, pork, egg, and benzoate, symptoms recurred in 15 of 16 children, including seizures in 8; none recurred with placebo. The oligoantigenic diet was unsuccessful in the treatment of 18 children who had epilepsy uncomplicated by migraine or hyperkinetic behavior. [1]

COMMENT. If reproducible and sustained, these results are impressive and deserve further investigation in children with frequently recurrent seizures and headache resistant to anticonvulsant medication. The authors point out that the diets are socially disruptive and may cause malnutrition. In the US, pediatric allergists are not generally impressed with the theory of food hypersensitivity as a cause of neurological disease and their enthusiastic collaboration in studies of this type is not readily available.