Food allergy and attention-deficit/hyperactivity disorder in children: evidence and implications for pediatric allergy practice

Families of children with food allergies (FA) and attention-deficit/hyperactivity disorder (ADHD) often ask whether the conditions are related and whether dietary changes could improve their children's attention or behavior. This narrative review examines FA-specific evidence and its implications for pediatric allergy practices, drawing on observational studies, reviews, clinical guidance, and contextual mechanistic research. One small FA-specific meta-analysis found no statistically significant association, whereas several individual observational studies reported positive associations. Differences in diagnostic definitions, reporting sources, temporal assessment, and confounder adjustment limited the ability to make comparisons. Studies of broader allergic phenotypes and Mendelian randomization provide no FA-specific causal estimate, and proposed microbiota-immune-brain pathways remain unconfirmed in humans. Restrictive or elimination diets should not be routinely recommended for ADHD because evidence of sustained benefit is limited, and additional restriction may compromise nutrition or worsen feeding difficulties, particularly in children already avoiding allergens. Pediatric allergy care should verify the FA diagnosis, preserve tolerated foods, monitor growth and dietary adequacy, and refer persistent attention or behavioral concerns for appropriate assessment. This review distinguishes direct FA evidence from broader allergy findings and relates these uncertainties to practical decisions about diagnosis, dietary restriction, and coordinated care.