Definitions and diagnosis of food intolerance and food allergy: consensus and controversy.

Abstract

This article describes the terms used for the various syndromes and diseases associated with reactions to foods; it outlines the principal types of food intolerance encountered in children, with particular emphasis on those caused by immune-mediated reactions of immediate hypersensitivity. Terms defined include food intolerance or food sensitivity; food allergy or food hypersensitivity; psychologically based food reactions (food aversions); and psychosocial and neurologic dysfunction. The spectrum of food sensitivity is considerable, and diagnosis is generally based on the monitoring of effects of exclusion diets and provocation tests, after appropriate objective measures are first selected. In children, manifestations of IgE-mediated food allergy (often in association with other immune mechanisms) include self-limiting and immediate reactions (e.g., urticaria, wheeze) and chronic diseases (food-sensitive enteropathies, eczema). Controversial and unresolved issues exist with some other conditions, including eosinophilic gastroenteritis, occult gastrointestinal bleeding, protein-losing enteropathy, and attention deficit disorder with hyperactivity. New methods for clinical investigation of gastrointestinal tract function and intestinal immune reactions are required to assess the relevance of foods in these conditions.