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Food intolerances—a diagnostic challenge

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Abstract

Background

Food-associated complaints in the gastrointestinal tract can be signs of an intolerance of different etiology, which is reported by almost a quarter of the population. Due to the unspecific symptoms, a whole range of different triggers and immune reactions can be considered for the differential diagnosis, which cannot always be determined unambiguously and quickly.

Differentiation and diagnosis of disease entity

The time course in connection with the clinical picture already allows a rough estimation of the underlying pathomechanism and points the diagnostic way. Thus, immune-mediated clinical pictures such as allergy must be distinguished from nonimmune-mediated intolerances. An allergic reaction can be IgE-mediated or cellularly induced. Secondary food allergies are triggered by other allergens than primary allergies, differ in their sensitization routes and course of disease. Non-immunological intolerance reactions also play a not insignificant role, including carbohydrate utilization disorders and histamine intolerance in addition to toxic reactions. Often difficult to identify are also those food components which trigger a nonspecific mast cell activation. Due to their particular clinical relevance, wheat intolerances of different pathogenesis are also discussed. As a consequence of their complexity with regards to disease-causing proteins, target organ manifestations, pathomechanisms and diagnostic clarification, these require a particularly differentiated approach.

Purpose

This review article presents the current recommendations regarding the diagnosis of food intolerance and food allergy, with a separate focus on the specifics in the interpretation of different tests including IgE diagnostics.

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Abbreviations

α‑Gal:

Galactose-α‑1,3‑galactose

DD:

Differential diagnoses

EGID:

Eosinophilic gastrointestinal disorder

EoE:

Eosinophilic esophagitis

FA:

Food allergy

FPIES:

Food protein-induced enterocolitis syndrome

HIT:

Histamine intolerance

HWP:

Hydrolyzed wheat protein

IBD:

inflammatory bowel disease

IBS:

Irritable bowel syndrome

IFN γ:

Interferon γ

Ig:

Immunoglobulin

nsLTP:

Nonspecific lipid transfer protein

OAS:

Oral allergy syndrome

WDEIA:

Wheat-dependent exercise-induced anaphylaxis

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Authors and Affiliations

  1. Competence Center for Allergology and Immunology, Karl Landsteiner Private University for Health Sciences, Krems, Austria

    U. Petra Zieglmayer

  2. Vienna Challenge Chamber, Vienna, Austria

    U. Petra Zieglmayer

  3. Floridsdorfer Allergiezentrum, Vienna, Austria

    Wolfgang Hemmer

  4. MacroArray Diagnostics GmbH, Vienna, Austria

    Sandra Wieser

  5. Institute of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria

    Karin Hoffmann-Sommergruber

Authors
  1. U. Petra Zieglmayer
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  2. Wolfgang Hemmer
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  3. Sandra Wieser
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  4. Karin Hoffmann-Sommergruber
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Correspondence to U. Petra Zieglmayer.

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Conflict of interest

U. P. Zieglmayer discloses that she was employed by Thermo Fisher Scientific until September 2019. There is no conflict of interest with the present work. S. Wieser states that she is employed by MacroArray Diagnostics. There is no conflict of interest with the present work. W. Hemmer and K. Hoffmann-Sommergruber declare that they have no competing interests.

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Zieglmayer, U.P., Hemmer, W., Wieser, S. et al. Food intolerances—a diagnostic challenge. Allergo J Int 31, 23–35 (2022). https://doi.org/10.1007/s40629-021-00194-2

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  • DOI: https://doi.org/10.1007/s40629-021-00194-2

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