[Food allergy, food intolerance or functional disorder?].

Area of Science:

• Immunology
• Gastroenterology
• Clinical Medicine

Context:

• The terms "food allergy" and "food intolerance" are often confused, leading to misdiagnosis and inappropriate management of adverse food reactions.
• Food allergy (FA) is an immune-mediated hypersensitivity, typically involving IgE antibodies, while food intolerance (FI) encompasses non-immune adverse reactions.
• Accurate differentiation is essential for patient care and research.

Purpose:

• To clarify the distinct immunological mechanisms underlying food allergy (FA) and food intolerance (FI).
• To outline the diagnostic criteria and gold standard testing for IgE-mediated FA, including case history, sensitization tests, and oral food challenges.
• To highlight the current therapeutic limitations and the primary reliance on dietary elimination for managing FA.

Summary:

• Food allergy (FA) is an IgE-mediated immune response to specific foods, distinct from food intolerance (FI), which involves non-immune mechanisms like enzymatic or pharmacological reactions.
• Diagnosis of IgE-mediated FA relies on clinical history, IgE sensitization tests (skin prick or in vitro), and confirmed by oral provocation, with double-blind, placebo-controlled food challenges (DBPCFC) as the scientific gold standard.
• Currently, the only effective treatment for FA is the strict elimination of the causative food allergen from the diet, as causal therapies are lacking.

Impact:

• Improved understanding of FA versus FI can lead to more accurate diagnoses and personalized patient management strategies.
• Standardized diagnostic approaches, particularly DBPCFC, ensure reliable identification of food allergens, reducing risks associated with misdiagnosis.
• Future advancements in diagnostic tools, such as recombinant allergens, may refine IgE-mediated FA diagnosis, potentially paving the way for targeted therapies.