Debates in allergy medicine: food intolerance does exist

Area of Science:

• Pediatric Gastroenterology
• Clinical Immunology
• Allergy and Intolerance Diagnostics

Background:

• Healthcare professionals and patients often confuse hypersensitivity, allergy, and intolerance, leading to diagnostic discrepancies.
• Current terminology lacks clarity, causing confusion in identifying and managing adverse food reactions.
• A consensus on precise terminology is needed to improve patient care and diagnostic accuracy.

Purpose of the Study:

• To clarify proposed terminology for adverse food reactions for primary healthcare professionals.
• To provide a pediatric gastroenterologist's perspective on differentiating food allergy, intolerance, and related symptoms.
• To establish clear definitions that aid in accurate diagnosis and management.

Main Methods:

• Review and redefinition of existing terms: allergy, intolerance, hypersensitivity.
• Clinical case examples illustrating diagnostic challenges in pediatric gastroenterology.
• Proposal of a standardized terminology for describing symptoms related to food ingestion.

Main Results:

• "Food related symptom" is proposed for cases with unidentified pathophysiological mechanisms.
• Intolerance should be reserved for symptomatic carbohydrate malabsorption.
• Allergy should be defined by immune-mediated mechanisms (IgE or non-IgE).
• (Hyper)sensitivity is deemed inappropriate due to its suggestion of unproven immune involvement.
• Diagnostic tools for non-IgE mediated allergy are lacking in primary care.

Conclusions:

• "Food related symptom" is recommended when the underlying mechanism is unclear.
• Intolerance is defined as symptomatic carbohydrate malabsorption.
• Allergy should be exclusively used when immune system involvement is confirmed.