Debates in allergy medicine: food intolerance does not exist

Area of Science:

• Allergy and immunology
• Pediatric gastroenterology
• Clinical nomenclature

Background:

• The term "intolerance" is not recognized in World Allergy Organization (WAO) allergy nomenclature.
• Pediatric gastroenterologists often conflate allergy and intolerance, using terms like "cow's milk protein allergy/intolerance (CMPA/I)" for various cow's milk sensitivities.
• This conflation stems partly from the impracticality of diagnostic food challenges, leading to proposed exclusion/reintroduction methods in primary care.

Purpose of the Study:

• To delineate the reasons for excluding the term "intolerance" from the field of allergy.
• To advocate for precise terminology in diagnosing pediatric gastrointestinal issues.

Main Methods:

• Literature review and analysis of current allergy nomenclature standards.
• Discussion of the clinical implications of using mixed terminology in pediatric allergy.

Main Results:

• "Intolerance" is used by the public to mean "not tolerating" and by clinicians for non-immunological hypersensitivity (e.g., lactose intolerance), which is acceptable.
• The combined term "CMPA/I" is problematic as it groups diverse gastrointestinal symptoms and underlying mechanisms.
• Current WAO nomenclature lacks clear distinction between non-IgE-mediated allergy and non-allergic hypersensitivity.

Conclusions:

• The term "intolerance" should be reserved for non-immunological/non-allergic conditions and not combined with allergy terms like CMPA/I.
• Clearer definitions and restricted use of "intolerance" are needed to avoid diagnostic confusion.
• A revision of the WAO nomenclature is recommended to improve clarity in allergy and hypersensitivity distinctions.