Psychopathology masquerading as food allergy

Three patients who presented with vague symptoms previously diagnosed as food allergy are reviewed. No evidence for allergy to foods was found in any of the patients. Two were depressed with psychotic thinking and the third had moderately severe anxiety with depression. All three improved following psychiatric diagnosis and intervention. One was treated with antidepressant and one with antidepressant-antipsychotic medication. All three maintained improvement two years later. The diagnosis of food allergy must be based on showing a direct relationship between the inciting food and the immunologically mediated reaction. Anxiety and depression may masquerade as food allergy. Evidence of psychopathology should be present to make such a diagnosis.