Nonallergic Diseases Associated With Foods

Area of Science:

• Gastroenterology and Immunology
• Clinical Nutrition
• Allergy and Immunology

Background:

• Clinicians often evaluate food reactions, distinguishing between allergic and non-allergic causes.
• Non-immunoglobulin E (IgE)-mediated food reactions encompass a spectrum of conditions with varying severity.
• Understanding these non-IgE mediated diseases is crucial for accurate diagnosis and management.

Approach:

• This review synthesizes current knowledge on the pathogenesis, diagnosis, and treatment of non-IgE-mediated food-related conditions.
• It examines available diagnostic tests for immunologic and non-immunologic non-IgE-mediated diseases.
• The review also addresses the diagnostic challenges and therapeutic approaches for conditions like nonceliac gluten sensitivity and irritable bowel syndrome.

Key Points:

• Defined non-IgE-mediated diseases such as celiac disease, carbohydrate maldigestion, pancreatic insufficiency, and histamine intolerance have diagnostic criteria and testing.
• Nonceliac gluten sensitivity and irritable bowel syndrome lack definitive diagnostic tests but are linked to dietary triggers (FODMAPs).
• Dietary alteration can be both diagnostic and therapeutic for nonceliac gluten sensitivity and irritable bowel syndrome after ruling out other conditions.

Conclusions:

• Accurate diagnosis of non-IgE-mediated food reactions requires careful clinical evaluation and appropriate testing.
• While some non-IgE-mediated conditions have established diagnostic pathways, others like nonceliac gluten sensitivity remain challenging.
• Dietary interventions are essential considerations in managing patients with suspected food reactions, particularly functional gastrointestinal disorders.