[Sick of food? Knowledge and hypothesis on food intolerance]

Food intolerance is frequently reported by patients and represent a diagnostic and therapeutic challenge. We review the nomenclature and report on symptoms, diagnostic tests and treatment. The nomenclature presented is based on the primary events such as toxic reactions, allergy or an undefined mechanism, including psychosomatic, although these subgroups may involve common pathogenetic mechanism. Double blind placebo controlled food challenge is the golden standard in the diagnostic workup and the importance of elimination diets--individually tailored to each patients requirements in cooperation with a nutritionist--is stressed. Through strict adherence to diagnostic and therapeutical guidelines, therapy may resolve food induced symptoms. Based on preliminary findings of signal transduction, we propose that symptoms in some patients may depend on an allergy type IV reaction. This working hypothesis forms the basis for further accumulation of knowledge of food intolerance reactions.