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Review
. 2009 May;106(21):359-69; quiz 369-70; 4 p following 370.
doi: 10.3238/arztebl.2009.0359. Epub 2009 May 22.

The differential diagnosis of food intolerance

Yurdagül Zopf  1 , Hanns-Wolf Baenkler, Andrea Silbermann, Eckhart G Hahn, Martin Raithel
Affiliations
Review

The differential diagnosis of food intolerance

Yurdagül Zopf et al. Dtsch Arztebl Int. 2009 May.

Abstract

Introduction: More than 20% of the population in industrialized countries suffer from food intolerance or food allergy.

Methods: Selective literature search for relevant publications in PubMed and the Cochrane Library combined with further data from the interdisciplinary database on chronic inflammatory and allergic diseases of the Erlangen University Hospital.

Results: The majority of cases of food intolerance (15% to 20%) are due to non-immunological causes. These causes range from pseudoallergic reactions to enzymopathies, chronic infections, and psychosomatic reactions that are associated with food intolerance. The prevalence of true food allergy, i.e., immunologically mediated intolerance reactions, is only 2% to 5%.

Conclusions: The differential diagnosis of food intolerance is broad. Therefore, a structured diagnostic algorithm with input from multiple clinical disciplines should be applied. The treatment consists of eliminating the offending substance from the diet as well as medications and psychosomatic support, when indicated.

Keywords: Food intolerance; critical appraisal; decision making; diagnosis; food allergy; histamine intolerance; provocative testing; quality assurance; study.

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Figures

Figure 1
Figure 1
Overview of range of food intolerance reactions
Figure 2
Figure 2
Examples of important functional and structural causes of food intolerances; anti-tTG antibodies, antibodies to tissue transglutaminase; EHEC, entero-toxic Escherichia coli; ETEC, entero-hemorrhagic Escherichia coli; CIBD, chronic inflammatory bowel disease
Figure 3
Figure 3
Overview of diagnostic approaches to the differential diagnostic spectrum of food intolerances and allergies; *1 both clinical pictures can also coexist; ESR, erythrocyte sedimentation rate; GPT, glutamate pyruvate transaminase; NSE neuron specific enolase; ERCP, endoscopic retrograde cholangio-pancreaticography
Figure 4
Figure 4
Immunological mechanisms in food allergies (gastrointestinally mediated Grade I-IV allergies) according to Coombs and Gell
See this image and copyright information in PMC

Comment in

  • Correction required.
    Tebbe JK, Werfel T, Niggemann B, Worm M. Tebbe JK, et al. Dtsch Arztebl Int. 2010 Jan;107(3):39; author reply 40-1. doi: 10.3238/arztebl.2010.0039a. Epub 2010 Jan 15. Dtsch Arztebl Int. 2010. PMID: 20140176 Free PMC article. No abstract available.
  • Clinical relevance.
    Schäfer C, Lepp U, Reese I. Schäfer C, et al. Dtsch Arztebl Int. 2010 Jan;107(3):39; author reply 40-1. doi: 10.3238/arztebl.2010.0039b. Epub 2010 Jan 15. Dtsch Arztebl Int. 2010. PMID: 20140177 Free PMC article. No abstract available.
  • Bacteriological stool examinations.
    Mrowietz-Ruckstuhl B. Mrowietz-Ruckstuhl B. Dtsch Arztebl Int. 2010 Jan;107(3):40; author reply 40-1. doi: 10.3238/arztebl.2010.0040a. Epub 2010 Jan 15. Dtsch Arztebl Int. 2010. PMID: 20140178 Free PMC article. No abstract available.

References

    1. Crowe SE, Perdue MH. Gastrointestinal food hypersensitivity: basic mechanisms of pathophysiology. Gastroenterology. 1992;103:1075–1095. - PubMed
    1. Raithel M HE, Baenkler HW. Klinik und Diagnostik von Nahrungsmittelallergien (Gastrointestinal vermittelte Allergien Grad I-IV) Dtsch Arztebl. 2002;99(103):717–728.
    1. Teitelbaum JE FG. Immune mechanisms of food allergy. Curr Opin Gastroenterol. 1998;14:498–503.
    1. Aiuti F, Paganelli R. Food allergy and gastrointestinal diseases. Ann Allergy. 1983;51(2 Pt 2):275–280. - PubMed
    1. Baenkler H. Salicylatintoleranz: Pathophysiologie, klinisches Spektrum, Diagnostik und Therapie. Dtsch Arztebl. 2008;105(8):137–142. - PubMed

MeSH terms