Food intoleranceT78.19

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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DefinitionThis section has been translated automatically.

Dose-dependent, non-immunological intolerance reaction to various food components with different symptoms. Clinical symptoms are already possible at first contact with the trigger.

Occurrence/EpidemiologyThis section has been translated automatically.

The prevalence of food intolerance reactions of different pathogenesis, which was determined on the basis of self-reports in individual studies, ranges from 2.1% for children in France to 35% for Berlin adults. Women more frequently report food intolerance reactions.

EtiopathogenesisThis section has been translated automatically.

The causes are often intolerances to biogenic amines (see also histamine intolerance), e.g. after eating fish (e.g. tuna, mackerel), certain types of cheese (e.g. cheddar), beer, wine and diseases such as lactose intolerance (due to a lack of the enzyme lactase), fructose intolerance, proctocolitis associated with breast or cow's milk and food protein-induced enterocolitis syndrome (FPIES), which is triggered by soya or cow's milk products (see below cow's milk allergy).

Clinical featuresThis section has been translated automatically.

Intolerance reactions usually occur 30 minutes to 3 hours after administration of an agent (latency periods of up to 24 hours are possible). In the foreground of clinical symptoms are type I analogous symptoms, especially urticaria, angioedema, skin redness, headache, bronchial symptoms. S.a.u. Scombroid poisoning. Atopic and dyshidrotic eczema may worsen. In the following refractory period (approx. 72 hours) the substances are tolerated again for a short time. Relatively frequent is also a salicylate intolerance or sulphite hypersensitivity.

DiagnosisThis section has been translated automatically.

Diagnostically important is the determination of the triggering substance by specific, exact anamnesis, if necessary, keeping a record in case of recurrence. Testing with a diagnostic diet (see table 2 Food allergy) under stationary conditions: allergen-free diet (potato and rice diet), testing of colouring and preservatives (see table 3 Food allergy) per capsule, then provoking with original food (emergency preparedness!). Patients must be free of symptoms at the time of testing and have a sufficient time interval to take immunomodulating medication ( systemic glucocorticoids: 3 days, systemic antihistamines: 5 days).

TherapyThis section has been translated automatically.

  • Acute type I symptoms are treated according to the individual stages of the anaphylactic reaction (see shock, anaphylactic).
  • Take a detailed anamnesis and keep a record if necessary. Exclusion of a food allergy by testing.
  • Avoid the agent for 6-12 months, then provocation testing. Pronounced tendency to spontaneous healing. 30% of the patients remain free of symptoms after 1 year of waiting for re-exposure.

Note(s)This section has been translated automatically.

The term "food intolerances" is sometimes also defined in an overarching way, as "all pathological phenomena that occur in connection with the intake of food, spices and food additives". The following classification results from this definition:

Non-toxic reaction:

  • Immunologically caused:
    • IgE-mediated (food allergy)
    • not IgE-mediated (e.g. celiac disease).
  • Not immunological (food intolerance):
    • Unclear (e.g. Additiva intolerance, protein intolerances that cannot be further attributed - e.g. enterocolitis syndrome, food protein-induced)
    • Pharmacological (e.g. biogenic amines)
    • Enzymatic (e.g. lactose, -histamine intolerance).

Toxic reaction (e.g. histamine poisoning, bacterial contamination).

LiteratureThis section has been translated automatically.

  1. Bertram B (1987) Dyes: How dangerous are they really? An overview of substances used for food and drug colouring. Dt Apotheker Zeitung 127: 499-508
  2. Breuer K et al (2003) The impact of food allergy in patients with atopic dermatitis. dermatologist 54: 121-129
  3. de Leon MP et al (2003) Immunological analysis of allergenic cross-reactivity between peanut and tree nuts. Clin Exp Allergy 33: 1273-1280
  4. Ma S et al (2003) A survey on the management of pollen-food allergy syndrome syndrome in allergy practices. J Allergy Clin Immunol 112: 784-788
  5. Maurer M et al (2003) Relevance of food allergies and intolerance reactions as causes of urticaria. dermatologist 54: 138-143
  6. Ring (1991) Applied allergology. MMW publishing house, Munich S. 112-121
  7. Ring J et al (1987) Allergy Diet: Methods for the diagnosis and treatment of food allergy and pseudo-allergy. dermatologist 38: 198-205
  8. Schäfer T (2008) Epidemiology of food allergy in Europe. Allergology 31: 255-263
  9. Schafer T et al (2003) Epidemiology of food allergies. dermatologist 54: 112-120
  10. Zuberbier T et al (1992) Food intolerance. dermatologist 43: 805-811

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer