Abstract
Food intolerances are estimated to affect up to 20% of the population but complete understanding of diagnosis and management is complicated, given presentation and non-immunological mechanisms associated vary greatly. This review aims to provide a scientific update on common food intolerances resulting in gastrointestinal and/or extra-intestinal symptoms. FODMAP sensitivity has strong evidence supporting its mechanisms of increased osmotic activity and fermentation with the resulting distention leading to symptoms in those with visceral hypersensitivity. For many of the other food intolerances reviewed including non-coeliac gluten/wheat sensitivity, food additives and bioactive food chemicals, the findings show that there is a shortage of reproducible well-designed double-blind, placebo-controlled studies, making understanding of the mechanisms, diagnosis and management difficult. Enzyme deficiencies have been proposed to result in other food sensitivities including low amine oxidase activity resulting in histamine intolerance and sucrase-isomaltase deficiency resulting in reduced tolerance to sugars and starch. Lack of reliable diagnostic biomarkers for all food intolerances result in an inability to target specific foods in the individual. As such, a trial-and-error approach is used, whereby suspected food constituents are reduced for a short-period and then re-challenged to assess response. Future studies should aim to identify biomarkers to predict response to dietary therapies.
Highlights
Adverse food reactions are defined as any abnormal reaction following the ingestion of food
The different adverse reactions are described as food hypersensitivity, including food intolerance and food allergy, or food aversion, which is a psychological avoidance by Pavlovian conditioning of adverse reactions [1]
The definition of food intolerance is a non-immunological response initiated by a food or food component at a dose normally tolerated and account for most adverse food responses
Summary
Adverse food reactions are defined as any abnormal reaction following the ingestion of food. The different adverse reactions are described as food hypersensitivity, including food intolerance and food allergy, or food aversion, which is a psychological avoidance by Pavlovian conditioning of adverse reactions [1]. Food allergy is an abnormal immune response to a food protein mediated by immunoglobulin E (IgE), non-IgE or mixed IgE/non-IgE immunological mechanisms. Despite food intolerance being so common worldwide, the diagnosis is often not straightforward and requires an understanding of the varied clinical presentation including severity and timing of symptom onset. This is further complicated by Nutrients 2019, 11, 1684; doi:10.3390/nu11071684 www.mdpi.com/journal/nutrients
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