Skip to main content

Advertisement

Springer Nature Link
Log in

Differentiating Food Allergies from Food Intolerances

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Adverse reactions to foods are extremely common, and generally they are attributed to allergy. However, clinical manifestations of various degrees of severity related to ingestion of foods can arise as a result of a number of disorders, only some of which can be defined as allergic, implying an immune mechanism. Recent epidemiological data in North America showed that the prevalence of food allergy in children has increased. The most common food allergens in the United States include egg, milk, peanut, tree nuts, wheat, crustacean shellfish, and soy. This review examines the various forms of food intolerances (immunoglobulin E [IgE] and non–IgE mediated), including celiac disease and gluten sensitivity.

  • Immune mediated reactions can be either IgE mediated or non-IgE mediated. Among the first group, Immediate GI hypersensitivity and oral allergy syndrome are the best described.

  • Often, but not always, IgE-mediated food allergies are entities such as eosinophilic esophagitis and eosinophilic gastroenteropathy.

  • Non IgE-mediated immune mediated food reactions include celiac disease and gluten sensitivity, two increasingly recognized disorders.

  • Finally, non–immune mediated reactions encompass different categories such as disorders of digestion and absorption, inborn errors of metabolism, as well as pharmacological and toxic reactions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1-58. This article is a result of an expert consensus convened by the National Institutes of Allergy and Infectious Diseases (NIAID), part of the NIH. It provides new guidelines regarding diagnosis and management of food allergies in the United States.

    PubMed  Google Scholar 

  2. •• Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183–91. The American Academy of Pediatrics new policy statement on dietary management for the prevention of atopic disease. The recommendations in this important update represent a somewhat revolutionary change from the previous guidelines, acknowledging the lack of evidence for the delayed introduction of some food proteins in children at risk of atopy.

    Article  PubMed  Google Scholar 

  3. Lohi S, Mustalahti K, Kaukinen K, et al. Increasing prevalence of coeliac disease over time. Aliment Pharmacol Ther. 2007;26(9):1217–25.

    Article  PubMed  CAS  Google Scholar 

  4. Rubio-Tapia A, Kyle RA, Kaplan EL, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009;137(1):88–93.

    Article  PubMed  Google Scholar 

  5. Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124(6):1549–55.

    Article  PubMed  Google Scholar 

  6. Sicherer SH, Munoz-Furlong A, Burks AW, Sampson HA. Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey. J Allergy Clin Immunol. 1999;103(4):559–62.

    Article  PubMed  CAS  Google Scholar 

  7. Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2011;128(1):3–20

    Article  PubMed  CAS  Google Scholar 

  8. • Lack G. Epidemiologic risks for food allergy. J Allergy Clin Immunol. 2008;121(6):1331–6. This article reviews possible risk factors and theories for the development of food allergy and proposes a provocative alternative hypothesis, suggesting that sensitization to allergen occurs through environmental exposure to allergen through the skin and that consumption of food allergen induces oral tolerance.

    Article  PubMed  CAS  Google Scholar 

  9. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2006;117(2 Suppl Mini-Primer):S470–5.

    Article  PubMed  CAS  Google Scholar 

  10. Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol. 2007;120(5):1172–7.

    Article  PubMed  CAS  Google Scholar 

  11. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. 2007;120(6):1413–7.

    Article  PubMed  CAS  Google Scholar 

  12. Savage JH, Kaeding AJ, Matsui EC, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol. 2010;125(3):683–6.

    Article  PubMed  CAS  Google Scholar 

  13. • Kotaniemi-Syrjanen A, Palosuo K, Jartti T, Kuitunen M, Pelkonen AS, Makela MJ. The prognosis of wheat hypersensitivity in children. Pediatr Allergy Immunol. 2010;21(2 Pt 2):e421-8. The study aimed to determine the natural history of wheat hypersensitivity and to define risk factors for persistent wheat hypersensitivity. The authors showed that almost all children with wheat hypersensitivity can tolerate wheat by adolescence.

    Article  PubMed  Google Scholar 

  14. Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA. The natural history of wheat allergy. Ann Allergy Asthma Immunol. 2009;102(5):410–5.

    Article  PubMed  CAS  Google Scholar 

  15. Byrne AM, Malka-Rais J, Burks AW, Fleischer DM. How do we know when peanut and tree nut allergy have resolved, and how do we keep it resolved? Clin Exp Allergy. 2010;40(9):1303–11.

    Article  PubMed  CAS  Google Scholar 

  16. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S116–25.

    Article  PubMed  Google Scholar 

  17. • Chafen JJ, Newberry SJ, Riedl MA, et al. Diagnosing and managing common food allergies: a systematic review. JAMA. 2010;303(18):1848–56. A comprehensive and rigorous systematic review of publications regarding the diagnosis and management of food allergies from 1988 to 2009. The authors conclude that the evidence for the prevalence and management of food allergy is greatly limited by a lack of uniformity for criteria for making a diagnosis.

    Article  PubMed  Google Scholar 

  18. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol. 1997;100:444–51.

    Article  PubMed  CAS  Google Scholar 

  19. Sampson HA. Utility of food-specific IgE concentration in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001;107:891–6.

    Article  PubMed  CAS  Google Scholar 

  20. Edwards HE. Oral Desensitization in Food Allergy. Can Med Assoc J. 1940;43(3):234–6.

    PubMed  CAS  Google Scholar 

  21. •• Varshney P, Jones SM, Scurlock AM, et al. A randomized controlled study of peanut oral immunotherapy: clinical desensitization and modulation of the allergic response. J Allergy Clin Immunol. 2011;127(3):654–60. A multicenter study, the first of its kind double blind and placebo controlled, investigating the safety and effectiveness of oral immunotherapy (desensitization) for peanut allergy in 28 children. The study shows that peanut oral immunotherapy was able to induce desensitization and concurrent immune modulation.

    Article  PubMed  CAS  Google Scholar 

  22. Zapatero L, Alonso E, Fuentes V, Martinez MI. Oral desensitization in children with cow's milk allergy. J Investig Allergol Clin Immunol. 2008;18(5):389–96.

    PubMed  CAS  Google Scholar 

  23. Morisset M, Moneret-Vautrin DA, Guenard L, et al. Oral desensitization in children with milk and egg allergies obtains recovery in a significant proportion of cases. A randomized study in 60 children with cow's milk allergy and 90 children with egg allergy. Eur Ann Allergy Clin Immunol. 2007;39(1):12–9.

    PubMed  CAS  Google Scholar 

  24. Meglio P, Bartone E, Plantamura M, Arabito E, Giampietro PG. A protocol for oral desensitization in children with IgE-mediated cow's milk allergy. Allergy. 2004;59(9):980–7.

    Article  PubMed  CAS  Google Scholar 

  25. Martorell A, De la Hoz B, Ibanez MD, et al. Oral desensitization as a useful treatment in 2-year-old children with cow's milk allergy. Clin Exp Allergy. Apr 11 2011.

  26. Kim JS, Nowak-Wegrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA. Dietary baked milk accelerates the resolution of cow's milk allergy in children. J Allergy Clin Immunol. May 20 2011.

  27. • Land MH, Kim EH, Burks AW. Oral desensitization for food hypersensitivity. Immunol Allergy Clin North Am. 2011;31(2):367–76. This article examines the mechanisms of oral tolerance and the breakdown that leads to food allergy, as well as the history and current state of oral and sublingual immunotherapy development.

    Article  PubMed  Google Scholar 

  28. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106(2 Pt 1):346–9.

    Google Scholar 

  29. Host A, Halken S, Muraro A, et al. Dietary prevention of allergic diseases in infants and small children. Pediatr Allergy Immunol. 2008;19(1):1–4.

    Article  PubMed  Google Scholar 

  30. Fifty-Fourth World Health Assembly Provisional Agenda Item 13.1.1. Global strategy for infant and young child feeding: the optimal duration of exclusive breastfeeding. Geneva: World Health Organization; 2001.

  31. •• Berg A, Kramer U, Link E, et al. Impact of early feeding on childhood eczema: development after nutritional intervention compared with the natural course - the GINIplus study up to the age of 6 years. Clin Exp Allergy. 2010;40(4):627–36. A study in almost 6000 children aiming to compare the course of eczema in predisposed children after nutritional intervention with hydrolyzed formulas to the natural course of eczema. The results suggest that early intervention with hydrolyzed infant formulas can substantially compensate up until the age of 6 years for an enhanced risk of childhood eczema due to familial predisposition to allergy.

    PubMed  CAS  Google Scholar 

  32. Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003;111(4 Pt 1):829–35.

    Article  PubMed  Google Scholar 

  33. Caubet JC, Nowak-Wegrzyn A. Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome. Expert Rev Clin Immunol. 2011;7(3):317–27.

    Article  PubMed  CAS  Google Scholar 

  34. Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009;123(3):e459–64.

    Article  PubMed  Google Scholar 

  35. Katz Y, Goldberg MR, Rajuan N, Cohen A, Leshno M. The prevalence and natural course of food protein-induced enterocolitis syndrome to cow's milk: a large-scale, prospective population-based study. J Allergy Clin Immunol. 2011;127(3):647–653 e641-643.

    Google Scholar 

  36. Chang JW, Wu TC, Wang KS, Huang IF, Huang B, Yu IT. Colon mucosal pathology in infants under three months of age with diarrhea disorders. J Pediatr Gastroenterol Nutr. 2002;35(3):387–90.

    Article  PubMed  Google Scholar 

  37. Chehade M, Magid MS, Mofidi S, Nowak-Wegrzyn A, Sampson HA, Sicherer SH. Allergic eosinophilic gastroenteritis with protein-losing enteropathy: intestinal pathology, clinical course, and long-term follow-up. J Pediatr Gastroenterol Nutr. 2006;42(5):516–21.

    Article  PubMed  Google Scholar 

  38. •• Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128(1):3–20. Updated consensus recommendations for eosinophilic esophagitis. The paper includes a review of previous guidelines, summary of the literature, committee recommendations and recommendations for the future.

  39. Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104 Suppl 1:S1–S35.

    PubMed  Google Scholar 

  40. Verdu EF. Editorial: Can gluten contribute to irritable bowel syndrome? Am J Gastroenterol. 2011;106(3):516–8.

    Article  PubMed  CAS  Google Scholar 

  41. Sapone A, Lammers KM, Casolaro V, et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011;9:23.

    Article  PubMed  CAS  Google Scholar 

  42. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106(3):508–514; quiz 515.

    Google Scholar 

  43. • Troncone R, Jabri B. Coeliac disease and gluten sensitivity. J Intern Med. 2011;269(6):582–590. A timely review on celiac disease and gluten sensitivity, examining the possible immunological mechanisms underlying these conditions. Emphasis is given to specific autoantibodies as markers of the celiac spectrum and to the hypothesis that innate epithelial stress can exist independently from adaptive intestinal immunity in gluten sensitivity.

    Article  PubMed  CAS  Google Scholar 

  44. Abadie V, Sollid LM, Barreiro LB, Jabri B. Integration of genetic and immunological insights into a model of celiac disease pathogenesis. Annu Rev Immunol. 2011;29:493–525.

    Article  PubMed  CAS  Google Scholar 

  45. Dickey W, Hughes DF, McMillan SA. Patients with serum IgA endomysial antibodies and intact duodenal villi: clinical characteristics and management options. Scand J Gastroenterol. 2005;40(10):1240–3.

    Article  PubMed  Google Scholar 

  46. Kurppa K, Ashorn M, Iltanen S, et al. Celiac disease without villous atrophy in children: a prospective study. J Pediatr. 2010;157(3):373–80, 380 e371.

    Google Scholar 

  47. Kurppa K, Collin P, Viljamaa M, et al. Diagnosing mild enteropathy celiac disease: a randomized, controlled clinical study. Gastroenterology. 2009;136(3):816–23.

    Article  PubMed  Google Scholar 

  48. Tosco A, Salvati VM, Auricchio R, et al. Natural history of potential celiac disease in children. Clin Gastroenterol Hepatol. 2011;9(4):320–5; quiz e336.

    Google Scholar 

  49. Fleischer DM, Bock SA, Spears GC, et al. Oral food challenges in children with a diagnosis of food allergy. J Pediatr. 2011;158(4):578–83 e571.

    Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Section of Pediatric Gastroenterology, Celiac Disease Center, University of Chicago, 5839 S. Maryland Ave, MC 4065, Chicago, IL, 60637, USA

    Stefano Guandalini & Catherine Newland

Authors
  1. Stefano Guandalini
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Catherine Newland
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Stefano Guandalini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guandalini, S., Newland, C. Differentiating Food Allergies from Food Intolerances. Curr Gastroenterol Rep 13, 426–434 (2011). https://doi.org/10.1007/s11894-011-0215-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-011-0215-7

Keywords

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy