Food intolerance and food allergy in adults: An overview
- Scott P Commins, MD, PhD
Scott P Commins, MD, PhD
- Associate Professor of Medicine
- University of North Carolina School of Medicine
Food allergies are adverse reactions to foods due to immunologic mechanisms. Most adverse food reactions in adults are due to various forms of food intolerance, which are nonimmunologic reactions. This topic provides an overview of the most common forms of food allergies seen in adults and briefly outlines the many different forms of food intolerance. Childhood food allergy is presented elsewhere in detail, as are specific food allergy syndromes. (See "Food allergy in children: Prevalence, natural history, and monitoring for resolution" and "Clinical manifestations of food allergy: An overview".)
NONALLERGIC ADVERSE FOOD REACTIONS
Nonallergic adverse food reactions can arise from gastroesophageal reflux disease (GERD), gastrointestinal infections, deficiency of digestive enzymes, disorders resulting from anatomic and neurologic abnormalities, metabolic diseases, toxin-mediated reactions, and a host of other processes (table 1) [1-5].
Food intolerance — Food intolerance refers to difficulty digesting or metabolizing a particular food. Food intolerance disorders are a subset of all adverse food reactions and are reported by 15 to 20 percent of the population . Food intolerances are even more common among patients with irritable bowel syndrome and other functional gastrointestinal disorders, with 50 to 80 percent reporting consistent problems with certain foods [7-9]. (See "Pathophysiology of irritable bowel syndrome", section on 'Food sensitivity'.)
Comparison with food allergy — Food intolerances are not immunologic allergies and do not carry the same risk, although patients may not appreciate this distinction. A simple way to explain the difference is that food intolerance generally involves the digestive system, the amount of food ingested is directly related to the severity of symptoms, and the food causes similar symptoms with each exposure. In contrast, food allergies involve the immune system, and with immunoglobulin E (IgE)-mediated food allergies, even tiny amounts of the food can cause severe reactions. Finally, IgE-mediated, food-allergic reactions are unpredictable and have the potential to progress to a serious or life-threatening reaction called anaphylaxis.
Clinical features of food intolerance — Clinical features of food intolerances traverse a spectrum of organ systems and vary among different disorders, although most involve prominent gastrointestinal symptoms. Excessive intestinal gas, bloating, abdominal pain, and diarrhea are common symptoms.
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- NONALLERGIC ADVERSE FOOD REACTIONS
- Food intolerance
- - Comparison with food allergy
- - Clinical features of food intolerance
- - Specific disorders
- - Unproven syndromes of food intolerance
- DEFINITION OF FOOD ALLERGY
- IMMEDIATE (IgE-MEDIATED) FOOD ALLERGY
- - Predisposing factors
- Signs and symptoms
- Causative foods and allergens
- Common types of IgE-mediated food allergy
- - Oral allergy syndrome
- - Seafood allergies
- - Peanut and tree nut allergies
- Uncommon types
- - Food-dependent, exercise-induced anaphylaxis
- - Occupational food allergy
- - Food allergies related to latex allergy
- - Delayed allergy to red meat
- - Natto allergy
- Initial management
- - Assess the need for an epinephrine autoinjector
- - Counsel about avoidance
- - Referral
- Overview of an allergy evaluation
- - Laboratory testing
- Unvalidated forms of testing
- OTHER TYPES OF FOOD ALLERGY
- Eosinophilic esophagitis
- Food protein-induced enterocolitis syndrome
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS