Food intolerance T78.19

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

NMU

Definition
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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/Epidemiology
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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.

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Etiopathogenesis
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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 features
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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.

Diagnosis
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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).

Therapy
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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)
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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).

Literature
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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
Breuer K et al (2003) The impact of food allergy in patients with atopic dermatitis. dermatologist 54: 121-129
de Leon MP et al (2003) Immunological analysis of allergenic cross-reactivity between peanut and tree nuts. Clin Exp Allergy 33: 1273-1280
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
Maurer M et al (2003) Relevance of food allergies and intolerance reactions as causes of urticaria. dermatologist 54: 138-143
Ring (1991) Applied allergology. MMW publishing house, Munich S. 112-121
Ring J et al (1987) Allergy Diet: Methods for the diagnosis and treatment of food allergy and pseudo-allergy. dermatologist 38: 198-205
Schäfer T (2008) Epidemiology of food allergy in Europe. Allergology 31: 255-263
Schafer T et al (2003) Epidemiology of food allergies. dermatologist 54: 112-120
Zuberbier T et al (1992) Food intolerance. dermatologist 43: 805-811