Food intolerance

Classification according to ICD-10
A05	Other bacterial food poisoning
L27.2	Dermatitis from ingested foods
T78.0	Anaphylactic shock from food intolerance
T78.1	Other food intolerance, not elsewhere classified
E70-E90	Metabolic disorders
K90.0	Celiac disease
ICD-10 online (WHO version 2019)

As a food intolerance or food intolerance reaction ( Engl. : Adverse food reaction ) are as defined by the European Academy of Allergy and Clinical Immunology (EAACI) designated in 1994 following reactions after ingestion:

• toxic reactions: food poisoning
• non-toxic reactions
  • non-immunological reactions
    • enzymatic intolerances
    • pharmacological intolerances
    • Food additive intolerance
  • immunological reactions
    • IgE -mediated: food allergy
    • IgE-independent ( IgA or IgG -mediated): Celiac disease

In the narrower sense, the term, and especially the synonymously used term food intolerance, only covers intolerance reactions without a toxic and / or allergic background.

Epidemiology

It is estimated that around one to two percent of all people are food intolerant. Deviating from this number, 10–20% of people in surveys state that they themselves think they suffer from food intolerance.

Pathophysiology

Toxic reactions

Toxic reactions after ingestion of food are based on the general toxicity of individual food components for the body .

Non-toxic reactions

Non-toxic reactions are based on an individual's sensitivity to food components. A distinction is made between immunological and non-immunological reactions.

Immunological reactions

Immunological reactions, usually referred to as food allergies , are individually occurring intolerance reactions, the symptoms of which occur after repeated allergen contact ( sensitization ). According to the underlying pathomechanisms, a distinction is made between two forms:

• IgE-mediated reactions
  
  → Main article : Food allergy
• Non-IgE-mediated reactions
  , the gluten intolerance ( celiac disease , in adulthood as celiac sprue called) is one of the immunologically -related, non-IgE-mediated food intolerances.

Non-immunological reactions

According to the underlying pathomechanisms, a distinction is made between three types of intolerance reactions that have neither a toxic nor an allergic background.

• Absorption-related intolerances (transporter
  defects ) The cause of absorption- related intolerances are reduced or reduced functioning transporters which make it impossible for the affected person to (completely) absorb certain food components. The transporter defects can either be congenital or acquired.
  • Fructose malabsorption (intestinal fructose intolerance)
• Enzymatic intolerances (enzymopathies)
  The cause of enzymopathies are certain enzyme deficiencies or enzyme defects that make it impossible for the affected person to (completely) digest certain food components. The enzyme deficiencies or defects can either be congenital or acquired.
  The following enzymopathies are known:
  • Lactose intolerance
  • Hereditary fructose intolerance
  • Galactose intolerance (see also galactosemia )
  • Histamine intolerance
  • Sucrose intolerance
  • Sorbitol intolerance
• Pharmacological food intolerances
  Certain substances in food are pharmacologically active and, if consumed in large quantities, can lead to symptoms of food intolerance (relative intolerance):
  • Biogenic amines ( tryptamine in tomatoes, phenylethylamine in chocolate, tyramine in mature cheese and chocolate, serotonin in bananas and nuts)
  • Glutamate ( glutamate intolerance )
  • caffeine
• Pseudoallergic reactions to food additives
  Pseudoallergies are the same as allergies in their clinical picture, so they show similar symptoms . The pseudo allergies , there is a non-specific activation and degranulation of mast cells .
  Typical triggers are:
  • Lectins (contained e.g. in beans)
  • Salicylates in apples or apricots, but also the acetylsalicylic acid used in pain relievers
  • Preservatives (e.g. benzoic acid )
  • Acidulants (e.g. citric acid , acetic acid )
  • certain medications (see intolerance (medicine) )
  • Dyes (e.g. tartrazine ),
  • Emulsifiers (e.g. lecithin ),
  • Sulfites

Symptoms

Mostly, food intolerances show up on the skin and mucous membranes . But the lungs , gastrointestinal system (20%) and cardiovascular system (10%) can also be affected.

The main symptoms are:

• Itching , flushing , urticaria , angioedema
• Rhinoconjunctivitis , hoarseness , throat irritation , asthma
• Itching and swelling of the lining of the mouth or larynx
• Nausea , vomiting , colic , diarrhea
• Tachycardia , hypotension , extrasystole
• Flare-up of atopic dermatitis

Therapy, prevention

The therapy of choice is avoiding the blamed foods . In the case of high-risk infants who, for various reasons, cannot be breast-fed exclusively, there are limited indications that prolonged administration of infant formula made from hydrolyzed proteins can cause food intolerance (allergies in infancy and childhood in general and the occurrence of cow's milk allergy in particular). can reduce. However, more well-planned studies are needed for final clarification.

In the hospital sector, the organ-related light diets (intestinal, bile, liver, stomach and pancreas diets ) have been abandoned in favor of the light whole food (or basic gastroenterological diet ) that is customary today . According to a survey carried out in 1978 by the German Working Group for Clinical Nutrition and Dietetics on over 2000 non-selected clinical patients, those foods that caused symptoms in over 10% of those surveyed are avoided.

These are (in brackets the frequency of the information):

• Legumes (30.1%)
• Cucumber salad (28.6%)
• fried food (22.4%)
• White cabbage (20.2%)
• carbonated drinks (20.1%)
• Kale (18.1%)
• fatty foods (17.2%)
• Paprika (16.8%)
• Sauerkraut (15.8%)
• Onions (15.8%)
• Savoy cabbage (15.6%)
• hard-boiled eggs (14.7%)
• Coffee beans (12.5%)
• Mayonnaise (11.8%)
• Smoked (10.7%)

literature

• P. Fritsch: Pathogenesis and systematics of food intolerance. In: Dermatology, Venereology: Basics, Clinic, Atlas. 2nd Edition. Springer, 2004, ISBN 3-540-00332-0 , pp. 227ff.

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1. ↑ C. Bruijnzeel-Koomen, C. Ortolani, K. Aas, C. Bindslev-Jensen, B. Björkstén, D. Moneret-Vautrin, B. Wüthrich: Adverse reactions to food. European Academy of Allergology and Clinical Immunology Subcommittee. In: Allergy. 1995 Aug; 50 (8), pp. 623-635, PMID 7503398 .
2. ^ Pschyrembel clinical dictionary. 261. rework. Edition. 2007, ISBN 978-3-11-018534-8 .
3. ↑ M. Classen, V. Diehl, K. Kochsiek: 14.4.3 Food intolerance In: Internal medicine. 5th edition. Urban & Fischer-Verlag, Munich 2006, ISBN 3-437-44405-0 , p. 1198.
4. ^ I. Koop, K. Beckh: 4.21 Food intolerance, food allergy. In: Gastroenterology Compact. Georg Thieme Verlag, 2002, ISBN 3-13-126311-3 , p. 146.
5. ^ P. Fritsch: Dermatology & Venereology for Studies. Springer, Heidelberg 2009, ISBN 978-3-540-79302-1 , pp. 124ff.
6. ^ P. Fritsch: Dermatology & Venereology for Studies. 2009, p. 124ff.
7. ↑ DA Osborn, J. Sinn: Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. In: Cochrane Database Syst Rev. 2006 Oct 18; (4), S. CD003664. PMID 17054180
8. ↑ German Federal Pension Insurance: Nutritional medicine and dietetics in rehabilitation facilities, 2005 (PDF; 2.0 MB).