Papers of the Week

Clinicians are faced with evaluating real and alleged reactions to foods that may be allergic or non-allergic. Pathogenesis, diagnosis, and treatment of a variety of non-immunoglobulin E (IgE) mediated diseases are discussed in this review. These food-related conditions range from mild to severe. Referral for an allergy work-up may be pursued despite the lack of IgE-mediated symptoms. Diagnostic testing is available for defined non-IgE mediated food diseases that are either immunologic or non-immunologic. These include celiac disease and related disorders, carbohydrate maldigestion, pancreatic insufficiency, and histamine intolerance. In contrast, there is a paucity of definitive studies to prove food intolerance diseases. There are no definitive diagnostic criteria or testing for non-celiac gluten sensitivity (NCGS). Functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), are better stratified diagnostically but still lack reliable testing. Both NCGS and IBS are linked to dietary triggers including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Therefore, dietary alteration alone may be diagnostic and therapeutic when all other conditions are ruled out. These conditions are important considerations when evaluating a patient with history of a food reaction. There is little evidence that foods are causative in other ailments such as acne, migraines, and nasal congestion and hypersecretion.