Food intolerance

Food Intolerance

Lactose Intolerance: Caused by lactase deficiency, leading to bloating, diarrhea, and flatulence after consuming dairy products.
Gluten Sensitivity (Non-Celiac Gluten Sensitivity): Symptoms similar to celiac disease but without the autoimmune component; includes abdominal pain, bloating, and fatigue.
Histamine Intolerance: Caused by an inability to break down histamine in foods, leading to symptoms such as headaches, flushing, and gastrointestinal discomfort.
FODMAP Intolerance: Sensitivity to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, causing bloating, diarrhea, and abdominal pain.
Fructose Intolerance: Malabsorption of fructose leading to bloating, gas, and diarrhea after consuming high-fructose foods.
Caffeine Sensitivity: Excessive reaction to caffeine, leading to symptoms like palpitations, anxiety, and insomnia.
Sulfite Sensitivity: Reaction to sulfites in foods, leading to respiratory symptoms, especially in asthmatic individuals.
Food Additive Intolerance: Reactions to additives like MSG, leading to symptoms such as headaches, flushing, or gastrointestinal discomfort.

Food Allergy

IgE-Mediated Food Allergy: Rapid onset of symptoms after ingestion, including urticaria, angioedema, respiratory symptoms, and anaphylaxis; common allergens include nuts, shellfish, and eggs.
Non-IgE-Mediated Food Allergy: Delayed reactions involving gastrointestinal symptoms, such as in food protein-induced enterocolitis syndrome (FPIES); common in infants.
Mixed IgE and Non-IgE-Mediated Food Allergy: Conditions such as eosinophilic esophagitis, which involve both immediate and delayed hypersensitivity reactions.
Oral Allergy Syndrome: Localized allergic reaction in the mouth and throat after consuming certain raw fruits or vegetables, often in individuals with pollen allergies.

Other Gastrointestinal Disorders

Celiac Disease: Autoimmune disorder triggered by gluten, leading to villous atrophy in the small intestine; symptoms include diarrhea, weight loss, and anemia.
Irritable Bowel Syndrome (IBS): Functional gastrointestinal disorder characterized by abdominal pain, bloating, and altered bowel habits, often exacerbated by certain foods.
Inflammatory Bowel Disease (IBD): Includes Crohn’s disease and ulcerative colitis, presenting with chronic diarrhea, abdominal pain, and possible food intolerances.
Gastroesophageal Reflux Disease (GERD): Chronic reflux of stomach acid causing heartburn, regurgitation, and sometimes intolerance to certain foods.
Liver Disease: Hepatic dysfunction can lead to malabsorption and food intolerances, particularly fats.

Symptom Onset and Timing

Immediate vs. Delayed Symptoms: Immediate onset suggests IgE-mediated allergy, while delayed onset is more typical of intolerances or non-IgE-mediated allergies.
Relation to Food Intake: Identify specific foods and the quantity required to trigger symptoms, which can help differentiate between intolerance and allergy.
Symptom Duration: Persistent symptoms after food intake might suggest intolerance, whereas transient symptoms are more typical of allergic reactions.
Pattern of Symptoms: Determine if symptoms occur consistently after eating specific foods or vary, suggesting a possible functional disorder like IBS.

Associated Symptoms

Gastrointestinal Symptoms: Bloating, diarrhea, abdominal pain, and flatulence are common in food intolerances and IBS.
Respiratory Symptoms: Wheezing, coughing, or nasal congestion may suggest an IgE-mediated food allergy.
Dermatological Symptoms: Urticaria, eczema, or angioedema can occur in both food allergies and intolerances.
Systemic Symptoms: Anaphylaxis, dizziness, or hypotension strongly suggests a severe IgE-mediated food allergy.
Weight Loss: Unintentional weight loss might suggest a more chronic condition like celiac disease or IBD.
Nutritional Deficiencies: Symptoms like fatigue or pallor might indicate malabsorption related to celiac disease or IBD.
Psychological Symptoms: Anxiety or stress related to food intake can exacerbate symptoms in functional disorders like IBS.
Family History: A family history of food allergies, atopy, or autoimmune conditions might increase the likelihood of similar conditions.

Background

Past Medical History: Conditions like asthma, eczema, or a history of anaphylaxis might suggest an atopic background.
Drug History: Certain medications can exacerbate gastrointestinal symptoms or cause pseudo-allergic reactions.
Family History: Consider family history of food allergies, celiac disease, or other gastrointestinal disorders.
Social History: Assess diet, alcohol consumption, stress levels, and any recent changes in lifestyle or eating habits.
Occupational History: Certain occupations may increase exposure to food allergens or stress, potentially exacerbating symptoms.
Travel History: Recent travel may expose patients to unfamiliar foods, which could trigger intolerance or allergy symptoms.

Blood Tests

Full Blood Count (FBC): To assess for anemia or eosinophilia, which may suggest celiac disease or an allergic response.
IgE Levels: Elevated total IgE or specific IgE tests can help diagnose IgE-mediated food allergies.
Celiac Serology: Tests such as tissue transglutaminase (tTG) antibodies are used to diagnose celiac disease.
Liver Function Tests (LFTs): To assess for liver disease, which can be associated with malabsorption or intolerance.
Thyroid Function Tests: Hypothyroidism or hyperthyroidism can present with gastrointestinal symptoms that mimic food intolerance.
Vitamin and Mineral Levels: Assess for deficiencies in iron, B12, folate, calcium, and vitamin D, which may indicate malabsorption.
CRP/ESR: Elevated inflammatory markers may suggest IBD or other inflammatory conditions.
Hydrogen Breath Test: Used to diagnose lactose intolerance or small intestinal bacterial overgrowth (SIBO).
Fructose Breath Test: Assesses for fructose malabsorption.
Stool Tests: Stool microscopy, culture, and calprotectin can help diagnose infections, inflammation, or malabsorption.

Imaging and Other Tests

Endoscopy: Upper or lower endoscopy with biopsy may be indicated in cases of suspected celiac disease, IBD, or other structural gastrointestinal diseases.
Abdominal Ultrasound: Useful in assessing for gallstones, liver disease, or other abdominal pathology that may contribute to symptoms.
Barium Studies: Occasionally used to assess for structural abnormalities in the gastrointestinal tract.
Skin Prick Testing: To identify specific allergens in cases of suspected IgE-mediated food allergies.
Elimination Diet: Removing suspected foods from the diet and reintroducing them to observe for symptoms can help identify food intolerances.
Food Challenge: Under medical supervision, a gradual introduction of the suspected allergen to confirm diagnosis in cases of food allergy.
Capsule Endoscopy: May be indicated in cases of suspected small bowel disease, including celiac disease or Crohn’s disease.
Lactose Tolerance Test: Measures blood glucose levels after ingestion of lactose to diagnose lactose intolerance.
Serum Trypsinogen: Consider in cases of suspected chronic pancreatitis, where fat malabsorption may cause symptoms of food intolerance.

Gastrointestinal