Food intolerances—a diagnostic challenge

U. Petra Zieglmayer*, Wolfgang Hemmer, Sandra Wieser, Karin Hoffmann-Sommergruber

*Corresponding author for this work

Research output: Journal article (peer-reviewed)Review article

3 Citations (Scopus)


Background: Food-associated complaints in the gastrointestinal tract can be signs of an intolerance of different etiology, which is reported by almost a quarter of the population. Due to the unspecific symptoms, a whole range of different triggers and immune reactions can be considered for the differential diagnosis, which cannot always be determined unambiguously and quickly. Differentiation and diagnosis of disease entity: The time course in connection with the clinical picture already allows a rough estimation of the underlying pathomechanism and points the diagnostic way. Thus, immune-mediated clinical pictures such as allergy must be distinguished from nonimmune-mediated intolerances. An allergic reaction can be IgE-mediated or cellularly induced. Secondary food allergies are triggered by other allergens than primary allergies, differ in their sensitization routes and course of disease. Non-immunological intolerance reactions also play a not insignificant role, including carbohydrate utilization disorders and histamine intolerance in addition to toxic reactions. Often difficult to identify are also those food components which trigger a nonspecific mast cell activation. Due to their particular clinical relevance, wheat intolerances of different pathogenesis are also discussed. As a consequence of their complexity with regards to disease-causing proteins, target organ manifestations, pathomechanisms and diagnostic clarification, these require a particularly differentiated approach. Purpose: This review article presents the current recommendations regarding the diagnosis of food intolerance and food allergy, with a separate focus on the specifics in the interpretation of different tests including IgE diagnostics.

Original languageEnglish
Pages (from-to)23-35
Number of pages13
JournalAllergo Journal International
Issue number2
Publication statusPublished - Mar 2022


  • Adverse reaction
  • Celiac disease
  • Histamine
  • IgE-mediated
  • Lactose

ASJC Scopus subject areas

  • Immunology and Allergy


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