Talk:Food intolerance/Archive 2

Archive 1

Archive 2

Migraine and FI

In spite of extensive discussion above & in the migraine article, I find it remarkable that there is currently no reference to migraine in this article.

As a long term sufferer from migraine with a family history over several generations, I find it amazing that it is controversial that migraines can be triggered by certain foods. Perhaps there are no scientific papers on this subject that can be cited, since the causal link is so obvious... I suspect that it might be equally difficult to find citations that link dogs with barking! On behalf of fellow sufferers I would misquote Dickens “If [science] supposes that ... science is a ass — a idiot ... the worst I wish [science] is that his eye may be opened by experience — by experience.”

I suggest adding a suitably worded statement, linked to the migraine article. In view of the previous discussions I hesitate to do it myself.GilesW (talk) 17:22, 5 May 2010 (UTC)

I think a lot of studies have looked at it, but have not found any correlation. People have a habit of blaming their food for various health problems. I have been thinking of having a hard look at all that unreferenced stuff in the migraine article, but I haven't had a chance yet. If you are interested, I'd suggest you look on google scholar and pubmed for high quality, well-cited reviews that look into this. There may already be such reviews cited in the migraine article. If you need any advice or help in looking for research and evaluating it, let me know. --sciencewatcher (talk) 18:01, 5 May 2010 (UTC)

There are certainly some diet-related triggers for migraines. For example, the "weekend headache" is a well-known and well-documented phenomenon. Presumably they would fall under ICHD 8 (ICD10 G44.4 or G44.83), "Headache attributed to a substance or its withdrawal". I'm just not convinced that "symptom provoked by the absence of caffeine" is quite the same as a food intolerance.

This news story discusses a new/non-mainstream test for IgG-mediated food intolerances, called the Yorktest. This webpage claims the association was reported in ancient Hippocratic texts and what they describe as "Living's classic monograph of 1873".

It might depend on the age of the population: PMID 8488128 shows a fairly clear association between foods and headaches among children and adolescents with common migraines. PMID 12657413, a 2003 review, also accepts the existence of dietary triggers of migraines in a small population of children and adolescents. There are oral challenge studies in adults that support an association, e.g., PMID 8376104, but systematic reviews like PMID 14533654 tend to reject them, since it's essentially impossible to prevent people from figuring out what kind of regular food they're eating (and thus it can't be a double-blind study).

All of this is a long-winded way of saying that there are conflicts in the literature. What we can say, without fear of contradiction, is that some migraineurs say that certain foods trigger their headaches. There's no particular reason why this fact can't be included in this article. WhatamIdoing (talk) 18:03, 7 May 2010 (UTC)

Reference to the connection between FI & migrane: Loblay RH and Swain AR, 'Food intolerance'. In: Wahlqvist ML and Truswell AS editors. Recent Advances in Clinical Nutrition. 1986 London: John Libbey, 169-177. This comes from a source I trust, but I don't know how to look it up. Could someone check it out, please? --Another287person (talk) 02:50, 12 June 2013 (UTC)

Well, it's available here, but a 27 year old source is hardly "recent". There should be much newer reviews, informed by later research papers:

• PMID 10885103 dates to 2000, which is still rather dated, but better.
• Hikmat Hayder, Utz Mueller, Andrew Bartholomaeus Review of Intolerance Reactions to Food and Food Additives Int. food risk anal. j. 2011, 1(2):23-32 -- this one is quite current, but in a brand new journal that has no established reputation for reliability.
• Guandalini S, Newland C. Differentiating food allergies from food intolerances. Curr Gastroenterol Rep. 2011 Oct;13(5):426-34. doi: 10.1007/s11894-011-0215-7. PMID 21792544 -- 2011 review in a PubMed indexed journal, may be useful

LeadSongDog come howl! 05:14, 12 June 2013 (UTC)

There's also mention of food intolerance causing headaches here: http://www.sswahs.nsw.gov.au/rpa/allergy/resources/foodintol/ffintro.html This book was first published in 2004 and has been reprinted every year since then. This book, "Friendly Food" was written by "allergy experts at the Royal Prince Alfred Hospital Allergy Unit." So the institution has put its name on the book, rather than any individual(s) there. The Royal Prince Alfred Hospital is over a hundred years old and employs over 20,000 staff. It's also a world leader on food intolerance research. This book is not a journal, nor is it designed to be "scholarly". It is designed to be accessible information (a recipe book, actually) put out by a reputable institution. Does this count as an adequate reference? --Another287person (talk) 06:46, 15 June 2013 (UTC)

The British Allergy association (currently linked from the article, bottom) talks about migraine in connection to FI. http://www.allergyuk.org/migraine/migraine Specifically it says:

"Migraine is one of a number of chronic conditions in which food is not the underlying cause, but some foods may exacerbate or trigger symptoms in some sufferers."

So, this is a reputable/approved source, clearly stating that there is a connection between migraine and FI. Not underlying, but certainly able to exacerbate or trigger symptoms in some cases. Does this mean that headaches or migraine is worth mentioning on the FI page? --Another287person (talk) 10:42, 16 June 2013 (UTC)

Re-reading the symptoms section, I notice that "headache" is currently listed as a symptom of FI. Please feel free to tell me if I'm continuing to bore you about something that is already agreed upon. Am still learning how to navigate Wikipedia editing. I assume there is some sort of "recent edits" page that I am missing...? --Another287person (talk) 11:32, 16 June 2013 (UTC)

Welcome to Wikipedia, which is incredibly complicated.

A published source needs to be strong enough to support the claim. A patient-oriented brochure is usually strong enough to support simple claims (e.g., antibiotics don't kill viruses). For an extraordinary claim (e.g., this new drug cures cancer), you need the strongest possible source, which is a review article in a reputable medical journal or a textbook used for medical school students. So the answer is that it depends on exactly what you want to write in the article. WhatamIdoing (talk) 14:13, 20 June 2013 (UTC)

Diagnosis

The diagnosis section needs to start with a clear paragraph saying that it is important to seek a formal diagnosis. Something like:

"Medical advice should be sought, in order to determine that symptoms do not have another more readily identifiable cause. Where food intolerance remains a possibility, some medical tests have been developed for some types of food intolerance (see below). Where there is no reputable medical test, diagnosis must be made through the analysis of careful observations made in conjunction with an Elimination Diet and challenge program, preferably under the supervision of a dietician who is familiar with food intolerance diagnosis. Dieticians warn that if diagnosis is not formalized, unnecessary dietary restriction can lead to adverse effects on nutrition and health [needs a reference]."

I think that a paragraph of this sort helps to further establish the necessity of a scientific approach to this subject, and will improve the quality of the FI page. --Another287person (talk) 13:31, 16 June 2013 (UTC)

I think that telling people that they ought to seek medical advice violates our rules against giving medical advice. WhatamIdoing (talk) 14:18, 20 June 2013 (UTC)

Not only that, but food challenges can be dangerous. Not necessarily recommended. And, repeated illnesses from food challenges may damage the body in some way we don't know yet. Puffysphere (talk) 18:50, 23 June 2013 (UTC)

Behavioral Symptoms

I notice that no behavioral symptoms are currently mentioned in the symptoms section of the FI page. This is a significant symptom category which is worthy of it's own little paragraph. The Wikipedia Salicylate sensitivity page already mentions the following behavioral symptoms: Hyperactivity, Memory loss and poor concentration, and Depression.

The Food Intolerance Network has collated extensive information on behavioral symptoms and FI. Some symptoms are caused by the FI, and other symptoms (like autism) are merely exacerbated by food chemicals (in some people). Those who have the food intolerance, can use diet to assist in the management of their underlaying condition.

Here are some links to give you an idea of the breadth of behavioral symptoms of FI. If someone is interested in pursuing this, you will need to chase down the proper WP:IRS links, but the following links are a heads up on what to look for. Food Intolerance Network Symptom Factsheet Index ADHD Autism and Asperger Down Syndrome Eating Disorders Head banging Opposition Defiance Disorder Self harm Sensitivity to sound Sleep disturbance and insomnia Speech Delay Stuttering Tantrums Teeth grinding Tics and Tourettes Trichitillomania (compulsive hair pulling)

--Another287person (talk) 13:36, 16 June 2013 (UTC)

However, food intolerance is here defined as a food reaction that does not involve the immune system, and these kinds of symptoms may well result from immune reactions. Puffysphere (talk) 22:03, 23 June 2013 (UTC)

Coeliac Disease

Hi I removed the line about Coeliac disease and fructose intolerance - the part about fructose intolerance didn't make much sense. Coeliac disease should not be mentioned in a food intolerance article. Although this article is very confused about what it wants to be - instead of being a medical definition of intolerance (i.e. lack of or poorly functioning enzyme as in lactose intolerance, phenylketonuria as opposed to allergy or other immune conditions) it has bloated to include assorted other conditions. That's okay as I understand that this article is trying to be more than the narrow definintion we get taught in medical school.

Coeliac disease does not fit here however because the introduction to this aricle states food intolerance "is not considered directly related to the immune system". Coeliac disease is obvioulsy directly related to the immune system as seen in the introduction page of Coeliac disease in which the first line states that it is an autoimmune disorder. Since this article purports to be about non-immune-related disorders it has been removed. —Preceding unsigned comment added by 124.169.175.35 (talk) 12:22, 18 October 2009 (UTC)

You are correct. However Celiac disease is also called "gluten intolerance", so I think it should be in this article. I would suggest changing that first sentence to say "not considered a true allergy" rather than "not considered directly related to the immune system". --sciencewatcher (talk) 20:04, 19 October 2009 (UTC)

Actually, the definition in the lead is wrong, and that's the part that ought to be fixed. WhatamIdoing (talk) 20:06, 19 October 2009 (UTC)

Isn't that precisely what I said?! In fact I see you have done exactly what I suggested. --sciencewatcher (talk) 21:14, 19 October 2009 (UTC)

So it is. I didn't see your comment when I typed mine. The wonders of the mediawiki software are evident. WhatamIdoing (talk) 21:47, 19 October 2009 (UTC)

Ah, ok. No worries. --sciencewatcher (talk) 21:55, 19 October 2009 (UTC)

Coeliac Disease is not called gluten intolerance anymore. It is an old term and is no longer used because it is misleading - it implies that it is a food intolerance, which I would and most of the medical proffesion would argue it is not. However, this article incorporates far more than the medical definition so I can accept the reasons for keeping it in. 124.169.148.196 (talk) 14:39, 26 October 2009 (UTC)

And how would you classify it, if it is neither "food allergy" nor "food intolerance"? More pointfully, perhaps, can you provide sources that support this view? I'm confident that could trivially provide dozens of high-quality sources that disagree with it. WhatamIdoing (talk) 16:59, 26 October 2009 (UTC)

I (as does wikipedia) would classify it as an autoimmune disorder and would not try and fit it in to food allergy or food intolerance (though it does share some features of an allergy). I doubt very much that you'll find any 'high-quality sources' that disagree with that. As for the definition of food intolerance according to the US National Institute of Allergy of Infectious Diseases " Food intolerance is more common than food allergy. The immune system does not cause the symptoms of food intolerance, though these symptoms may look and feel like those of a food allergy" from http://www3.niaid.nih.gov/topics/foodAllergy/understanding/whatIsIt.htm. This definition is also found on medlineplus patient information and the American Academy of Asthma, Allergy and Immunology (http://www.aaaai.org/patients/gallery/foodallergy.asp?item=1c). A google scholar search for food allergy + intolerance shows articles such as http://linkinghub.elsevier.com/retrieve/pii/S0091674999704112 that define it like so "Nontoxic reactions depend on individual susceptibilities and may be the result of immune mechanisms (allergy or hypersensitivity)or nonimmune mechanisms (intolerance)." As I said above however these definitions of food allergy and intolerance are not universally agreed upon and this article has a different definition to mine (and the sources listed above), which I disagree with, but I accept that this article does not need to use my definition 124.169.9.107 (talk) 09:53, 1 November 2009 (UTC)

Many scholarly sources say that celiac disease is either a "gluten intolerance"[1] and/or a "food intolerance"[2], including peer-reviewed journal articles that say things like "celiac disease is the most common food intolerance in the world" (PMID 15285531). I think, therefore, that we can safely include it in this article.

If you want to start an article specifically on pharmacological reactions, then please feel free to do that. WhatamIdoing (talk) 03:32, 7 November 2009 (UTC)

Did you even read my reply? I just showed reliable sources explaining how it is an autoimmune disorder. I think you should read wikipedia's own article on coeliac disease as a place to start learning about it. Also coeliac disease does cause temporary lactose intolerance so when you edit please do it for the good of the article do not remove things that are true just for your own personal vendettas. The reference was in support of the fructose intolerance statement the lactose statement did not have its own reference but instead of removing it you could easily do something constructive and find a reference for it. Remember the idea of wikipedia is to make good articles and not to just delte anything that you don't agree with. Of course if you find something to be false then remove it but in this case is true so it's unhelpful and lazy to just delete it. 203.206.94.48 (talk) 12:58, 18 November 2009 (UTC)

It's not helpful calling people 'lazy' or saying they have 'vendettas'. Add to that, the fact that you don't have a user account automatically reduces the credibility of anything you say. Having said that, let me address the point about gluten intolerance. If you look at this page you will see that the National Institute of Allergy and Infectious Diseases actually includes Gluten Intolerance in their 'food intolerance' page. So the fact that they say on another page 'The immune system does not cause the symptoms of food intolerance' is clearly a contradiction. If you read between the lines, I think you'll see that it is an error and what they actually meant to say was 'Food intolerance does not involve an IgE reaction of the immune system'. Sometimes web pages, even when written by government health organisations, have mistakes - they are not peer reviewed like journals! --sciencewatcher (talk) 15:32, 18 November 2009 (UTC)

(ec)While there are WP:MEDRS (such as this) which justify classifying CeD as an autoimmune disorder, that is a separate question from whether or not it is also a form of food intolerance. This review article addresses recent advances and remaining questions. Also, please understand that no WP article can be used as a reliable source. The policy explicitly reads "Wikipedia itself, although a tertiary source, should not be used as a source within articles, nor should any mirrors or forks of Wikipedia be accepted as reliable sources for any purpose." Without this policy, WP would be subject to the self-referential internal propagation of errors. LeadSongDog come howl 17:02, 18 November 2009 (UTC)

LeadSongDog has it right: this is a case of "both/and", not "either/or". WhatamIdoing (talk) 00:37, 19 November 2009 (UTC)

Hello, new editor here (be gentle). My understanding is that gluten intolerance is separate from coeliac disease. People who test negative to the coeliac gene test (ie Coeliac disease is ruled out) can still have a gluten intolerance. It seems reasonable to address gluten intolerance in this article, while adding a comment that people who suspect gluten intolerance should first rule out coeliac disease with the existing medical tests.--Another287person (talk) 02:38, 12 June 2013 (UTC)

Coeliac does not technically require a particular gene. It just happens that people with the gene are far more likely to get it than people without the gene. And the result is still that they are unable to tolerate gluten, but are (strictly speaking) not allergic to it, so they technically do have gluten intolerance. WhatamIdoing (talk) 23:13, 13 June 2013 (UTC)

Fascinating. Thanks :) --Another287person (talk) 06:29, 15 June 2013 (UTC)

I suggest that celiac disease be mentioned in this article, BUT it should be said that it is an immune reaction, and redirected to the celiac disease article. Also mention here that celiac disease can cause lactose intolerance.

IgA antibodies to gluten (gliadin) are elevated in celiac disease, also autoimmune antibodies (TtG, EMA) are elevated.

Celiac disease isn't diagnosed with a genetic test, but rather with a blood test or biopsy.

There are various kinds of gluten sensitivity, i.e. non-celiac immune reactions to gluten.

These also aren't "intolerances". The newer nomenclature is that a food reaction that does involve the immune system, but isn't a classical IgE-mediated allergy, would be called a "food sensitivity".

Puffysphere (talk) 12:31, 24 June 2013 (UTC)

New info on non-classical food allergies

This article is outdated and I found it confusing.

First, the nomenclature has been changed such that "food intolerance" is understood to be a food reaction that doesn't involve the immune system.

Thus, the very definition of the subject of this article is wrong!

I have looked at many definitions of "food intolerance" and they all say that food intolerance does not involve the immune system!

"Food intolerance" is being used in this article as an umbrella term. That is inconsistent with the Food Allergy article.

There should probably be a Food Hypersensitivity page, where "Food Hypersensitivity" is the umbrella term.

It has been discovered that the immune system is compartmentalized to some extent. So, one can have an IgE-mediated allergy that is associated with a particular mucous membrane. This is known to happen in the nose (look up "local allergic rhinitis"). Less is known about IgE-mediated allergies that might be localized in the GI tract, but I saw a reference to locally produced IgE antibodies in the gut. The various mucous membranes communicate immune system information among each other. Non-classical food allergies have passed double-blind placebo-controlled food challenges.

ALSO, it has been discovered that allergic reactions can be mediated by immunoglobulin free light chains, as well as IgE. FLC's can degranulate mast cells when bound to an antigen. IgE-mediated allergic reactions also are initiated via mast cell degranulation. The FLC-mediated reactions might cause the same symptoms as IgE-mediated reactions, or FLC's might more gradually degranulate mast cells. Since these reactions start with mast cells degranulating, it makes sense to call them allergies.

FLC's are increased in (at least some) autoimmune diseases, so it makes sense that people with autoimmune diseases would be liable to have allergies that are FLC-mediated to some extent.

A 2012 thesis with some current research on FLC's in the Netherlands: http://igitur-archive.library.uu.nl/dissertations/2012-0120-200303/UUindex.html

Casein hypersensitivity may involve FLC's: http://www.ncbi.nlm.nih.gov/pubmed/20434201

A review article on the evidence for localized IgE allergies, along with a discussion of possible non-IgE mechanisms: http://www.ncbi.nlm.nih.gov/pubmed/20642577

The details of how IgE and FLC mediated allergies interact, and exactly how FLC binds to mast cells, are not yet known.

I don't have the energy or time right now to work on the article, but I'm hoping someone else will, because this is important information. So many people report food allergies that don't show up on skin or blood tests for IgE antibodies. Puffysphere (talk) 18:24, 23 June 2013 (UTC)

Can you provide a good source for your claim that "First, the nomenclature has been changed such that "food intolerance" is understood to be a food reaction that doesn't involve the immune system"?

Last I checked, food allergy required an IgE-based reaction, and food intolerance and food sensitivity were synonyms for all other reactions, including non-IgE-based immune reactions. Egg white intolerance, for example, is a food intolerance even though the mechanism (pharmacological degranulation of mast cells) is very much dependent on the immune system.

Do you know much about the difference between anaphylaxis and pseudoanaphylaxis? That's the distinction that we're making here between food intolerance/sensitivity and true food allergy. WhatamIdoing (talk) 08:53, 26 June 2013 (UTC)

OK, at http://www.mayoclinic.com/health/food-allergy/AN01109 it says "Food intolerance symptoms generally come on gradually and don't involve an immune system reaction."

At http://apfed.org/drupal/drupal/sites/default/files/files/IgE%20vs%20nonIgE%20reactions.pdf

"Food allergy is the term used to refer to reactions to foods that are primarily caused by the immune system. In the recently published guidelines for the diagnosis and management of food allergy in the United States, a food allergy was defined as “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.” Allergic reactions to foods are categorized based on the part of the immune system involved as immunoglobulin E (IgE)-mediated (common type of allergic response), non-IgE-mediated, mixed IgE- and non-IgE mediated or cell mediated. "

There has been a lot of new research finding new immune reactions to foods, so the terminology is in flux. There's a gray area - what about non-celiac gluten sensitivity that results from innate immunity, not acquired immunity? And, we aren't used to thinking of celiac disease as an allergy. The phrase "food allergy" still carries an implication of "IgE-mediated" in many people's minds.

But when immunoglobulin free light chains are found to degranulate mast cells in a specific and acquired way, initiating a similar process to IgE-mediated allergy, it should qualify as an allergy.

I have heard the classification

food intolerance = food reaction that isn't an immune response"

food sensitivity = food reaction that is an immune response

food allergy certainly includes IgE-mediated, but can also include non-IgE mediated if you specify that.

The Hypersensitivity Wikipedia article made me think that "food sensitivity" might be understood recently in this sense - since "hypersensitivity" in that article is used to describe various immune reactions.

However, the Hypersensitivity article is also outdated.

I doubt there IS a nailed-down terminology in existence, because the research on non-IgE food allergies is too recent for that.

But, "food intolerance" encompasses a huge number of different non-immune kinds of food reactions anyway - so I don't think it should be stretched even more, to include immune reactions. It's complicated enough as it is.

How about "food intolerance" for non-immune reaction, "food hypersensitivity" for immune reaction - that would be consistent.

Puffysphere (talk) 18:00, 26 June 2013 (UTC)

I haven't found scientific support for the idea that eggwhites release histamine from mast cells through some non-immune mechanism. According to the article http://www.njmonline.nl/getpdf.php?id=418 , "histamine-releasing foods" are an unproven idea.

I should have said, a food intolerance reaction is not initiated by the immune system. It could involve the immune system in subsequent steps. Puffysphere (talk) 02:00, 27 June 2013 (UTC)

Please take the time to read and understand wp:MEDREV. We need high quality secondary sources such as review articles and systematic reviews. LeadSongDog come howl! 05:42, 27 June 2013 (UTC)

If you haven't "found scientific support for the idea that eggwhites release histamine from mast cells through some non-immune mechanism", then you haven't read the medical reference works cited at egg white intolerance. The key word is "pharmacological". WhatamIdoing (talk) 16:26, 30 June 2013 (UTC)

"food chemicals"

There's a lot of talk of food chemicals in the article which looks silly. 87.83.31.234 (talk) 22:22, 6 May 2015 (UTC)