Adverse Reactions to Food -- Contents -- Foreword -- Terms of Reference -- Task Force Membership -- 1 Introduction and Definitions -- 1.1 Introduction -- 1.2 Food intolerance -- 1.2.1 Allergic reactions -- 1.2.2 Enzymic reactions -- 1.2.3 Pharmacological reactions -- 1.2.4 Other non-defined idiosyncratic responses -- 1.3 Food aversion -- 1.3.1 Food avoidance -- 1.4 Food poisoning -- 1.4.1 Chemical food poisoning -- 1.4.2 Foodborne bacterial gastroenteritis -- 1.4.3 Food vehicles -- 1.4.4 Foodborne viral gastroenteritis -- 1.5 Key points -- Appendix A Classification of adverse reactions to foods -- 2 The Immune System -- 2.1 Introduction -- 2.2 The immune system -- 2.3 Innate immunity -- 2.4 Adaptive immunity -- 2.4.1 Anatomy and cells of adaptive immunity -- 2.4.2 Clonal expansion of lymphocytes -- 2.4.3 B cells, immunoglobulins and humoral immunity -- 2.4.4 T cells and cell mediated immunity -- 2.4.5 The generation of effector T cells -- 2.4.6 Effector CD4+ T cells -- 2.4.7 Effector mechanisms of Th1 mediated immunity -- 2.4.8 Effector mechanisms of Th2 mediated immunity -- 2.5 Allergy -- 2.5.1 IgE mediated allergy -- 2.5.2 Clinical patterns of IgE mediated allergy -- 2.5.3 Non-IgE/T cell mediated allergy -- 2.6 Why do food antigens fail to produce a detrimental immune response? -- 2.6.1 Oral tolerance/true immunological tolerance -- 2.6.2 Mechanisms of oral tolerance -- 2.6.3 Factors influencing oral tolerance -- 2.6.4 Immunological acceptance -- 2.7 Conclusion -- 3 Nutrition and the Immune System -- 3.1 Introduction -- 3.2 Impact of infection on nutrient status -- 3.2.1 Infection is characterised by anorexia -- 3.2.2 Infection is characterised by nutrient malabsorption and loss -- 3.2.3 Infection is characterised by increased resting energy expenditure -- 3.2.4 Infection is characterised by altered metabolism and redistribution of nutrients.

3.3 Protein-energy malnutrition and immune function -- 3.4 The influence of individual micronutrients on immune function -- 3.4.1 Vitamin A -- 3.4.2 Carotenoids -- 3.4.3 Vitamin B6 -- 3.4.4 Vitamin C -- 3.4.5 Vitamin E -- 3.4.6 Zinc -- 3.4.7 Copper -- 3.4.8 Iron -- 3.4.9 Micronutrient combinations and resistance to infection -- 3.4.10 Micronutrients and HIV infection -- 3.4.11 Micronutrients and asthma -- 3.5 Dietary fat and immune function -- 3.5.1 Fatty acids in the human diet -- 3.5.2 Amount of dietary fat and immune function -- 3.5.3 Eicosaniods: a link between fatty acids and the immune system -- 3.5.4 Linoleic acid and immune function -- 3.5.5 a-Linolenic acid and immune function -- 3.5.6 Fish oil and immune function -- 3.5.7 Dietary fat and Th1 skewed immunological diseases -- 3.5.8 Fatty acids and Th2 skewed immunological diseases -- 3.6 Dietary amino acids and related compounds and immune function -- 3.6.1 Sulphur amino acids and glutathione -- 3.6.2 Arginine -- 3.6.3 Glutamine -- 3.7 Probiotics, immune function and allergy -- 3.7.1 The theoretical basis for the use of probiotics -- 3.7.2 Probiotics and immune function -- 3.7.3 Probiotics and allergy -- 3.8 Breast feeding and immune function -- 3.8.1 The composition of breast milk -- 3.8.2 Breast feeding, immune function and infection -- 3.9 General comments -- 3.10 Key points -- 4 Epidemiology of Food Intolerance and Food Allergy -- 4.1 Introduction -- 4.2 The adequacy of currently available epidemiological data for food intolerance -- 4.2.1 Non-IgE mediated allergy -- 4.3 Infants and children -- 4.3.1 Cows' milk intolerance and allergy -- 4.3.2 Allergy to egg -- 4.3.3 Peanut allergy -- 4.3.4 Intolerance to food additives -- 4.4 Adults -- 4.4.1 Peanut allergy in adults -- 4.4.2 Intolerance to food additives in adults -- 4.5 Time trends and geographic differences.

4.6 The relationship between IgE mediated food allergy and other IgE mediated allergies -- 4.7 General epidemiology of IgE mediated allergy -- 4.8 Key points -- 5 Pre- and Postnatal Sensitisation to Foods -- 5.1 Introduction and definition of terms -- 5.1.1 IgE mediated allergy -- 5.2 Factors that influence neonatal sensitisation to food -- 5.2.1 Genetic background -- 5.2.2 Prenatal exposure -- 5.2.3 Antibody responses -- 5.3 Assessment of abnormal immune response -- 5.3.1 Cord blood or term IgE concentration -- 5.3.2 CD4+ T cell responses to allergens in cord blood -- 5.3.3 CD4+ T cell responses and IgG antibodies to constituents of food -- 5.4 Trigger foods -- 5.5 Dietary factors in the development of atopy in infants -- 5.6 Maternal diet during pregnancy -- 5.7 Breast feeding -- 5.7.1 Evidence supporting the protective effect of breast milk -- 5.7.2 Evidence against breast feeding -- 5.8 Maternal diet during lactation -- 5.9 Use of protein hydrolysate formula -- 5.10 Introduction of solids -- 5.11 Key points -- 6 Common Food Allergies -- 6.1 Introduction -- 6.2 Allergens involved -- 6.3 Diagnosis -- 6.3.1 Misdiagnoses and misconceptions -- 6.4 Clinical features of atopic disease -- 6.4.1 Clinical features of food allergy -- 6.4,2 Childhood eczema -- 6.4.3 Childhood asthma -- 6.4.4 Clinical features in adults -- 6.4.5 The oral allergy syndrome -- 6.5 Foods that cause allergic reactions -- 6.5.1 Allergic reactions to food in young children -- 6.5.2 Peanut allergy -- 6.5.3 Can genetic modification influence allergenicity? -- 6.6 Management of food allergy in childhood -- 6.7 Difficulties in diagnosis and management -- 6.8 Key points -- 7 Other Manifestations of Food Intolerances -- 7.1 Introduction -- 7.2 Reactions affecting the skin -- 7.2.1 Urticaria and angio-oedema -- 7.3 Reactions affecting the gastrointestinal tract -- 7.3.1 Vomiting.

7.3.2 Gastro-oesophageal reflux -- 7.3.3 Abdominal pain, distension and flatulence -- 7.3.4 Diarrhoea -- 7.3.5 Bacterial overgrowth -- 7.3.6 Constipation -- 7.4 Enteropathies -- 7.4.1 Allergic eosinophilic gastroenteropathy -- 7.4.2 Infantile colic -- 7.4.3 Irritable bowel syndrome -- 7.5 Respiratory system effects -- 7.5.1 Asthma -- 7.5.2 Rhinitis and conjunctivitis (hay fever) -- 7.5.3 Serous otitis media -- 7.5.4 Milk-induced pulmonary haemosiderosis (Heiner's syndrome) -- 7.6 The central nervous system and behaviour -- 7.6.1 Migraine and food intolerance -- 7.6.2 Migraine and diet -- 7.6.3 Food allergy and migraine -- 7.6.4 Migraine and non-immunologic effects -- 7.6.5 Foods commonly associated with migraine -- 7.7 Evidence of reactions to food in teenagers and adults with mental disorders -- 7.7.1 Children and adolescents -- 7.8 Hyperactivity and attention deficit hyperactivity disorder (ADHD) -- 7.8.1 Studies on attention deficit hyperactivity disorder -- 7.8.2 Studies on the Feingold diet -- 7.8.3 Clinical studies of wider food exclusions -- 7.8.4 Mental illness and gluten sensitivity: schizophrenia -- 7.8.5 Autism -- 7.8.6 Cot death (sudden infant death syndrome, SIDS) -- 7.9 Other clinical symptoms that may be related to adverse effects of foods -- 7.9.1 Enuresis and cystitis -- 7.9.2 Vaginitis/vaginal discharge -- 7.9.3 Athropathy, arthritis -- 7.10 Key points -- 8 Enzyme Defects and Food Intolerance -- 8.1 Introduction -- 8.2 The nature of lactose intolerance -- 8.3 Types of lactose intolerance -- 8.3.1 Congenital lactase deficiency -- 8.3.2 Late onset lactase deficiency/actase non-persistence -- 8.3.3 Secondary lactose intolerance -- 8.4 Prevalence of lactose intolerance -- 8.5 Clinical features of lactose intolerance -- 8.6 Diagnosis of lactose intolerance -- 8.6.1 Lactose maldigestion - reducing substances in stools.

8.6.2 Lactose maldigestion - breath test -- 8.6.3 Tissue lactase activity -- 8.6.4 Other tests -- 8.7 Treatment of lactose intolerance -- 8.7.1 Secondary lactose intolerance -- 8.7.2 Late onset lactase deficiency -- 8.7.3 Potential for adaptation -- 8.8 Nutritional adequacy of low lactose diets -- 8.9 Hereditary fructose intolerance -- 8.10 Key points -- 9 Coeliac Disease and other Gluten Sensitive Disorders -- 9.1 Gluten -- 9.2 Manifestations of gluten sensitivity -- 9.3 Gluten sensitive enteropathy -- 9.3.1 Subclinical or silent coeliac disease -- 9.3.2 Latent coeliac disease -- 9.3.3 Transient gluten intolerance -- 9.4 Dermatitis herpetiformis -- 9.5 Prevalence of coeliac disease -- 9.6 Presentation of coeliac disease -- 9.6.1 Infants and children -- 9.6.2 Adults -- 9.7 Diagnosis of coeliac disease -- 9.7.1 Small intestinal biopsy -- 9.7.2 Serum antibody tests -- 9.8 Disease associations -- 9.8.1 Dermatitis herpetiformis -- 9.8.2 Type I (insulin dependent) diabetes and other autoimmune disorders -- 9.8.3 Malignancy -- 9.8.4 Neurological disorders -- 9.8.5 Down's syndrome -- 9.8.6 Epilepsy -- 9.9 Genetics -- 9.10 Epidemiology of coeliac disease -- 9.11 Pathogenesis of coeliac disease -- 9.12 The immune system and coeliac disease -- 9.12.1 Antibody production in the small intestine -- 9.12.2 Cell mediated immunity -- 9.13 Treatment -- 9.14 Compliance with a gluten-free diet -- 9.15 Legislation relating to gluten-free food -- 9.16 The cereals: taxonomy and chemistry -- 9.16.1 Definition of prolamins -- 9.17 Methods for assessing suitability of cereal proteins for gluten sensitive individuals -- 9.17.1 In vivo gluten challenge -- 9.17.2 In vitro tissue culture -- 9.17.3 Tests based on non-human tissue -- 9.18 Which cereals contain gluten? -- 9.19 Which cereals are gluten-free? -- 9.20 What about oats? -- 9.21 Other problematic substances.

9.21.1 Malt, malt extract, beer and lager.