Multiple studies have suggested that particular trigger foods are implicated in generating the symptoms of common gastrointestinal disorders such as irritable bowel syndrome in as high as 84 % of patients ( Reference Bohn, Storsrud and Tornblom7, Reference Locke, Zinsmeister and Talley8).
Despite the inherent challenges that accompany clinical trials of nutrition-based interventions, a double-blinded, placebo-controlled oral challenge is considered by some to be the criterion standard for identifying food-related intolerance the number of clinically useful diagnostics is limited ( Reference Lomer5). These adverse reactions typically resolve upon elimination of the culprit food from the diet and return with its reintroduction. Symptoms attributed to food intolerance vary, and may include complaints of the gastrointestinal tract such as flatulence, abdominal pain, bloating and diarrhoea ( Reference Lomer5). Food chemical reactions, enzyme and transport defects, microbiome diversity and composition, perturbations the microbiota–gut–brain axis and fermentable oligo-, di-, mono-saccharides and polyols are potential mechanisms that may contribute to food hypersensitivity ( Reference Lomer5, Reference Chey6). The pathogenesis of food intolerance or non-allergic food hypersensitivity is less clearly defined. The literature is more robust when it comes to prevalence of traditional immune-mediated IgE-associated food allergies.
Food intolerance is not a novel ailment, but there remains a paucity of recent US-based research in this area. There appears to be some variability across countries. Prior data from the USA collected over 25 years ago found a prevalence of 12 % among 555 subjects ( Reference Woods, Abramson and Bailey2). Australia and Mexico also had higher rates of food hypersensitivity measured at 19♱ % and 30♱ %, respectively ( Reference Woods, Abramson and Bailey2, Reference Puente-Fernandez, Maya-Hernandez and Flores-Merino4). In a multicentre European study measuring ‘illness’ or ‘trouble’ caused by ingestion of particular foods, rates of food intolerance were lower in Spain and Ireland compared with Scandinavian countries and Germany ( Reference Woods, Abramson and Bailey2). Most studies report prevalence rates ranging from 4 to 20 % of the general population ( Reference Young, Stoneham and Petruckevitch1– Reference Gislason, Bjoernsson and Gislason3). Self-reported food intolerances are common.
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