Jean-Pierre Girard, Department of Agriculture and Fisheries for Scotland, Marine Laboratory, Aberdeen, UK
Untoward reactions to foods - especially cow's milk - were recognized in ancient times by Hippocrates and Galea. However, the first thorough clinical inquiries were undertaken at the beginning of the twentieth century, when chronic diarrhea and ana-phylactic-type reactions were observed in babies fed with cow's milk. Later, other types of clinical manifestations were described, e.g. urticaria, eczema, anemia and various respiratory tract and gastrointestinal problems, but the concept of immunologically mediated clinical reactions appeared only progressively, with the discovery of the immunoglobulins and an improved method for the detection of specific antibodies.
More recently, the discovery of IgE imrnuno globulins by Ishizaka has considerably increased our understanding of immediate type I hypersensitivity. Having a more accurate means of measuring IgF-mediated reactions, it soon became evident that only a modest part of all the intolerances due to food could be verified by these new in vivo and in vitro procedures. Consequently, the concept of false food allergy (pseudoallergy) gained in importance and now, besides IgE-mediated reactions, a large variety of mechanisms has been proposed and sometimes verified by appropriate techniques.
The following classification of adverse reactions to food is suggested.
1. Toxic reactions (favism, mushrooms, etc.).
2. Immunologic mechanisms: IgE, IgG and T cell mediated.
3. Food intolerance or pseudoallergy: pharmacologic, enzymatic and undefined reactions.
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