Diagnosis and Management
T J David, University of Manchester, Manchester, UK
© 2005 Elsevier Ltd. All rights reserved.
The concept that certain foods can produce adverse reactions in susceptible individuals has a long history. Hippocrates (460-370 bc) reported that cow's milk could cause gastric upset and urticaria. Later, Galen (131-210 bc) described a case of intolerance to goat's milk. It was Lucretius (96-55 bc) who said, ''What is food to one man may be fierce poison to others.'' In the 1920s and 1930s, a fashion developed of blaming food intolerance for a large number of hitherto unexplained disorders. The uncritical and overenthusiastic nature of the claims, in addition to the anecdotal evidence on which they were based, generally discredited the whole subject. Indeed, the field of food intolerance has been described as ''a model of obstruction to the advancement of learning.'' The whole area has provoked much controversy. The introduction of double-blind provocation tests has placed studies on a more scientific footing, but they are impractical in routine management. The lack of objective and reproducible diagnostic laboratory tests that could eliminate bias has ensured that controversy about food intolerance continues.
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