Intended for healthcare professionals

Clinical Review Lesson of the week

Physiological effects of starvation interpreted as food allergy

BMJ 1999; 319 doi: (Published 31 July 1999) Cite this as: BMJ 1999;319:304
  1. C A Bethune, specialist registrara,
  2. M M Gompels, consultantb,
  3. G P Spickett, consultanta
  1. a Regional Department of Immunology, Royal Victoria Infirmary, Newcastle upon Tyne NEI 3LP
  2. b Department of Immunology, Southmead Hospital, Bristol BS10 5NB
  1. Correspondence to: Dr Bethune
  • Accepted 29 January 1999

Carbohydrate restriction can disturb glucose metabolism, and this may be interpreted falsely as food allergy

It is a common misconception that food allergy can cause a wide variety of symptoms. A population study in the English town of High Wycombe showed a perceived prevalence of food intolerance of almost 20%, but double blind food challenge (the definitive test) provided objective evidence of symptoms related to food in fewer than 2% of subjects.1 This popular belief is fuelled by extensive and often misleading reports on the subject, as well as the emergence of clinics offering unvalidated tests that claim to diagnose allergy.2

We describe three patients who undertook strict, low carbohydrate diets because of perceived allergy. Starvation may affect the response to an oral glucose challenge. It results in an initial excessive rise in the blood glucose concentration followed by hypoglycaemia, which can be accompanied by symptoms.3 4 All three of the patients described developed symptoms several hours after meals and attributed these to food allergy. Further restriction of carbohydrate intake exacerbated their problem Symptoms continued to occur after meals and were erroneously interpreted as further evidence of their carbohydrate allergy.

Case reports

Case 1

A 24 year old woman was referred with a 4 month history of diarrhoea and abdominal pain. A self prescribed wheat free diet had improved her symptoms at first, but as she restricted her diet further she began to complain of dizziness, weakness, nausea, and palpitations, which were most severe several hours after meals. She concluded that she was allergic to many foods, and cut down her intake further. The woman lost 5 kg in weight, and …

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