Bindslev-Jensen C, Skov P S, Madsen F, Poulsen L K
Food Allergy Unit TTA 7523, National University Hospital, Copenhagen, Denmark.
Ann Allergy. 1994 Apr;72(4):317-20.
The literature is contradictory concerning the use (and misuse) of the terms "food allergy" and "food intolerance." When using double-blind, placebo-controlled food challenge as the gold standard, the clinical picture characterizing both diseases is identical, ie, concomitant signs and symptoms from the skin, gastrointestinal-tract and respiratory system (classical allergic signs and symptoms). A distinction between food allergy and food intolerance thus depends on whether the involvement of the immune system can be verified. The basic problem with diagnostic tests such as skin prick test (SPT), measurement of specific IgE (RAST) or histamine release from basophils (HR) is that in contrast to inhalant allergens, no standardized extracts are commercially available. It is therefore often not possible to discriminate between the ability of a test per se in the diagnosis of food allergy and differences in allergen extract quality. This is probably the reason for the great variability in diagnostic sensitivity and specificity reported in the literature. Many cases of food allergy to proteins may be therefore misdiagnosed as food intolerance due to a low sensitivity of the tests (SPT, RAST, and HR) used.
关于“食物过敏”和“食物不耐受”这两个术语的使用（及误用），文献中的观点相互矛盾。当以双盲、安慰剂对照食物激发试验作为金标准时，这两种疾病的临床表现是相同的，即皮肤、胃肠道和呼吸系统出现伴随的体征和症状（典型的过敏体征和症状）。因此，食物过敏和食物不耐受的区别取决于免疫系统的参与能否得到证实。诸如皮肤点刺试验（SPT）、特异性IgE测量（RAST）或嗜碱性粒细胞组胺释放（HR）等诊断测试的基本问题在于，与吸入性过敏原不同，没有标准化的提取物可供商业使用。因此，通常无法区分测试本身在食物过敏诊断中的能力与过敏原提取物质量的差异。这可能就是文献中报道的诊断敏感性和特异性差异很大的原因。因此，由于所使用的测试（SPT、RAST和HR）敏感性较低，许多蛋白质食物过敏病例可能被误诊为食物不耐受。
