Vatn M H
Medical Department A, Rikshospitalet University Hospital, Department of Medicine, Oslo, Norway.
Scand J Work Environ Health. 1997;23 Suppl 3:75-8.
The mechanism behind food intolerance is regarded as one of the greatest enigmas in modern medicine. Its multidisciplinary modalities, sharing properties with immunologic, environmental and psychosomatic reaction patterns, make the grouping and individual approach rather complex in regard to classification of disease, diagnosis, and therapy. In this presentation, emphasis is placed on emerging knowledge about immunologic reactions in the bowel and blood circulation as a balance against the evidence for psychosomatic reactions. As a basis for discussion, the psychosomatic experience of patients with food intolerance is illustrated by a brief presentation of three studies. The first was cross-sectional. The second was prospective and controlled. The third was a double-blind placebo-controlled study using provocation with an active substance in comparison with a placebo. Both the patients and referents were characterized by interviews and scoring systems based on questionnaires. When either combined or kept separately, the results of these studies suggest a correlation between somatic and neuropsychiatric symptoms and emotional disturbances. It also seems that patients identifying themselves as sensitive to food and chemicals have higher scores for depression, anxiety, shyness, and defensiveness. On the other hand, in 62% of the cases, there was agreement between diet history and provocation. The next-of-kin of the food intolerant subjects also had various diseases more frequently, increased immunoglobulin E levels, and a higher prevalence of allergy and infectious diseases. For the same patients, major distress or trauma during childhood, as well as undifferentiated somatoform disorders, were common. In conclusion, both somatic symptomatology and self-reported psychological disturbances can be regarded as rather weak documentations. The experience within these fields today may, however, seem promising for further research. One should then emphasize the importance of the nature of exposure and the nature of disposition, represented by immunologic or psychological mechanisms, or a combination of both. Future studies should be aimed at classifying patients into subgroups through the use of improved diagnostic and clinical methods, assessment of organ sensitivity, and immunologic and psychological tests.
食物不耐受背后的机制被视为现代医学中最大的谜团之一。其多学科模式与免疫、环境和身心反应模式具有共同特性，这使得在疾病分类、诊断和治疗方面的分组及个体化方法相当复杂。在本报告中，重点是关于肠道和血液循环中免疫反应的新认识，以此来平衡身心反应的证据。作为讨论的基础，通过简要介绍三项研究来说明食物不耐受患者的身心体验。第一项是横断面研究。第二项是前瞻性对照研究。第三项是双盲安慰剂对照研究，使用活性物质激发并与安慰剂进行比较。患者和对照者均通过基于问卷的访谈和评分系统进行特征描述。这些研究结果无论是综合起来还是单独来看，都表明躯体症状与神经精神症状及情绪障碍之间存在关联。似乎那些认为自己对食物和化学物质敏感的患者在抑郁、焦虑、害羞和防御性方面得分更高。另一方面，在62%的病例中，饮食史与激发试验结果相符。食物不耐受受试者的亲属也更频繁地患有各种疾病，免疫球蛋白E水平升高，过敏和传染病的患病率更高。对于这些患者来说，童年时期的重大困扰或创伤以及未分化的躯体形式障碍很常见。总之，躯体症状和自我报告的心理障碍都可被视为相当薄弱的证据。然而，目前这些领域的经验似乎为进一步研究带来了希望。届时应强调暴露性质和易感性性质的重要性，易感性由免疫或心理机制或两者结合来体现。未来的研究应旨在通过使用改进的诊断和临床方法、评估器官敏感性以及免疫和心理测试，将患者分类为不同亚组。
