Food allergy has been defined as 'a reaction to a food, which is both reproducible and associated with evidence of an abnormal immunological reaction to the food (mediated by antibody or T-lymphocytes or both)'. The Food and Agricultural Organisation of the United Nations defined food allergy as 'an untoward reaction [to food] due to an immunological mechanism'.1 These broad headings distinguish food allergy from food intolerance depending on the immunological basis of a reaction. Food intolerance is defined generally as a reproducible but not immunologically mediated reaction. Food aversion is considered to be a psychologically mediated non-reproducible reaction. The term reproducible is important: many people report allergic or intolerance reactions that, when stringently investigated, are found to be spurious. For a reaction to be considered allergic or intolerant in nature, psychological and emotional factors need to be controlled - by exclusion. This is the basis of the double-blind placebo-controlled food challenge (DBPCFC), where patient and observer bias are eliminated or minimised.2 Allergic reactions and intolerant reactions are reproducible in a double-blind placebo-controlled food challenge if the threshold dose is reached. Food aversion is not reproducible in blinded food challenges. The rest of this discussion is restricted to food allergy and food intolerance reactions.

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