Adverse reactions to food. (Book Reviews).

Buttriss J, (editor), Blackwell Science, Oxford, 2002, 236 pages, $114.40, ISBN 0-632-05547-2

The British Nutrition Foundation (BNF) has from time to time organised publication of reviews of nutritional topics that have become prominent and of potential difficulty for the food industry. Among these were 'Complex Carbohydrates in Foods' (1990) and 'Unsaturated Fatty Acids' (1992). They have been written by a 'task force' of academics, industry scientists and senior representatives from the British Ministry of Agriculture, Fisheries and Food and the Department of Health, with the secretariat provided by the BNF.

The latest BNF report is Adverse Reactions to Food. This is a book with the 13 chapters drafted by different independent scientists, members of the 23-person task force chaired by Professor Dame Barbara Clayton of Southampton University. It concludes with useful Conclusions of the Task Force (six pages), Recommendations of the Task Force (four pages), Questions (and answers) on Food Allergy and Intolerance (28 of them over eight pages), a Glossary and about 800 references. Each chapter is summarised with half a page of 'key points'.

This seems to me a very fair presentation of the present experience and understanding of adverse reactions to foods written in a reader-friendly way for health professionals and food scientists. The main focus is on 'food intolerance' which the task force uses here as a broad term to cover food allergies (involving IgE), enzyme defects (e.g. lactase insufficiency) as well as pharmacological reactions to food components.

Though confirmed adverse reactions to foods have been shown to be less common than many people suppose and claim, these reactions can affect food choice and nutrient intake, family life and children's social interactions. They have implications for food and catering industries, for the health services, for schools and for government.

The types of food intolerance rightly given most space in this report are IgE allergies to food proteins, gluten sensitivity (coeliac disease) and lactase insufficiency. Non-immunological reactions to foods now appear to be less common and important than we used to think and this includes any role for diet in attention deficit hyperactivity disorder. Sections in the report on the Feingold diet and on infantile (three-month) colic, are very short and on foods and migraine, food and irritable bowel syndrome are not much longer. But this probably reflects the paucity and difficulty of well-controlled clinical research on these conditions.

The most common foods that cause allergy are (in descending order) peanuts, tree nuts, eggs, fish, cows milk, crustacea, soya beans and cereals containing gluten. The food industry has to handle, monitor and declare these very carefully. Peanuts are the most likely foods to cause life-threatening anaphylaxis in western countries (and it is puzzling that this doesn't seem to be a problem in Asian and African countries).

The cost of this softback, medium-length book is reasonable (considering the BRP/AUD conversion and GST) and I think anyone who has clinical or food industry responsibility for food intolerances will find this a helpful book to have nearby. It is nicely produced and I did not find any writing or printing errors.