Review of Intolerance Reactions to Food and Food Additives

There is ongoing interest in the community in the area of intolerance reactions to food and food additives. To inform future discussions on this subject, FSANZ initiated a scientific review to give further consideration to key issues underpinning the public debate. This paper provides an overview of the contemporary understanding of food intolerance, and highlights the individual nature of intolerance reactions and the wide range of food chemicals, whether naturally occurring or added to food, which may contribute to intolerance reactions. The clinical manifestations of intolerance described in the literature vary widely, both in relation to the symptoms reported and the substances implicated. Symptoms associated with food intolerance reactions range from mild to severe but the effects are largely transient. The immune system is not involved in these reactions, and therefore these forms of food intolerance are not allergies. Food substances most commonly associated with intolerance reactions are naturally occurring chemicals such as salicylates and biogenic amines. While some food additives may contribute to intolerance reactions, clinical observations suggest that affected individuals are usually sensitive to several substances, including both natural food chemicals as well as artificial and natural food additives. Food additives, particularly food colours, are perceived to be a major cause of intolerance reactions in the community. However, except for sulphites, clinical evidence of a causal link between food additives and intolerance reactions is limited, and the frequency, severity and spectrum of symptoms are yet to be determined. In Australia and New Zealand, the approval of food additives follows a rigorous process based on two principles: the additive must fulfil a technological function, and must not pose a safety concern to consumers at the proposed level of use. Approved additives must be declared on the food label. This regulatory approach ensures a high level of safety for all consumers and supports dietary management for individuals affected by food intolerance.