42. Neurologic Reactions to Foods and Food Additives

  1. Dean D. Metcalfe MD2,
  2. Hugh A. Sampson MD3,
  3. Ronald A. Simon MD4,5 and
  4. Gideon Lack MBBCh (Oxon), MA (Oxon), FRCPCH6
  1. Richard W. Weber

Published Online: 24 FEB 2014

DOI: 10.1002/9781118744185.ch42

Food Allergy: Adverse Reactions to Foods and Food Additives, Fifth Edition

Food Allergy: Adverse Reactions to Foods and Food Additives, Fifth Edition

How to Cite

Weber, R. W. (2013) Neurologic Reactions to Foods and Food Additives, in Food Allergy: Adverse Reactions to Foods and Food Additives, Fifth Edition (eds D. D. Metcalfe, H. A. Sampson, R. A. Simon and G. Lack), John Wiley & Sons Ltd, Chichester, UK. doi: 10.1002/9781118744185.ch42

Editor Information

  1. 2

    Chief, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

  2. 3

    Kurt Hirschhorn Professor of Pediatrics, Dean for Translational Biomedical Sciences, Director, Jaffe Food Allergy Institute Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

  3. 4

    Head, Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA

  4. 5

    Adjunct Professor, Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA, USA

  5. 6

    Professor of Paediatric Allergy, King's College London Clinical Lead for Allergy Service, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK

Author Information

  1. Denver School of Medicine, University of Colorado, Denver, CO, USA

Publication History

  1. Published Online: 24 FEB 2014
  2. Published Print: 10 DEC 2013

ISBN Information

Print ISBN: 9780470672556

Online ISBN: 9781118744185



  • migraine;
  • epilepsy;
  • gluten;
  • ketogenic diet;
  • anaphylaxis;
  • vasoactive amines


There is a wealth of clinical data supporting that dietary migraine is a bona fide entity, with both pharmacologic and immunologic mechanisms. What the exact pathophysiology is remains unclear, but release of immediate hypersensitivity mediators has been demonstrated. While some reactions may be IgE mediated, many are probably pseudoallergic or anaphylactoid. Why the release of these mediators causes migraine in susceptible persons and not more traditional allergic manifestations, is unclear. Less is known concerning dietary factors in epilepsy. The efficacy of ketogenic diets is established, but the manner in which they operate remains uncertain. That bona fide anaphylactoid reactions could trigger convulsions in susceptible patients appears likely, but double-blind placebo-control (DBPC) studies are absent, and would be helpful in validating the clinical observations, as would mediator-release studies. The neurologic complications associated with gluten sensitivity remain of uncertain etiology, with direct neurotoxic effects, autoimmune injury, or resultant metabolic deficiency from malabsorption, all possible mechanisms.