LNSLNS The authors describe the differential diagnoses and the methodological approach and refer to national guidelines, the PubMed and Cochrane databases, and their own data registry. Since some of their statements do not reflect current insights or are not in line with recommendations of current guidelines but may be misunderstood in everyday clinical practice, these paragraphs urgently need correcting.

We wish to take up the following points:

• The diagnostic approaches shown in Figure 3, which include measurements of methylhistamine, or fecal elastase 1, immunocomplexes, mediators of the mucosa oxygenation, and segmental intestinal lavage, are not among the established procedures to diagnose food intolerance.

• The details on therapeutic measures in mastocytosis are not consistent with the recommendations of the medical specialty societies. There are no adequate data for treatment with corticosteroids, ciclosporin, and above all, the leukotriene receptor antagonist montelukast. No controlled clinical trials are available; these drugs are not licensed for treatment of mastocytosis.

• Except for IgE mediated immediate reactions, no confirmed results exist for reactions based on the Coombs and Gell type I–IV allergy with regard to their frequency and importance as a cause of immunologically mediated food intolerances.

We welcome the fact that this important and much discussed topic was conceived as a CME article by Deutsches Ärzteblatt. However, this makes it even more important that all reported data are based on scientifically confirmed results and recommendations from current guidelines—standard clinical practice should not be based on published opinions of individuals.
DOI: 10.3238/arztebl.2010.0039a

PD Dr. med. Jörg Kleine Tebbe
Prof. Dr. med. Thomas Werfel
Prof. Dr. med. Bodo Niggemann
Prof. Dr. med. Margitta Worm
Allergie-Centrum-Charité
Klinik für Dermatologie, Venerologie und Allergologie
Charité Campus Mitte
Universitätsmedizin Berlin
Charitéplatz 1
10117 Berlin, Germany
margitta.worm@charite.de

Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Zopf Y, Baenkler HW, Silbermann A, Hahn EG, Raithel M: The differential diagnosis of food intolerance [Differenzialdiagnose von Nahrungsmittelunverträglichkeiten]. Dtsch Arztebl Int 2009; 106: 359–69.
1. Zopf Y, Baenkler HW, Silbermann A, Hahn EG, Raithel M: The differential diagnosis of food intolerance [Differenzialdiagnose von Nahrungsmittelunverträglichkeiten]. Dtsch Arztebl Int 2009; 106: 359–69.