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This thesis presents an exploration of the experience and interpretation of food intolerance and uses the established literature in the areas of symptom perception, lay sources of health information, and the structure and influences of cognitive illness representations to illustrate and interpret how individuals make sense of this illness identity. The thesis consists of four qualitative studies examining food intolerance from three different perspectives. Study 1 involved in-depth interviews with those who perceive themselves to have a food intolerance, study 2 and 3 involved a content analysis and discourse analysis of the ways in which food intolerance is presented in the print media and study 4 involved in-depth interviews with General Practitioners. The findings of these studies, when examined as a whole, suggested several shared central components in the interpretation of food intolerance. Specifically, the results indicated that food intolerance was not interpreted as an illness per se, nor as a route to the sick role, but as providing an explanation for many of the nonspecific symptoms that frequently occur in the general population. The results indicated that food intolerance is experienced as having an embedded treatment, namely the avoidance of specific foods, which is perceived as both effective and accessible to the individual, and that although food intolerance is interpreted as an uncertain diagnosis, it remains plausible. The thesis concludes that the experience of food intolerance does not sit well within the theories of functional somatic syndromes and pseudo-disease that are commonly used to explain such conditions, but fits instead with the theory of self- diagnosis and lay remedies. It suggest that there may be a justification for the general practitioners cautiously supporting patients' own management strategies of specific food avoidances for food intolerance though some guidance is required to ensure nutritional well-being. Further research is suggested in this area.

Existing immunoglobulin (Ig) tests only give a limited picture of the immunological response to food antigens. Furthermore, existing tests require large volumes of sample, over a limited number of foods, are not amenable to a high sample through-put system and the results are limited to normally just one immunoglobulin class. In order to investigate the global immune response towards food products we have developed the "all diet" microarray concept. The "all-diet food protein microarray contains extracts of over 400 food ingredients that cover most of the food products found in the UK. Using this system we have retrospectively determined food specific IgE, IgA, IgG and IgM from 17 well characterized sera. The results were analyzed by multivariate techniques and parametric methods. The proof-of-concept of the ''all diet microarray to investigate the relationships between food antigen specificity and multiple Ig type was demonstrated here. The novelity of this protein microarray is the use of arrayed food samples sequentially extracted with detergent and chaotropic agents. The array system possesses many advantages over traditional systems such as requirement of low sample volume, high sensitivity and a global view of the immune response. Notwithstanding these potential advantages to clinical practices, these benefits remain yet to be demonstrated. The development of the technique will allow further expansion into areas of research such as conjugation of the microarray with sensitized human basophils and also immunoglobulin binding to extracts of parasites.

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The emphasis for UK dwelling refurbishment to date has centred on reducing heating energy use. However, there has been increasing evidence pointing to the need for a more holistic approach. Many existing dwellings already experience overheating during hot weather periods. Climate change projections predict increases in both the frequency and severity of extreme weather events including heat waves such as the one in August 2003, which is estimated to have claimed the lives of over 35,000 people throughout Europe, including 2,000 in the UK. Demand for housing exceeds the supply of new stock and it is estimated that over 70% of the dwellings that will be in use in 2050 have already been built. Therefore existing dwellings will require adaptation to provide more comfortable and safe environments, to reduce both summertime overheating and heating energy use. In this research, dynamic thermal simulation computer modelling was used to assess and rank the effectiveness of selected single and combined passive interventions (adaptations) on dwelling overheating during a heat wave period. Simulations were also carried out to assess the effect of those interventions on annual space heating energy use. Four distinct dwelling types were selected to represent the housing stock in London and South East England, producing seven modelling variants: 19th century end and mid-terraced houses; 1930s semi-detached house; 1960s ground, mid and top floor flats and a modern detached house. Simulations were carried out for two different occupancy profiles and four building orientations and the cost of interventions was also considered in the analysis. The first occupancy profile assumed a ‘typical’ family who left the dwellings unoccupied during the daytime, the second assumed residents who were at home all the time (e.g. elderly or infirm). Of the dwelling types studied the 1960s mid and top floor flats and the modern (2006) detached house (Tier 2) experienced more than twice as much overheating as the other dwelling types (Tier 1). Tier 2 dwellings were “harder to treat” and unlike Tier 1 dwellings their overheating exposure could not be eliminated using the selected passive interventions. It was possible to substantially reduce overheating and annual heating energy use of Tier 1 dwellings at moderate cost, whereas the costs for retrofitting Tier 2 dwellings were estimated to be many times higher. The results demonstrated that overheating exposure can be significantly greater for residents who have to stay at home during the daytime and they should not, where possible, be housed in the most vulnerable dwellings. External window shutters were found to be the single most effective intervention for overheating reduction in most of the dwelling types considered, typically resulting in a 50% reduction in overheating exposure. The exception was the 19th century terraced houses, where applying a solar reflective (high albedo) coating to the solid external walls was often more effective. In some cases the addition of insulation increased overheating and external wall insulation consistently outperformed internal wall insulation when considering the effect on overheating, though the latter could be effective as an element of combined interventions. Adaptation should therefore be considered together with mitigation, both in design practice and in regulations. If existing dwellings (for example the 19th century terraced houses) are retrofitted for energy efficiency, without considering summer use, overheating could increase dramatically. Subsequent corrective measures could be costly and energy efficiency may suffer as a result. This research builds on previous publications and research to generate systematic, quantitative and holistic guidance for retrofitting UK dwellings to reduce overheating risk during heat waves, whilst minimising annual space heating energy use and considering the cost of retrofit. An interactive retrofit advice toolkit has been developed (and made publicly available) as part of the research, which allows selection of the best performing interventions within a given budget. Recommendations for further development of the research are also suggested.

L’allergie alimentaire est un problème majeur de santé publique. Sa prévalence est estimée à 5 % chez l’adulte et à 8 % chez l’enfant dans les pays industrialisés. L’objectif de cette thèse est d’apporter une contribution à la diététique diagnostique et thérapeutique de l’allergie alimentaire. Nos travaux ont porté sur l’allergie alimentaire au pois jaune et au sésame. Le pois jaune est un allergène émergent à risque de réaction grave. Son seuil réactogène est bas, soit 0,13 g de protéines alors que la teneur des aliments peut atteindre 20 g/100g. L’étude de 35 personnes allergiques au sésame a permis de définir que le seuil réactogène pouvant déclencher une réaction chez 5% de la population allergique se situe entre 1,2 et 4,0 mg de protéines de sésame. Nous avons validé la progression optimale des doses de sésame pour le test de provocation orale en lien avec le consensus européen Europrevall. L’absence d’harmonisation internationale concernant les allergènes à déclaration obligatoire, nous a conduit dans une seconde partie, à étudier l’impact de l’allergie alimentaire sur la décision, l’organisation et le déroulement d’un séjour à l’étranger. Cette étude réalisée en collaboration avec l’Observatoire Régional de Santé et des Affaires Sociales de Lorraine et les associations française et belge pour la prévention des allergies montre, sur un panel de 102 répondants, que l’allergie alimentaire contraint 14 % des répondants à ne pas voyager à l’étranger et que 30% des personnes ayant voyagé ont présenté une réaction allergique. Les accidents sont survenus principalement dans les restaurants. Ces résultats soulignent la nécessité de développer un système d’information et de formation des personnes allergiques et des professionnels de l’alimentation pour mettre en oeuvre des stratégies de prévention du risque. / Food allergy is a major public health problem. Its prevalence is estimated at 5% in adults and 8% in children in industrialized countries. The objective of this thesis is to bring a contribution to the diagnostic and therapeutic dietetics in food allergy. Our work focused on yellow pea and sesame food allergies. Yellow pea is an emerging allergen with risk of a severe reaction. Its reactogenic threshold is of 0.13 g of protein while the content of food can reach 20 g / 100g. The study of 35 people allergic to sesame has enabled the identification of the reactogenic threshold that can trigger a reaction in 5% of the allergic population. It is estimated between 1.2 and 4.0 mg of sesame protein. We validated optimal progression dosing scheme for sesame for oral challenge test taking in account the European consensus Europrevall. Lack of international harmonization on mandatory allergens, led us in a second part of this thesis, to study the impact of food allergy on the decision, trip organization and a stay abroad of an allergic person. This study, conducted in collaboration with the regional health observatory and Social Affairs of Lorraine and the French and Belgian associations for allergy prevention shows, on a panel of 102 respondents, that food allergy forced 14% of respondents do not travel abroad and that 30% of people who have traveled had an allergic reaction. The accidents occurred mainly in restaurants. These results highlight the need to develop an information system and training of allergies and food professionals to implement risk prevention strategies.