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The Clinical Use of IgG Food Sensitivity Testing with Migraine Headache Patients: a Literature Review.
Geiselman, JF
Current pain and headache reports. 2019;23(11):79
Abstract
PURPOSE OF REVIEW This literature review describes the relationship between IgG food sensitivities and their relation to migraine headaches. RECENT FINDINGS IgG food sensitivities have been linked to various symptoms and disorders. While food sensitivities and intolerances are recognized within the clinical medicine community, diagnosing these sensitivities and intolerances can be challenging because symptoms are usually delayed hours to days and may not occur after every exposure to the allergen. Some reports indicate that foods such as chocolate, cheese, cow's milk, eggs, and red wine may be triggers for migraine headaches. The pathophysiology of migraine headaches is not well understood. Some evidence supports the use of IgG food sensitivity testing to determine food sensitivities and intolerances. IgG food sensitivity testing may prove to be a beneficial tool for healthcare practitioners, especially for patients experiencing migraine headache symptoms. Utilizing IgG food sensitivity testing to create customizable dietary recommendations for patients may allow healthcare providers to treat migraine headaches without the use of medications.
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Chronic Food Antigen-specific IgG-mediated Hypersensitivity Reaction as A Risk Factor for Adolescent Depressive Disorder.
Tao, R, Fu, Z, Xiao, L
Genomics, proteomics & bioinformatics. 2019;17(2):183-189
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The prevalence of major depressive disorder (MDD) among adolescents has been on the rise recently. A high level of systemic low-grade inflammation is found in the serum of MDD adults, which is believed to interfere with neurotransmitter metabolism, resulting in symptoms of depression. Furthermore, disruption of the blood-brain barrier may inhibit neurotransmitter metabolism. One hundred and eighty-four adolescents with moderate MDD were evaluated against the same number of healthy controls to determine their serum levels of markers of inflammation, homocysteine, food sensitivity, histamine, and histamine metabolism. The study found that histamine levels and food antigen-specific antibodies in MDD adolescent patients were significantly higher than those in the control group. Increasing histamine levels, food-specific IgG levels, and S100 calcium-binding protein B levels suggest blood-brain barrier leakage may contribute to adolescent depression. There is still much to be learned about the pathophysiology of MDD, and further studies are needed to elucidate the mechanisms involved. The results of this study can be used by healthcare professionals to understand the role of histamine and food sensitivities in the development of adolescent depression rather than low-grade inflammation.
Abstract
Major depressive disorder (MDD) is the most common nonfatal disease burden worldwide. Systemic chronic low-grade inflammation has been reported to be associated with MDD progression by affecting monoaminergic and glutamatergic neurotransmission. However, whether various proinflammatory cytokines are abnormally elevated before the first episode of depression is still largely unclear. Here, we evaluated 184 adolescent patients who were experiencing their first episode of depressive disorder, and the same number of healthy individuals was included as controls. We tested the serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), IgE, 14 different types of food antigen-specific IgG, histamine, homocysteine, S100 calcium-binding protein B, and diamine oxidase. We were not able to find any significant differences in the serum levels of hs-CRP or TNF-α between the two groups. However, the histamine level of the patients (12.35 μM) was significantly higher than that of the controls (9.73 μM, P < 0.001, Mann-Whitney U test). Moreover, significantly higher serum food antigen-specific IgG positive rates were also found in the patient group. Furthermore, over 80% of patients exhibited prolonged food intolerance with elevated levels of serum histamine, leading to hyperpermeability of the blood-brain barrier, which has previously been implicated in the pathogenesis of MDD. Hence, prolonged high levels of serum histamine could be a risk factor for depressive disorders, and antihistamine release might represent a novel therapeutic strategy for depression treatment.
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Serological investigation of IgG and IgE antibodies against food antigens in patients with inflammatory bowel disease.
Wang, HY, Li, Y, Li, JJ, Jiao, CH, Zhao, XJ, Li, XT, Lu, MJ, Mao, XQ, Zhang, HJ
World journal of clinical cases. 2019;7(16):2189-2203
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Crohn's disease and ulcerative colitis are relapsing gut inflammatory diseases that are usually referred to as Inflammatory Bowel Disease (IBD). It may be triggered by an imbalance in immune response in response to environmental factors such as diet. The aim of this retrospective study was to evaluate the presence of IgG and IgE mediated antibodies to food antigens in IBD patients. There were one hundred and thirty-seven IBD patients participating in this study, including forty Ulcerative colitis patients and ninety-seven Crohn's disease patients against fifty healthy controls to test serum IgG antibodies to fourteen specific food antigens and serum IgE antibodies to fourteen specific food antigens. There were significantly higher IgG antibodies in response to food antigens in Crohn's disease patients than in Ulcerative colitis patients and healthy controls. Food antigens such as tomato, corn, egg, rice, and soybean exhibited varying levels of IgG antibody responses in Crohn's disease patients and ulcerative colitis patients. Smokers were more likely to develop IgG reactions. Further robust research is needed to examine more IgG-specific food antigens to help manage IBD with an elimination rotation diet. The results of this study can help healthcare professionals understand the importance of diagnosing food intolerances when treating IBD.
Abstract
BACKGROUND Food antigens have been shown to participate in the etiopathogenesis of inflammatory bowel disease (IBD), but their clinical value in IBD is still unclear. AIM: To analyze the levels of specific immunoglobulin G (IgG) and E (IgE) antibodies against food antigens in IBD patients and to determine their clinical value in the pathogenesis of IBD. METHODS We performed a retrospective study based on patients who visited the First Affiliated Hospital of Nanjing Medical University between August 2016 and January 2018. A total of 137 IBD patients, including 40 patients with ulcerative colitis (UC) and 97 patients with Crohn's disease (CD), and 50 healthy controls (HCs), were recruited. Serum food-specific IgG antibodies were detected by semi-quantitative enzyme-linked immunosorbent assay, and serum food-specific IgE antibodies were measured by Western blot. The value of food-specific IgG antibodies was compared among different groups, and potent factors related to these antibodies were explored by binary logistic regression. RESULTS Food-specific IgG antibodies were detected in 57.5% of UC patients, in 90.72% of CD patients and in 42% of HCs. A significantly high prevalence and titer of food-specific IgG antibodies were observed in CD patients compared to UC patients and HCs. The number of IgG-positive foods was greater in CD and UC patients than in HCs (CD vs HCs, P = 0.000; UC vs HCs, P = 0.029). The top five food antigens that caused positive specific IgG antibodies in CD patients were tomato (80.68%), corn (69.32%), egg (63.64%), rice (61.36%), and soybean (46.59%). The foods that caused positive specific IgG antibodies in UC patients were egg (60.87%), corn (47.83%), tomato (47.83%), rice (26.09%), and soybean (21.74%). Significantly higher levels of total food-specific IgG were detected in IBD patients treated with anti-TNFα therapy compared to patients receiving steroids and immunosuppressants (anti-TNFα vs steroids, P = 0.000; anti-TNFα vs immunosuppressants, P = 0.000; anti-TNFα vs steroids + immunosuppressants, P = 0.003). A decrease in food-specific IgG levels was detected in IBD patients after receiving anti-TNFα therapy (P = 0.007). Patients who smoked and CD patients were prone to developing serum food-specific IgG antibodies [Smoke: OR (95%CI): 17.6 (1.91-162.26), P = 0.011; CD patients: OR (95%CI): 12.48 (3.45-45.09), P = 0.000]. There was no difference in the prevalence of food-specific IgE antibodies among CD patients (57.1%), UC patients (65.2%) and HCs (60%) (P = 0.831). CONCLUSION CD patients have a higher prevalence of food-specific IgG antibodies than UC patients and HCs. IBD patients are prone to rice, corn, tomato and soybean intolerance. Smoking may be a risk factor in the occurrence of food-specific IgG antibodies. Food-specific IgG antibodies may be a potential method in the diagnosis and management of food intolerance in IBD.
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Food Exclusion Based on IgG Antibodies Alleviates Symptoms in Ulcerative Colitis: A Prospective Study.
Jian, L, Anqi, H, Gang, L, Litian, W, Yanyan, X, Mengdi, W, Tong, L
Inflammatory bowel diseases. 2018;24(9):1918-1925
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Ulcerative Colitis (UC) is a chronic debilitating inflammatory bowel disease that may need lifetime management. Dietary management of UC by eliminating food antigens that may be causing a delayed immune response is one of the approaches used widely to manage the disease. Food intolerance, mediated by immunoglobulin G antibodies in response to food antigens that are otherwise harmless, could be one cause of UC. Low levels of digestive enzymes may result in poor digestion of glucose, amino acids, and glycerol, followed by an immune reaction that leads to food sensitivities. Ninety-seven UC patients were enrolled in this open-label, stratified, prospective, randomised controlled trial to evaluate the effect of an elimination diet versus a sham diet (a normal healthy diet). Following an IgG-specific exclusion diet for six months resulted in the alleviation of UC symptoms and an improvement in health-related quality of life. Further studies are needed to confirm the effectiveness of the exclusion diet since the intervention group did not show a significant reduction in IgG antibody levels. These results can be used by healthcare professionals to understand the potential role of exclusion diets in the management of UC.
Abstract
BACKGROUND Most patients with ulcerative colitis (UC) rely predominantly on medication for disease control. Diet interventions can reduce pharmaceutical expenditures and prolong remission. We designed a prospective study to evaluate whether an immunoglobulin G (IgG)-guided exclusion diet would improve symptoms and quality of life (QoL) in patients with UC. METHODS The 6-month diet intervention included 97 patients with UC, who were randomly divided into an intervention group (n = 49) and a control (n = 48) group. Individual diet plans were created for the intervention group according to IgG titers; the control group ate a healthy diet as normal. Observational indices included disease activity, extraintestinal manifestations, nutritional status, and QoL. Relationships between food-specific IgG antibodies and these indices were also analyzed. RESULTS At baseline, there were no significant differences between the groups. Food-specific IgG antibodies were detected in 70.10% of participants. After intervention, the Mayo score was significantly lower in the intervention group than in the control group (2.41 ± 0.89 vs 3.52 ± 1.15, P < 0.05). The number of patients with extraintestinal manifestations decreased from 7 to 2 in the intervention group and from 6 to 5 in the control group. As for nutritive indices, the intervention group had higher mean body mass index and albumin than the control group (23.88 ± 3.31 vs 21.50 ± 6.24 kg/m2, respectively, P < 0.05; 48.05 ± 6.39 vs 45.72 ± 5.48 g/L, respectively, P < 0.05), whereas prealbumin and transferrin were not significantly different between the groups. QoL improved after food exclusion (P < 0.05). CONCLUSIONS An IgG-guided exclusion diet ameliorated UC symptoms and improved QoL. Interactions between IgG-based food intolerance and UC warrant further study.
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Food intolerance in patients with manifest autoimmunity. Observational study.
Coucke, F
Autoimmunity reviews. 2018;17(11):1078-1080
Abstract
In the professional medical and scientific world, there is not many interest in the correlation of food intolerance and autoimmune diseases. However there is a lot of evidence that e.g. gluten or gliadine can induce autoimmmune diseases: example the interest in coeliac disease and autoimmunity. There is however a lot of informationavailable about leaky gut and autoimmunity. We performed an observational study in our data base;, where we selected 100 patients with manifest autoimmune disease with clear symptoms and autoimmune antibodies in the form of positive anf more tehn 160 titer. These patients were compared with 25 control patients without any autoimmunity. We could clearly find a difference in food intolerance profiles when we compared AI patients with people without any AI. Overall there is a much greater reaction to several food epitopes, which can be observed on the level of specific antibodies tot he food epitopes. These igG levels for specific food antibodies are significantly higher in the patient group then in the control group. We can also see that some food epitopes provocate a very pronounced reaction, while other show no increased level of igG. Among the most reactive food epitopes are caseine, cow milk, wheat, gliadine, white of egg and rice. A variable reaction can bes een on nuts e.g.; walnuts and almonds. Almost no antibody reaction is noticed on vegetables, fish and meat products, who seem tob e immunologially very neutral. We conclude that food intolerance test is very important tool in patients with AI disease, and should be performed in each patient to tailor an individual diet program, which if properly followed, could relieve symptoms and probably stop or slow the the progression of the autoimmune disease. Also interesting for global research in AI disease is the fact that food is probably an important trigger for autoimmunity in vulnerable patients. More research on great scale and multicenter around this topic is mandatory and urgent.
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Is perceived intolerance to milk and wheat associated with the corresponding IgG and IgA food antibodies? A cross sectional study in subjects with morbid obesity and gastrointestinal symptoms.
Kvehaugen, AS, Tveiten, D, Farup, PG
BMC gastroenterology. 2018;18(1):22
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Dairy and gluten are the most common triggers of irritable bowel syndrome (IBS) in the general population. Food intolerance is generally detected by IgG antibodies, but the test is controversial. In this cross-sectional study, 97 obese subjects (82.4% women) were included, of which 72.1% had gastrointestinal symptoms, 35.7% had IBS, 31.4% had symptoms of milk intolerance, 28.6% had symptoms of wheat intolerance, and 15.7% had symptoms of intolerance to both milk and wheat. The study examined the association between IgA and IgG antibodies corresponding to milk and wheat in subjects with and without gastrointestinal issues and with and without perceptions of food sensitivity. The results of this study found no association between s-IgG and s-IgA antibodies and perceived food intolerances to milk and wheat among morbidly obese subjects. Although IgA against gliadin correlated with increased levels of zonulin, a marker of intestinal permeability, tight-junctional gut permeability inversely correlated with wheat intolerance. Furthermore, the study results revealed a significant correlation between hypothyroidism and IgG against wheat and a marginal correlation between hypothyroidism and IgG against gluten. Further robust research is needed to confirm these findings. Healthcare professionals can use the results of this study to understand the current developments and the controversy surrounding food intolerance testing.
Abstract
BACKGROUND Serum IgG and IgA food antibodies have been used for dietary advice to subjects with gastrointestinal symptoms and perceived food intolerance, but the role of these antibodies in mediating intolerance is controversial. The present study investigated associations between perceived gastrointestinal intolerance to milk-or wheat and the corresponding s-IgG and s-IgA food antibodies in subjects with morbid obesity. METHODS Subjects with morbid obesity (BMI ≥ 40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were included. Irritable Bowel Syndrome (IBS) was diagnosed based on the Rome III criteria. Severity of specific gastrointestinal symptoms were measured with the Gastrointestinal Symptom Rating Scale (GSRS)-IBS. S-IgG against cow's milk, cheese, wheat and gluten, and s-IgA against casein and gliadin were measured. RESULTS Ninety-seven subjects (80 females) with mean age 45 (SD 8.4) years were included, 70 had gastrointestinal complaints, 25 had IBS, and 22 and 20 reported milk- and wheat- intolerance respectively. There were no significant differences in serum concentrations or proportions of subjects above defined cut-off values for the antibodies between subjects with and without gastrointestinal complaints. In the group with gastrointestinal complaints, no significant differences were found between subjects with and without perceived food intolerance. Except for a significant correlation between IgG against cheese and GSRS-diarrhea (Rho: -0.25, P = 0.04), no significant correlations were found between the antibodies and type or degree of gastrointestinal symptoms, including IBS. CONCLUSIONS The study showed no associations between perceived milk or wheat intolerance and the corresponding s-IgG and s-IgA food antibodies in subjects with morbid obesity.
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Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity.
Carroccio, A, Mansueto, P, Iacono, G, Soresi, M, D'Alcamo, A, Cavataio, F, Brusca, I, Florena, AM, Ambrosiano, G, Seidita, A, et al
The American journal of gastroenterology. 2012;(12):1898-906; quiz 1907
Abstract
OBJECTIVES Non-celiac wheat sensitivity (WS) is considered a new clinical entity. An increasing percentage of the general population avoids gluten ingestion. However, the real existence of this condition is debated and specific markers are lacking. Our aim was thus to demonstrate the existence of WS and define its clinical, serologic, and histological markers. METHODS We reviewed the clinical charts of all subjects with an irritable bowel syndrome (IBS)-like presentation who had been diagnosed with WS using a double-blind placebo-controlled (DBPC) challenge in the years 2001-2011. One hundred celiac disease (CD) patients and fifty IBS patients served as controls. RESULTS Two hundred and seventy-six patients with WS, as diagnosed by DBPC challenge, were included. Two groups showing distinct clinical characteristics were identified: WS alone (group 1) and WS associated with multiple food hypersensitivity (group 2). As a whole group, the WS patients showed a higher frequency of anemia, weight loss, self-reported wheat intolerance, coexistent atopy, and food allergy in infancy than the IBS controls. There was also a higher frequency of positive serum assays for IgG/IgA anti-gliadin and cytometric basophil activation in "in vitro" assay. The main histology characteristic of WS patients was eosinophil infiltration of the duodenal and colon mucosa. Patients with WS alone were characterized by clinical features very similar to those found in CD patients. Patients with multiple food sensitivity were characterized by clinical features similar to those found in allergic patients. CONCLUSIONS Our data confirm the existence of non-celiac WS as a distinct clinical condition. We also suggest the existence of two distinct populations of subjects with WS: one with characteristics more similar to CD and the other with characteristics pointing to food allergy.
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Celiac disease: diagnostic criteria in progress.
Volta, U, Villanacci, V
Cellular & molecular immunology. 2011;(2):96-102
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Abstract
Until a few years ago, celiac disease (CD) was thought to be a rare food intolerance that was confined to childhood and characterized by severe malabsorption and flat intestinal mucosa. Currently, CD is regarded as an autoimmune disorder that is common in the general population (affecting 1 in 100 individuals), with possible onset at any age and with many possible presentations. The identification of CD is challenging because it can begin not only with diarrhea and weight loss but also with atypical gastrointestinal (constipation and recurrent abdominal pain) and extra-intestinal symptoms (anemia, raised transaminases, osteoporosis, recurrent miscarriages, aphthous stomatitis and associated autoimmune disorders), or it could be completely symptomless. Over the last 20 years, the diagnostic accuracy of serology for CD has progressively increased with the development of highly reliable tests, such as the detection of IgA tissue transglutaminase and antiendomysial and IgG antideamidated gliadin peptide antibodies. The routine use of antibody markers has allowed researchers to discover a very high number of 'borderline' cases, characterized by positive serology and mild intestinal lesions or normal small intestine architecture, which can be classified as potential CD. Therefore, it is evident that the 'old celiac disease' with flat mucosa is only a part of the spectrum of CD. It is possible that serology could identify CD in its early stages, before the appearance of severe intestinal damage. In cases with a positive serology but with mild or absent intestinal lesions, the detection of HLA-DQ2 and HLA-DQ8 can help reinforce or exclude the diagnosis of gluten sensitivity.
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Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches.
Mitchell, N, Hewitt, CE, Jayakody, S, Islam, M, Adamson, J, Watt, I, Torgerson, DJ
Nutrition journal. 2011;10:85
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The exact causes of migraine are unknown, but it is thought that it may be a culmination of several different factors, such as stress, altered sleep patterns, weather and hypersensitivity to foods. Testing for food intolerances is a challenging process and several methods can be employed to test. This study aimed to determine the effectiveness of using a type of testing known as the enzyme linked immune-sorbent assay (ELISA), which tests the body’s delayed immune reaction to foods, and whether eliminating foods based on results from this test would help migraine sufferers. The results showed that 4 weeks of eliminating foods based on the ELISA test decreased migraines, however this was not sustained to 12 weeks of food elimination. It was concluded that in the short-term, eliminating foods based on results from the ELISA decreased headache frequency, but this could not be sustained long-term. This study could be used by healthcare professionals to understand that diet elimination based on measuring the body’s delayed immune response may have limited effects on migraines.
Abstract
BACKGROUND Research suggests that food intolerance may be a precipitating factor for migraine like headaches. AIM: To evaluate the effectiveness of the ELISA (Enzyme Linked Immuno-Sorbent Assay) Test and subsequent dietary elimination advice for the prevention of migraine like headaches. DESIGN Randomised controlled trial. SETTING Community based volunteers in the UK. PARTICIPANTS Volunteers who met the inclusion criteria for migraine like headaches and had one or more food intolerance were included in the study. Participants received either a true diet (n = 84) or a sham diet (n = 83) sheet. Participants were advised to remove the intolerant foods from their diet for 12 weeks. MAIN OUTCOME MEASURES Number of headache days over a 12 week period (item A MIDAS questionnaire). Other measures includes the total MIDAS score and total HIT-6 score. RESULTS The results indicated a small decrease in the number of migraine like headaches over 12 weeks, although this difference was not statistically significant (IRR 1.15 95% CI 0.94 to 1.41, p = 0.18). At the 4 week assessment, use of the ELISA test with subsequent diet elimination advice significantly reduced the number of migraine like headaches (IRR 1.23 95%CI 1.01 to 1.50, p = 0.04). The disability and impact on daily life of migraines were not significantly different between the true and sham diet groups. CONCLUSIONS Use of the ELISA test with subsequent diet elimination advice did not reduce the disability or impact on daily life of migraine like headaches or the number of migraine like headaches at 12 weeks but it did significantly reduce the number of migraine like headaches at 4 weeks.
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Testing for food reactions: the good, the bad, and the ugly.
Mullin, GE, Swift, KM, Lipski, L, Turnbull, LK, Rampertab, SD
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2010;25(2):192-8
Abstract
An increasing number of commercial tests for food allergies are marketed to consumers and healthcare practitioners with tenuous claims. The aim of this article is to provide an evidence-based review of the tests and procedures that currently are used for patients with suspected food allergy. A systematic review of the literature evaluating the validity of tests and procedures used in food reactions was performed using conventional search engines (eg, PubMed, Ovid) as well as consumer sites (eg, Google, Bing). The National Library of Medicine Medical Subject Headings (MeSH) term food hypersensitivity was used along with food allergy testing, food sensitivity testing, food intolerance testing, and adverse food reactions. Of the results obtained, testing for immunoglobulin E (IgE)-mediated food allergy was best represented in PubMed. IgE-based testing continues to be the gold standard for suspected food allergies. Among modalities used by many conventional and alternative practitioners, immunoglobulin G (IgG)-based testing showed promise, with clinically meaningful results. It has been proven useful as a guide for elimination diets, with clinical impact for a variety of diseases. Mediator release testing and antigen leukocyte cellular antibody testing were only represented on consumer sites. Further investigation into the validity and the clinical application of these tests and procedures is required. Disclosing the basis for food reactions continues to present a diagnostic challenge, and testing for food allergies in the context of an appropriate clinical history is paramount to making the correct diagnosis.
