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References

Scientific Studies in Support of Hypoallergenic Diet

1930-2016

Dating back to the 1930’s, investigators have been studying the effects of the Hypoallergenic Diet on different diseases. Most of these studies involved a relatively small number of individuals. Taken collectively though, these studies shed light on the role of this diet in treatment of diseases. Specifically, they point to the concept of individual variability in food tolerance and food sensitivity. since the first publication of this book the number of key research on the role of food related IgG and their associated  relation to specific disease has increased substantially.What follows are select studies pointing to the efficacy of hypoallergenic diet in treatment of specific conditions.

Migraines

In a 1983 study published in The Lancet (a prestigious medical journal) by Egger et al., 88 children suffering from severe, frequent migraines were placed on a hypoallergenic diet. The diet consisted typically of one meat (lamb or chicken), one carbohydrate (rice or potato), one fruit (banana or apple), vegetables (Brassica), water, and vitamin and calcium supplements for 3-4 weeks. If success was not achieved within 3-4 weeks, a second hypoallergenic diet (with different foods) was attempted. A recovery rate of 92% was reported. Of the 82 children who improved, 74 developed symptoms upon the re-challenge phase (reintroduction of offending foods to the diet). The most common offending foods were found to be milk 27%, eggs 24%, chocolate 22%, oranges 21%, and wheat 21%.

In a 1993 study published in the journal of Pediatric Medicine, Guariso G and colleagues studied the possible correlation between migraines and food intolerance in 43 patients aged from 7 to 18 years. Half of them (group A) followed a hypoallergenic diet (including 8 simple foods) for 4 weeks. Afterward, each patient was challenged weekly in an open trial, introducing into the diet the different foods and additives previously eliminated. The second half of the patients (group B) were not following any diet, or a pharmacological prophylaxis, but were followed up with a clinical diary. Among the patients on hypoallergenic diet, 12 only concluded the trial: 6/12 presented a completed reduction of headaches, 5/12 had a significant improvement of the migraine patterns. The foods recognized as responsible for the attacks were: cacao, bananas, eggs, and hazelnuts.

Arthritis

In 1980, Hicklin et. Al. published an article in the Journal of Clinical Allergy, titled The effect of diet in rheumatoid arthritis. In this study Heckling and colleagues administered a hypoallergenic diet to 22 patients with rheumatoid arthritis. Twenty of the patients (91%) reported an improvement in their symptoms.

Beri et. al. (1988) prescribed an elimination-and-rechallenge diet to 27 patients with rheumatoid arthritis. In this study, published in Annals of Rheumatological Diseases, 10 of 14 patients who completed the diet program demonstrated significant clinical improvements.

In another controlled trial published in The Lancet in 1991, 27 patients with rheumatoid arthritis underwent a partial fast, followed by individual food challenges (Kjeldsen-Kragh et. al., 1997). 17 foods which provoked symptoms were avoided. These foods were animal foods, refined sugar, citrus fruits, preservatives, coffee, tea, alcohol, salt, and strong spices. A control group of 26 patients ate an ordinary diet. After four weeks, the diet group showed a significant improvement in the number of tender joints, Ritchie’s articular index, number of swollen joints, pain score, duration of morning stiffness, grip strength, erythrocyte sedimentation rate, and C-reactive protein levels. In the control group, only pain score improved. The benefits in the hypoallergenic diet group were still present after one year.

Irritable Bowel Syndrome, and Inflammatory Bowel Diseases

In a 1989 study, 189 patients with irritable bowel syndrome consumed a hypoallergenic diet for three weeks. In this study, titled Food Intolerance and the Irritable Bowel Syndrome, Nanda R. et. al. (1989) eliminated dairy products, cereals, citrus fruits, potatoes, tea, coffee, alcohol, additives, and preservatives. Ninety-one patients (48.2%) improved. Subsequent reintroduction phase with individual foods provoked symptoms in 73 of the 91 responders. Of these, 72 remained well on a modified diet during a mean follow-up period of 14.7 months.

In another Lancet published study (1993), Riordan and colleagues treated 136 patients with active Crohn’s disease with a type of hypoallergenic diet. In this 1993 study, 78 (84%) of the 93 patients who continued the diet for 14 days achieved clinical remission. Of the patients who followed the diet, 45 percent remained disease-free for at least two years.

Asthma

In a 1977 investigation of 188 children with allergic rhinitis and/or bronchial asthma, Ogle and colleagues achieved complete remission in 62% of children, with partial improvements in an additional 28%. These children were treated solely with the hypoallergenic diet for six weeks. Upon challenge, 40% of the children, who had improved, experienced a recurrence of symptoms.

Hoj et. al. (1981) conducted a double-blind controlled trial of hypoallergenic diet in severe asthma. In this study 41 patients were randomly assigned to a modified form of Hypoallergenic Diet, or to a control diet. By the end of two weeks, 9 out of 21 patients consuming the diet showed improvements, compared to 1 out of 16 in the control group.

Other Diseases

Similar investigations have shown marked improvements in aphthous ulcers, gallbladder disease, recurrent otitis media, and nephrotic syndrome. Perhaps what is most intriguing is the effect of hypoallergenic diet on mental disorders. At least 6 trials in ADD/ ADHD have demonstrated improvement in 50-75% of children via intervention with hypoallergenic diets.

Comparative mapping of the local distribution of immunoglobulin-containing cells in ulcerative colitis and Crohn’s disease of the colonBaklien K. et al: Clin Exp Immunol, 22, 197-209 (1975)
The local response pattern of immunoglobulin-containing cells was compared in Crohn’s disease and ulcerative colitis by paired immunohistochemistry on specimens of the large bowel wall. In the “Crohn mucosa” with persisting glands the total cell count was on the average raised more than three times compared with controls. The numbers of IgA, IgM and IgG immunocytes were increased 2.0, 4.8 and 28.6 times, respectively. Only 0-2 IgD- and IgE-containing cells were generally found per section. No consistent differences in the mucosal response pattern were revealed when Crohn’s disease was compared with ulcerative colitis. The deeper layers of the bowel wall were in both diseases more or less densely infiltrated by immunocytes-IgG cells compromising about 80%. Immunoglobulin-containing cells in the muscularis propria and subserosa were characteristically found in Crohn’s disease. There was no indication of a primary defect in the secretory immunoglobulin system which appeared to be normal in areas with intact glands. The pronounced local humoral immune response, particularly that involving IgG, might be of pathogenetic importance by aggravating and perpetuating in the inflammatory bowel disease.

Study of IgG subclass antibodies in patients with milk intolerance Shakib F. et al: Clin Allergy, 16, 451-458 (1986)
An ELISA was applied to measure IgG sub-class antibodies to cow’s milk betalactoglobulin (BLG), alpha-lactalbumin (ALA) and alpha-casein (AC) and to hen’s egg ovalbumin (OA) in the sera of nineteen adult patients with milk intolerance causing either asthma, eczema or both. Results were compared with those of forty blood donors and twenty adult patients with either asthma or eczema due to inhalant allergy. Apart from one blood donor, high titres of IgG sub-class antibodies to all three milk proteins were found only in the milk intolerance group. The most frequently detected antibody was AC-specific IgG4; being high (i.e. > 9·98 μg/ml) in eight milk intolerance cases: six with eczema, one with asthma and one with both. A variable proportion of these eight patients also had high levels of IgG1, IgG2 and IgG3 antibodies to AC and IgG1, IgG2, IgG3 and IgG4 antibodies to BLG and ALA. In contrast, IgG antibody to the egg protein, OA, was remarkably restricted to IgG4 and was present in high titres in 68·4% of milk intolerant patients, 60% of inhalant allergy patients and 30% of blood donors. However, the greater incidence of high titres of IgG4 antibody to OA, compared to AC, was due to the superior coating efficiency of OA resulting in a more sensitive assay. We conclude that some adult cases of milk intolerance, particularly those with eczema, can be diagnosed by detecting raised serum levels of IgG sub-class antibodies to milk proteins.

Immunohistochemical characterisation of local immunoglobulin formation in Crohn’s disease of the ileum. Baklien K. et al: Scan J Gastroenterol, 11, 447-457 (1976)
Paired direct immunofluorescence was used to localize and differentially enumerate immunocytes containing the various immunoglobulin (Ig) classes in ileal bowel walls of patients with Crohn’s disease. In slightly inflamed mucosa the total number of Ig-containing cells of an average “tissue unit” increased threefold compared with normal controls, but only minor changes occurred in class ratios. In severely inflamed mucosa with persisting glands, the total immunocyte number was increased by a factor of 12.2 compared with the control unit. For IgA, IgM, and IgG cells this increase was 9.0, 12.0, and 60.9, respectively. The immunocyte ratios for these three major Ig classes were 57.5:14.7:27.7 in the inflamed mucosa, and 83.1:11.4:5.4 in the histologically normal control mucosa. When severely inflamed specimens from the ileum and from the colon were compared, there was no statistically significant difference in absolute immunocyte counts or class distributions. IgD and IgE immunocytes were extremely rare, and no consistent increase was found in the inflamed mucosae. In both the ileum and the colon fairly dense immunocyte populations with a marked IgG-cell predominance were encountered in the deeper layers of the inflamed bowel wall. The possible pathogenetic consequences of the pronounced local “over-production” of IgG in inflammatory bowel disease are discussed. November 8th 2010

Comparative mapping of the local distribution of immunoglobulin-containing cells in ulcerative colitis and Crohn’s disease of the colon. Baklien K. et al: Clin Exp Immunol, 22, 197-209 (1975)
The local response pattern of immunoglobulin-containing cells was compared in Crohn’s disease and ulcerative colitis by paired immunohistochemistry on specimens of the large bowel wall. In the “Crohn mucosa” with persisting glands the total cell count was on the average raised more than three times compared with controls. The numbers of IgA, IgM and IgG immunocytes were increased 2.0, 4.8 and 28.6 times, respectively. Only 0-2 IgD- and IgE-containing cells were generally found per section. No consistent differences in the mucosal response pattern were revealed when Crohn’s disease was compared with ulcerative colitis. The deeper layers of the bowel wall were in both diseases more or less densely infiltrated by immunocytes-IgG cells compromising about 80%. Immunoglobulin-containing cells in the muscularis propria and subserosa were characteristically found in Crohn’s disease. There was no indication of a primary defect in the secretory immunoglobulin system which appeared to be normal in areas with intact glands. The pronounced local humoral immune response, particularly that involving IgG, might be of pathogenetic importance by aggravating and perpetuating in the inflammatory bowel disease.

Dietary advice based on food specific IgG Results
Geoffrey Hardman, Gillian Hart, University of York, Heslington, York, UK
Nutrition and food science Vol 37 No 1 2007 pp 16-23
Purpose – Evidence has suggested that elimination diets based on food-specific IgG measurement can lead to improvements in chronic ill health
symptoms. This paper aims to review the evidence from studies on food-specific IgG measurement and dietary change. Design/methodology/approach – A literature review of studies on the putative role for food-specific IgG-based elimination diets was undertaken. Findings – The use of fully standardised clinically evaluated food-specific IgG tests as a basis for elimination diet could lead to a considerable improvement in many patients’ quality of life.

Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial
W Atkinson, T A Sheldon, N Shaath, PJ Whorwell Gut 2004:53 1459-1464 doi: 10.1136 Gut 2004;53:1459–1464. doi: 10.1136/gut.2003.037697
BACKGROUND: Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies. AIMS: To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food. PATIENTS: A total of 150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies. METHODS: Primary outcome measures were change in IBS symptom severity and global rating scores. Non-colonic symptomatology, quality of life, and anxiety/depression were secondary outcomes. Intention to treat analysis was undertaken using a generalised linear model. RESULTS: After 12 weeks, the true diet resulted in a 10% greater reduction in symptom score than the sham diet (mean difference 39 (95% confidence intervals (CI) 5-72); p = 0.024) with this value increasing to 26% in fully compliant patients (difference 98 (95% CI 52-144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24% greater deterioration in symptoms in those on the true diet (difference 52 (95% CI 18-88); p = 0.003). CONCLUSION: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.

Celiac Disease
Peter H.R. Green, M.D., and Christophe Cellier, M.D., Ph.D.The New England Journal of Medicine 2007; 357:1731-43
Celiac disease is a unique autoimmune disorder, unique because the environmental precipitant is known. The disorder was previously called celiac sprue, based on the Dutch word sprue, which was used to describe a disease similar to tropical sprue that is characterized by diarrhea, emaciation, aphthous stomatitis, and malabsorption.1,2 Celiac disease is precipitated, in genetically predisposed persons, by the ingestion of gluten, the major storage protein of wheat and similar grains.3 Originally considered a rare malabsorption syndrome of childhood, celiac disease is now recognized as a common condition that may be diagnosed at any age and that affects many organ system. November 8th 2010

IgG Antibodies against Food Antigens are Correlated with Inflammation and Intima Media Thickness in Obese Juveniles
M. Wilders-Truschnig, H.Mangge, C.Lieners, H.J.Gruber, C Mayer, W Marz Exp Clin Endocrinol Diabetes 2008; 116:241-245
OBJECTIVE: Systemic low grade inflammation may contribute to the development of obesity, insulin resistance, diabetes mellitus and atherosclerotic vascular disease. Food intolerance reflected by immunoglobulin G (IgG) antibodies may predispose to low grade inflammation and atherogenesis. We examined the relationship between IgG antibodies specific for food components, low grade inflammation and early atherosclerotic lesions in obese and normal weight juveniles. RESEARCH METHODS AND PROCEDURES: We determined IgG antibodies directed against food antigens, C-reactive protein (CRP) and the thickness of the intima media layer (IMT) of the carotid arteries in 30 obese children and in 30 normal weight children. RESULTS: Obese juveniles showed a highly significant increase in IMT (p=0.0001), elevated CRP values (p=0.0001) and anti-food IgG antibody concentrations (p=0.0001) compared to normal weight juveniles. Anti-food IgG showed tight correlations with CRP (p=0.001/r=0.546) and IMT (p=0.0001/r=0.513) and sustained highly significant in a multiple regression model. DISCUSSION: We show here, that obese children have significantly higher IgG antibody values directed against food antigens than normal weight children. Anti- food IgG antibodies are tightly associated with low grade systemic inflammation and with the IMT of the common carotid arteries. These findings raise the possibility, that anti-food IgG is pathogenetically involved in the development of obesity and atherosclerosis.

Toward an understanding of Allergy and In-Vitro Testing
By Mary James N.D Great Smokies Diagnostic Laboratory
Food represents the largest antigenic challenge facing the immune system. Assuming complete digestion, an intact intestine, a sturdy constitution, and minimal antigenic exposure such that the immune system is not over whelmed, all goes well. Weaknesses in one or more of these areas, however, can result in immune attacks upon foods as if they were foreign invaders. A long list of conditions have been associated with food reactions including fatigue, migraine, irritable bowel disease, gallbladder disease, arthritis, asthma, rhinitis, ADHD, enuresis, epilepsy ,eczema, psoriasis, apthous ulcers and recurrent sinusitis, otitis media and other infections.

Reported food intolerance and respiratory symptoms in young adults
R.K.Woods, M.Abramson, J.M.Raven, M Bailey, JM Weiner, E.H.Walters Eur Respir J 1998 11:151-155
The aim of the study was to assess the ability of the European Community Respiratory Health Survey (ECRHS) questionnaire to provide data on the prevalence, type and reported symptoms associated with food intolerance from a group of young adults in Melbourne. Six hundred and sixty nine randomly selected subjects completed the questionnaire with 553 attending the laboratory for skin-prick tests, anthropometry, and ventilatory function tests. A further 207 symptomatic participants completed the questionnaire, with 204 of them attending the laboratory. Seventeen per cent of all respondents reported food intolerance or food allergy. A wide variety of food items was cited as being responsible for food-related illnesses. Those with current asthma did not report food-related illness more frequently than those without asthma. Respondents who reported respiratory symptoms following food ingestion were more likely to be atopic, to have used inhaled respiratory medications in the previous 12 months, reported less exposure to regular passive smoking over the past 12 months and weighed more. These associations between respiratory symptoms and food intolerance require further prospective investigation and verification. The importance of using appropriate dietary methodology in future studies for determining diet-disease relationships was highlighted by this study. November 8th 2010

A critical review of IgG Immunoglobulins and Food Allergy- Implications in systemic health
Raymond M. Suen, MT (ASCP), Shalima Gordon, ND 13500 Linden Ave. N. Seattle, WA 98133 Ph: (206) 365-1256, (877) 318-8728, Fax: (206) 363-8790
Food allergy is defined as an adverse clinical reaction due to an immune-mediated hypersensitivity response resulting from the ingestion of a food. A wide variety of foods have been shown to produce allergic reactions including cow’s milk; chicken eggs; legumes; fish and shellfish; and cereals. (1) Depending on the speed of onset of symptoms, less than 45 minutes to 2 hours to days, immediate and delayed food allergies have been described throughout the literature encompassing a variety of gastrointestinal, respiratory, and cutaneous pathologies. (2) The inflammatory response is the common theme to all allergic pictures and is characterized by the release of chemical mediators, vasodilation, increased vascular permeability, edema, and tissue damage.

The clinical relevance of IgG food allergy testing through ELISA (Enzyme-Linked Immunosorbent Assay)
From: Townsend Letter for Doctors and Patients, Date: 1/1/2004, Author: Suen, Raymond M.; Gordon, Shalima

Allergic reactions to foods may be classified as either IgE-mediated or nonIgE-mediated–the role of the former in food allergy being well-established. However, interestingly enough, the majority of food allergies are associated with specific nonIgE-mediated immune sensitivities. As such, appropriate tests must be utilized to identify possible causes, including food-antigen specific IgG antibodies. There are many testing methods available for the detection of food allergies including the skin prick test and RAST, or radioallergosorbent test. Unfortunately, both of these methods only look for allergen-specific IgE antibodies from the patient’s serum. This poses considerable limitations in the clinical assessment of the chronically unwell patient.

Food allergy mediated by IgG antibodies associated with migraine in adults
Carlos M. Arroyave Hernández,* Mauro Echevarría Pinto,** Hebert Luis Hernández Montiel*** Revista Alergia México 2007;54(5):162-8
Background: Migraine occurs with a high prevalence of 18 per cent. Management requires a tailored regimen of pharmacological and other measures based on individual clinical history. In some patients, allergen-specific IgG has been suspected to be involved in their mechanism, however, serological methods to investigate such possibility, are seldomly used.Objective: The aim of this study was to investigate allergen-specific IgG in serum of patients with migraine refractory to traditional treatment.Material and methods: Serum antibodies to specific 108 food allergens were measured by enzyme immunoassay from 56 patients with migraine and a control group without migraine.Results: In addition to statistical significant differences in the number of positives for IgG food allergens between patients with migraine and a controlled group, elimination diets successfully control the migraine without the need of medications.Conclusion: According to the results obtained, serum IgG antibodies to common food should be investigated in patients with migraine.Key words: Food allergy, migraine, IgG antibodies. Correspondencia: Dr. Carlos M. Arroyave Hernández. Calle Hacienda Buenavista núm. 322-12, colonia Jardines de la Hacienda, CP 76180, Querétaro, Querétaro, México.Recibido: agosto, 2007. Aceptado: agosto, 2007.La versión completa de este artículo también está disponible en internet: www.revistasmedicasmexicanas.com.mx November 8th 2010

Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised, cross-over trial
Kadriye Alpay1, Mustafa Ertas¸1, Elif Kocasoy Orhan1, Didem Kanca U ¨ stay2, Camille Lieners3 and Betu¨ l Baykan Cephalalgia 0(00) 1–9 International Headache Society 2010 Reprints and permissions:sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102410361404 cep.sagepub.com
Introduction: It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks in this randomised, double blind, cross-over, headache-diary based trial on 30 patients diagnosed with migraine without aura.
Methods: Following a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA. Then, the patients were randomised to a 6-week diet either excluding or including specific foods with raised IgG antibodies, individually. Following a 2-week diet-free interval after the first diet period, the same patients were given the opposite 6-week diet (provocation diet following elimination diet or vice versa). Patients and their physicians were blinded to IgG test results and the type of diet (provocation or elimination). Primary parameters were number of headache days and migraine attack count. Of 30 patients, 28 were female and 2 were male, aged 19–52 years (mean, 35_10 years).
Results: The average count of reactions with abnormally high titre was 24_11 against 266 foods. Compared to baseline, there was a statistically significant reduction in the number of headache days (from 10.5_4.4 to 7.5_3.7; P<0.001) and number of migraine attacks (from 9.0_4.4 to 6.2_3.8; P<0.001) in the elimination diet period.
Conclusion: This is the first randomised, cross-over study in migraineurs, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.

The Role of Hidden Food Allergy/Intolerance in Chronic DiseaseAlan R. Gaby, M.D. Alt Med Rev 1998;3(2):90-100)
A large body of medical literature has indicated that hidden food allergy is a frequent cause of a wide range of physical and mental conditions. Hidden allergies can be “unmasked” by means of an elimination diet, followed by individual food challenges.Although the concept of hidden food allergy remains controversial, the evidence strongly suggests that identification and avoidance of allergenic foods can relieve a number of common and difficult-to-treat medical problems.
(Alt Med Rev 1998;3(2):90-100) November 8th 2010

Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics

Jeanne Drisko, MD, CNS, Bette Bischoff, MD, RD, Matthew Hall, PhD, Richard McCallum, MD
Program in Integrative Medicine (J.D.), School of Medicine (B.B.), Preventive Medicine and Public Health (M.H.),Gastrointerology and Hepatology (R.M.), University of Kansas Medical Center, Kansas City, KS Journal of the American College of Nutrition, Vol. 25, No. 6, 514–522 (2006)
Objective: In Irritable Bowel Syndrome, the gut-associated immune system may be up-regulated resulting in immune complex production, low-grade inflammation, loss of Class I bacteria, and translocation of inflammatory mediators and macromolecules outside of the GI lumen. Since food intolerance may be one of the reasons for this upregulation, our goal was to investigate the role of food intolerance in IBS patients. Methods: In this open label pilot study, we enrolled 20 patients with IBS by Rome II criteria (15 women, ages 24–81) who had failed standard medical therapies in a tertiary care GI clinic. Baseline serum IgE and IgG food and mold panels, and comprehensive stool analysis (CSA) were performed. Breath-hydrogen testing and IBS Quality-of-Life (QOL) questionnaires were obtained. Patients underwent food elimination diets based on the results of food and mold panels followed by controlled food challenge. Probiotics were also introduced. Repeat testing was performed at 6-months. We followed up with this cohort at 1 year after trial completion to assess the
reported intervention and for placebo effect. Results: Baseline abnormalities were identified on serum IgG food and mold panels in 100% of the study subjects with significant improvement after food elimination and rotation diet (p _ 0.05). Significant improvements were seen in stool frequency (p _ 0.05), pain (p _ 0.05), and IBS-QOL scores (p _ 0.0001). Imbalances of beneficial flora and dysbiotic flora were identified in 100% of subjects by CSA. There was a trend to improvement of beneficial flora after treatment but no change in dysbiotic flora. The 1-year follow up demonstrated significant continued adherence to the food rotation diet (4.00 _ 1.45), minimal symptomatic problems with IBS (4.00 _ 1.17), and perception of control over IBS (4.15 _ 1.23). The continued use of probiotics was considered less helpful (3.40 _ 1.60).
Conclusion: These data demonstrate that identifying and appropriately addressing food sensitivity in IBS patients not previously responding to standard therapy results in a sustained clinical response and impacts on overall well being and quality of life in this challenging entity.

IgG-mediated allergy: A new mechanism for Migraine attacks?

Julio Pascual and Agustı´n Oterino. Cephalalgia 0(00) 1–3! International Headache Society 2010 Reprints and permissions:sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102410364856
Despite recent advances offered by modern neuroimaging and genetic techniques, the pathophysiology of migraine has not been fully clarified. As pointed out by Selby and Lance 50 years ago, a relevant proportion of patients report that their migraine attacks are usually precipitated by dietary items (1). In a survey analysing the prevalence of dietary migraine in 500 new migraine patients, Peatfield et al. found in 1984 that 19.2% of migraine patients reported sensitivity to cheese, 18.2% to chocolate ad 11.1% to citrus fruit (2). The same year, Monro et al. published a paper in the Lancet with the categorical title ’Migraine Is a Food-Allergic Disease’, describing the treatment of just nine patients with severe refractory migraine with either sodium cromoglycate or placebo after the patients ate foods previously identified
as provocants (3). November 8th 2010

Testing for food reactions: the good, the bad, and the uglyMullin GE, Swift KM, Lipski L, Turnbull LK, Rampertab SD. Nutr Clin Pract 2010 Apr;25(2):192-8. Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. gmullin1@jhmi.edu
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.

Clinical relevance of IgG antibodies against food antigens in Crohn’s disease: A double-blind cross-over diet intervention studyBentz S. et al: Digestion, 81, 252-264 (2010)
Background: Environmental factors are thought to play an important role in the development of Crohn’s disease (CD). Immune responses against auto-antigens or food antigens may be a reason for the perpetuation of inflammation.Methods: In a pilot study, 79 CD patients and 20 healthy controls were examined for food immunoglobulin G (IgG). Thereafter, the clinical relevance of these food IgG antibodies was assessed in a double-blind cross-over study with 40 patients. Based on the IgG antibodies, a nutritional intervention was planned. The interferon (IFN)gamma secretion of T cells was measured. Eosinophil-derived neurotoxin was quantified in stool.Results: The pilot study resulted in a significant difference of IgG antibodies in serum between CD patients and healthy controls. In 84 and 83% of the patients, respectively, IgG antibodies against processed cheese and yeast were detected. The daily stool frequency significantly decreased by 11% during a specific diet compared with a sham diet. Abdominal pain reduced and general well-being improved. IFNgamma secretion of T cells increased. No difference for eosinophil-derived neurotoxin in stool was detected.Conclusion: A nutritional intervention based on circulating IgG antibodies against food antigens showed effects with respect to stool frequency. The mechanisms by which IgG antibodies might contribute to disease activity remain to be elucidated. November 8th 2010

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