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INGESTED INTOLERANCES and TOXINS

Ingested Intolerances and Toxins-Physical:  Research Article

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Food Elimination and Irritable Bowel Syndrome

CITATION:  Atkinson, W., Sheldon, T.R., et al.  (2004).  Food Elimination Based On IgG Antibodies In Irritable Bowel Syndrome: A Randomised Controlled Trial .  Gut 53:1459-1464.

ABSTRACT: 

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. 

References

1. Drossman DA, Camilleri M, Mayer EA, et al. American Gastroenterological Association Technical Review on Irritable Bowel Syndrome. Gastroenterology 2002;123:2108–31.[CrossRef][Medline] 

2. Lea R , Whorwell PJ. Quality of life in irritable bowel syndrome. Pharmacoeconomics 2001;19:643–53.[Medline] 

3. Talley NJ, Spiller R. Irritable bowel syndrome: a little understood organic bowel disease? Lancet 2002;360:555–64.[CrossRef][Medline] 

4. Jones VA, McLaughlan P, Shorthouse M, et al. Food intolerance: a major factor in pathogenesis of irritable bowel syndrome. Lancet 1982;2:1115–17.[Medline] 

5. Nanda R , James R, Smith H, et al. Food intolerance and the irritable bowel syndrome. Gut 1989;30:1099–104.[Abstract] 

6. Zwetchkenbaum J , Burakoff R .The irritable bowel syndrome and food hypersensitivity. Ann Allerg 1988;61:47–9. 

7. Zar S , Kumar D, Benson M. J. Review article: food hypersensitivity and irritable bowel syndrome, Aliment Pharm Ther 2001;15:439–43.[CrossRef][Medline] 

8. Petitpierre M , Gumowski P, Girard JP. Irritable bowel syndrome and hypersensitivity to food. Ann Allergy 1985;54:538–40.[Medline] 

9. Barau E , Dupont C. Modifications of intestinal permeability during food provocation procedures in pediatric irritable bowel syndrome. J Pediatr Gastroenterol Nutr 1990;11:72–7.[Medline] 

10. Roussos A , Koursarakos P, Patsopoulos D, et al. Increased prevalence of irritable bowel syndrome in patients with bronchial asthma. Respir Med 2003;97:75–9.[Medline] 

11. Crowe SE, Perdue MH. Gastrointestinal food hypersensitivity: basic mechanisms of pathophysiology. Gastroenterol 1992;103:1075–95.[Medline] 

12. el Rafei A , Peters SM, Harris N, et al. Diagnostic value of IgG4 measurements in patients with food allergy. Ann Allergy 1989;62:94–9.[Medline] 

13. Host A , Husby S, Gjesing B, et al. Prospective estimation of IgG, IgG subclass and IgE antibodies to dietary proteins in infants with cow’s milk allergy. Levels of antibodies to whole milk protein, BLG and ovalbumin in relation to repeated milk challenge and clinical course of cow’s milk allergy. Allergy 1992;47:218–29.[Medline] 

14. Awazuhara H , Kawai H, Maruchi N. Major allergens in soybean and clinical significance of IgG4 antibodies investigated by IgE and IgG4 immunoblotting with sera from soybean-sensitive patients. Clin Exp Allergy 1997;27:325–32.[CrossRef][Medline] 

15. Barnes RMR, Johnson PM, Harvey MM, et al. Human serum antibodies reactive with dietary proteins: IgG subclass distribution. Int Arch Allergy Appl Immunol 1988;87:184–8.[Medline] 

16. Lessof MH, Kemeny DM, Price JF. IgG antibodies to food in health and disease. Allergy Proc 1991;12:305–7.[Medline] 

17. Husby S , Mestecky J, Moldoveanu Z, et al. Oral tolerance in humans. T cell but not B cell tolerance after antigen feeding. J Immunol 1994;152:4663–70.[Abstract/Free Full Text] 

18. Haddad ZH, Vetter M, Friedmann J, et al. Detection and kinetics of antigen-specific IgE and IgG immune complexes in food allergy. Ann Allergy 1983;51:255.[Medline] 

19. Husby S , Oxelius VA, Teisner B, et al. Humoral immunity to dietary antigens in healthy adults. Occurrence, isotype and IgG subclass distribution of serum antibodies to protein antigens. Int Arch Allergy Appl Immunol 1985;77:416–22.[Medline] 

20. Kruszewski J , Raczka A, Klos M, et al. High serum levels of allergen specific IgG-4 (asIgG-4) for common food allergens in healthy blood donors. Arch Immunol Ther Exp 1994;42:259–61. 

21. Finn R , Smith MA, Youngs GR, et al. Immunological hypersensitivity to environmental antigens in the irritable bowel syndrome. Br J Clin Pract 1987;41:1041–3.[Medline] 

22. Drossman DA, Corazziari E, Talley NJ, et al. Rome II: a multinational consensus document on functional gastrointestinal disorders. Gut 1999;45:1–81.[Free Full Text] 

23. Foster AP, Knowles TG, Hotston Moore A, et al. Serum IgE and IgG responses to food antigens in normal and atopic dogs, and dogs with gastrointestinal disease. Vet Immunol Immunopathol 2003;92:113–24.[CrossRef][Medline] 

24. Francis CY, Morris J, Whorwell PJ. The irritable bowel scoring system: A simple method of monitoring IBS and its progress. Aliment Pharmacol Therap 1997;11:395–402.[CrossRef][Medline] 

25. Whorwell PJ, McCallum H, Creed FH, et al. Non-colonic features of irritable bowel syndrome. Gut 1986;27:452–6.[Abstract] 

26. Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy. Aliment Pharmacol Ther 1996;10:91–5.[Medline] 

27. Gonsalkorale WM, Toner BB, Whorwell PJ. Cognitive change in patients undergoing hypnotherapy for irritable bowel syndrome. J Psychosom Res 2004;56:271–8.[CrossRef][Medline] 

28. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002;97:954–61.[CrossRef][Medline] 

29. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70.[Medline] 

30. Everitt BS, Pickles A. Statistical aspects of the design and analysis of clinical trials. London: Imperial College Press Publishers, 2003:108–42. 

31. Altman DG, Schulz KF, Moher D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001;134:663–94.[Abstract/Free Full Text] 

32. Novick J , Miner P, Krause R, et al. A randomised, double blind, placebo controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2002;16:1877–88.[CrossRef][Medline] 

33. Niec AM, Frankum B, Talley NJ. Are adverse reactions to food linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184–90.[CrossRef][Medline] 

34. Burden S . Dietary treatment of irritable bowel syndrome: current evidence and guidelines for future practice. J Hum Nutr Diet 2001;14:231–41.[CrossRef][Medline] 

35. Bentley SJ, Pearson DJ, Rix KJB. Food hypersensitivity in irritable bowel syndrome. Lancet 1983;2:295–7.[CrossRef][Medline] 

36. McKee AM, Prior A, Whorwell PJ. Exclusion diets in irritable bowel syndrome: Are they worthwhile? J Clin Gastroenterol 1987;9:526–8.[Medline] 

37. Durham SR, Church MK. Principles of allergy diagnosis. In: Holgate ST, Church MK, Lichtenstein LM, eds. Allergy, 2nd edn. London: Mosby, 2001:3–16. 

38. Spiller RC, Jenkins D, Thornley JP, et al. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut 2000;47:804–11.[Abstract/Free Full Text] 

39. Gonsalkorale WM, Perrey C, Pravica V, et al. Interleukin 10 genotypes in irritable bowel syndrome: evidence for an inflammatory component? Gut 2003;52:91–3.[Abstract/Free Full Text] 

40. Collins SM, Piche T, Rampal P. The putative role of inflammation in the irritable bowel syndrome. Gut 2001;49:743–5.[Free Full Text] 

41. Collins SM. A case for an immunological basis for irritable bowel syndrome. Gastroenterology 2002;122:2078–80.[Medline] 

42. Chadwick VS, Chen W, Shu D, et al. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology 2002;122:1778–83.[CrossRef][Medline] 

43. Mertz H . Review article: visceral hypersensitivity. Aliment Pharmacol Ther 2003;17:623–33.[Medline] 

44. Francis CY, Houghton LA, Whorwell PJ. Enhanced sensitivity of the whole gut in patients with irritable bowel syndrome. Gastroenterology 1995;108:601abstract.