Citation Information :
Desai S, Misra M, Jatale R, Christy A, Ramchandran S. Food-specific IgG Antibody Levels in Indian Subjects: A Retrospective Analytical Study. Indian J Med Biochem 2024; 28 (3):63-71.
Background: Many adverse food reactions have shown association with the presence of food-specific IgG antibodies in human serum. However, testing for such antibodies for diagnosis of adverse food reactions remains controversial. This study aimed was to understand the significance of food-specific IgG antibodies among patients who presented with food-dependent gastrointestinal symptoms viz upset stomach, bloating, etc.
Materials and methods: A total of 2,748 cases who underwent testing for specific IgGs for 200+ food items under the ‘food intolerance test’ over 3 years from Jan 2020 to Dec 2022 across different Indian geographical regions were included in the study. The microarray food IgG assay was used to measure over 215 types of food-specific serum IgG antibodies, with the top 25 most common food IgGs found based on the biological reference interval further analyzed.
Results: Barley (98.70%), pea (96.70%), sheep milk (87.20%), and cow milk (86.40%) were found to be the most prevalent food IgG antibodies. Corn maize, goat milk, cashew nut, pistachio, potato, soya bean, wheat, peanut, and hazelnut were found to be significantly associated with gender. Intolerance to cashew nuts, pistachio, potato, peanut and hazelnut was found to be significantly higher in females than males, whereas only corn maize was found to be significantly higher in males than female. Except for sunflower seed (p = 0.0551) all the other 24 food IgG concentrations showed a significant relation with age-group. Intra-group correlation among 25 food items showed a positive correlation between milk (cow) and casein (r = 0.919), pea and cola nut (r = 0.721), cashew nut, and pistachio (r = 0.753). The food intolerance seen in the study was mainly for vegetarian food.
Conclusion: The study emphasizes the role of testing food-specific IgG antibodies in adverse food reactions which may further help in the diagnosis, management, and treatment of patients presenting with food-related gastrointestinal symptoms.
Chafen JJ, Newberry SJ, Riedl MA, et al. Diagnosing and managing common food allergies: A systematic review. JAMA 2010;303(18): 1848–1856. DOI: 10.1001/jama.2010.582.
Scott-Taylor TH, J OBH, Strobel S. Correlation of allergen-specific IgG subclass antibodies and T lymphocyte cytokine responses in children with multiple food allergies. Pediatr Allergy Immunol 2010;21(6):935–944. DOI: 10.1111/j.1399-3038.2010.01025.x.
Barnes RM. IgG and IgA antibodies to dietary antigens in food allergy and intolerance. Clin Exp Allergy 1995;25(suppl 1):7–9. DOI: 10.1111/j.1365-2222.1995.tb01124.x.
Zar S, Benson MJ, Kumar D. Food-specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome. Am J Gastroenterol 2005;100(7):1550–1557. DOI: 10.1111/j.1572-0241.2005.41348.x.
Teuber SS, Porch-Curren C. Unproved diagnostic and therapeutic approaches to food allergy and intolerance. Curr Opin Allergy Clin Imunol 2003;3(3):217–221. DOI: 10.1097/00130832-200306000- 00011.
Hochwallner H, Schulmeister U, Swoboda I, et al. Patients suffering from non-IgE-mediated cow's milk protein intolerance cannot be diagnosed based on IgG subclass or IgA responses to milk allergens. Allergy 2011;66(9):1201–1207. DOI: 10.1111/j.1398-9995.2011.02635.x.
Alpay K, Ertas M, Orhan EK, et al. Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised, cross-over trial. Cephalalgia 2010;30(7):829–837. DOI: 10.1177/03331024103 61404.
Atkinson W, Sheldon TA, Shaath N, et al. Food elimination based on IgG antibodies in irritable bowel syndrome: A randomised controlled trial. Gut 2004;53(10):1459–1464. DOI: 10.1136/gut.2003.037697.
Lomer MCE. Review article: The aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther 2015;41(3):262–275. DOI: 10.1111/apt.13041.
Abraham P, Dhoble P, Desai D, et al. Self-reported food intolerances in an Indian population: Need for individualization rather than a universal low-FODMAP diet. JGH Open 2023;7(11):772–776. DOI: 10.1002/jgh3.12981.
Shreffler WG, Lencer DA, Bardina L, et al. IgE and IgG4 epitope mapping by microarray immunoassay reveals the diversity of immune response to the peanut allergburten, Ara h 2. J Allergy Clin Immunol 2005;116(4):893–899. DOI: 10.1016/j.jaci.2005.06.033.
Shakoor Z, Alfaif A, Walamro B, et al. Prevalence of IgG-mediated food intolerance among patients with allergic symptoms. Annals of Saudi Medicine 2016;36(6):386–390. DOI: https://doi.org/10.5144/0256-4947.2016.386.
Antico A, Pagani M, Vescovi PP, et al. Food-specific IgG4 lack diagnostic value in adult patients with chronic urticaria and other suspected allergy skin symptoms. Int Arch Allergy Immunol 2011;155(1):52–56. DOI: 10.1159/000318736.
Kumar R, Kumar M, Singh M, et al. Prevalence of food intolerance in bronchial asthma in India. Indian J Allergy Asthma Immunol 2013;27(2):121–128. DOI: 10.4103/0972-6691.124394.
Zeng Q, Dong S-Y, Wu L-X, et al. Variable food-specific IgG antibody levels in healthy and symptomatic Chinese adults. PloS One 2013;8(1):e53612. DOI: 10.1371/journal.pone.0053612.
Pizza V, Mainenti M, Iannuzzi S, et al. Food intolerance in migraine. Pharmacologyonline 2013;1:18–24. Available from: https://pharmacologyonline.silae.it/files/archives/2013/vol1/PhOL_2013_1_A004_024_Pizza.pdf.
Poulos LM, Waters AM, Correll PK, et al. Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993–1994 to 2004–2005. J Allergy Clin Immunol 2007;120(4):878–884. DOI: 10.1016/j.jaci.2007.07.040.
Liu XJ, Zhu TT, Zeng R, et al. [An epidemiological study of food intolerance in 2434 children]. Zhongguo Dang Dai Er Ke Za Zhi 2013;15(7):550–554. Chinese. PMID: 23866277.
Harduar-Morano L, Simon MR, Watkins S, et al. A population based epidemiologic study of emergency department visits for anaphylaxis in Florida. J Allergy Clin Immunol 2011;128(3):594–600.e591. DOI: 10.1016/j.jaci.2011.04.049.
Lee HJ, Kim HJ, Kang EH, et al. Self-reported food intolerance in Korean patients with irritable bowel syndrome. J Neurogastroenterol Motil 2019;25(2):222–232. DOI: 10.5056/jnm18125.
Bhatnagar S, Aggarwal R. Lactose intolerance. BMJ 2007;334:1331. DOI: 10.1136/bmj.39252.524375.80.
Ramakrishna BS. Celiac disease: Can we avert the impending epidemic in India? Indian J Med Res 2011;133(1):5–8. PMID: 21321413.
Gupta R, Reddy DN, Makharia GK, et al. Indian task force for celiac disease: Current status. World J Gastroenterol 2009;15(48):6028–6033. DOI: 10.3748/wjg.15.6028.
Stapel SO, Asero R, Ballmer-Weber BK, et al. Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI task force report. Allergy 2008;63(7):793–796. DOI: 10.1111/j.1398-9995.2008.01705.x.
Gargano D, Appanna R, Santonicola A, et al. Food allergy and intolerance: A narrative review on nutritional concerns. Nutrients 2021;13(5):1638. DOI: 10.3390/nu13051638.