Food-specific IgG Antibody–guided Elimination Diets Followed by Resolution of Asthma Symptoms and Reduction in Pharmacological Interventions in Two Patients: A Case Report
GLOBAL ADVANCES IN HEALTH AND MEDICINE, Volume 4, Number 1 • January 2015 • www.gahmj.com
Kulveen Virdee, ND, United States; Jeannette Musset, BS, United States; Matthew Baral, ND, United States; Courtney
Cronin, ND, United States; Jeffrey Langland, PhD, United States
Asthma is one of the most common causes of office visits in the primary care and emergency care settings. Individuals are often able to maintain symptomatic control with long-term pharmacological therapy. Exacerbations of asthma commonly occur due to exposure to triggers such as viruses, pollutants, and allergens. While it is widely accepted that exposure to immunoglobulinE food allergens can exacerbate asthma symptoms, there is little evidence examining delayed immunoglobulin G-mediated reactions to food. Here we present two clinical cases of individuals who experienced a reduction in asthma symptoms, decreased dependence on pharmacological therapies, and increased quality of life by eliminating foods that demonstrated reactivity to immunoglobulin G levels identified through serum testing.
Asthma, a common chronic inflammatory disease of the airways is characterized by a reduction in airway size due to smooth muscle constriction, edema of the airways, and mucus hypersecretion.1
These changes lead to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. This inflammation can potentiate the preexisting airway hyperresponsiveness to stimuli such as pollutants, allergens, and viruses.2
Atopy is a major hereditary risk factor for the development of asthma. Atopic individuals have heightened immune responses to foreign antigens that tend towards an antigen-specific immunoglobulin E (IgE) allergic response.3 IgE food allergens trigger an immediate inflammatory reaction characterized by angioedema, urticaria, asthma, and/or anaphylaxis.
The presence of IgE antibodies in the serum directed toward foods is not diagnostic of allergy until confirmation through challenge testing.4
Asthmatics with food allergies are more likely to experience severe exacerbations of asthma.5 Patients and clinicians are aware that delayed-acting food allergens may exist outside of IgE antibody reactions.
However, accurate and clinically effective laboratory testing for non-IgE food allergens remains elusive and is not widely used. Laboratory testing for immunoglobulin G (IgG) and subfraction IgG4 food antibodies is becoming increasingly available to the public. However, research on IgG and food allergens remains controversial and inconclusive.6-9
In this case report, we utilized an enzyme-linked immunosorbent assay (ELISA) for IgG antibody assessment (US BioTek Laboratories, Shoreline, Washington) on 2 patients with asthma. This serum test measures total IgG1-IgG4 against 96 foods and reports them on a semi-quantitative scale ranging from 0 (“no reactivity”) to IV (“extremely high-reactivity”). Many physicians interpret ELISA IgG results differently and use varying treatment protocols for duration and extent of food elimination. For the patients described here, we recommended a trial period of complete avoidance of potential food allergens while monitoring for any symptomatic changes. Based on clinical experiences in utilizing the IgG antibody assessments for the treatment of asthma, we determined the classes of food to eliminate. The patients understood that the results of the ELISA test were not meant to indicate anaphylactic allergens but were meant to provide treatment considerations. In the cases presented, any changes made to medications were relayed to the prescribing physicians through the patients who maintained regular follow-up exams.