Clinical Outcomes, FAQ and Interpretations Dr. Jason Bachewich ND Presented December 7, 2011 The information in this webinar is meant for educational purposes only. It is not intended for the diagnosis, cure, mitigation, treatment or prevention of any disease or disorder in a specific individual. The information provided in this webinar is the result of years of clinical experience on the part of Dr Bachewich and does not necessarily reflect the opinions of Rocky Mountain Analytical. 2 Overview of IgE, IgG and IgA reactions. Conditions associated with IgG reactions. FAQ s. Interpretation t ti of various test tresults with confusing reports. Understanding cross sensitivities. Questions. 3 Mountain Analytical 1
IgE Type I hypersensitivity reaction (Immediate). IgA mucosal damage (Delayed). IG IgG Type III hypersensitivity reaction (Delayed). 4 Type I hypersensitivity. Reaction occurs within minutes of exposure (after priming on initial exposure). Only unbound IgE is measured in serum. Half life of IgE antibodies is short (approx 1 day). Wiki public 5 IgE is considered the only true food allergy. Reactions: hives, difficulty breathing, anaphylaxis. Testing for IgE Skin prick. ik ImmunoCAP. Serum IgE. 6 Mountain Analytical 2
Chronic intermittent hive reactions may be due to parasite infection. http://www.ncbi.nlm.nih.gov/pubmed/15368795 http://www.ncbi.nlm.nih.gov/pubmed/7008106 ih / b http://www.ncbi.nlm.nih.gov/pubmed/12880246 http://www.ncbi.nlm.nih.gov/pubmed/16637808 http://www.ncbi.nlm.nih.gov/pubmed/20669787 http://www.ncbi.nlm.nih.gov/pubmed/19598090 7 Delayed Type III hypersensitivity reaction. Antibody antigen complex forms. Circulating IgG antibodies encounter food antigens and form circulating immune complexes (CIC) If the number of complexes is more than can be eliminated, CIC will deposit in tissue and release inflammatory cytokines 8 Type III delayed hypersensitivity reaction. Reactions occur hours to days after food is consumed, which makes it difficult to identify trigger food without testing. Elimination of IgG reactive foods results in clinical improvement. 9 Mountain Analytical 3
Total IgG and IgG 4 are tested. IgG 4 is a blocking antibody for IgE. 10 11 Suspected IgG reaction Omit suspected food for approximately 5 days. Food antigen is cleared, but IgG antibodies are still being produced and present in high numbers. On day 6 consume a large amount of the suspected food. If food is truly IgG reactive, it will provoke a large immune response and an exacerbation of symptoms. Reference: Trevino R, Dixon H. Food Allergy. American Academy of Otolaryngic Allergy. Thieme Publishing 1997. pp. 8 9 12 Mountain Analytical 4
13 Ghrelin suppresses proinflammatory processes and augments antiinflammatory effect, in addition to stimulating appetite. Exorphins are compounds formed outside the brain that interact with opiate receptors produce feel good effect. Gluten and dairy proteins are common exorphins). 14 Delayed hypersensitivity reaction. IgA antibodies to foods are produced primarily in GI tract and other mucous membranes. 75% of total volume of immunoglobulins produced by the body. 3 5 grams secreted into intestine daily. Poor activator of the complement system (innate). New test panel available. 15 Mountain Analytical 5
16 6879 people. Tested IgG and IgE. IgG was as equally good an indicator as IgE for dairy derivatives and eggs. Journal of Immunoassay and Immunochemistry, 30: 51 69, 2009 17 150 outpatients half on sham diet. After 6 weeks, 10% reduction in symptoms. After 12 weeks, 26% reduction. Gut 2004;53:1459 1464. doi: 10.1136 Decreased stool frequency, abdominal pain and increased overall well being in patients that adhered to diet excluding IgG reactions. Digestion 2010;81:252 264 18 Mountain Analytical 6
Patients with IBS and Dyspepsia had elevated titers of IgG to 14 common foods (milk, eggs, beef, wheat etc.) Clinical and Experimental Allergy, 37, 823 830 19 IgG tested by ELISA. Diet avoidance led to a significant reduction in migraines days and migraine attacks. Revista Alergia México 2007;54(5):162 8 IgG tested. Restriction diets avoiding allergens successfully controlled migraines. Digestion 2010;81:252 264 20 Obese juveniles showed an increase in IMT (intima media thickness) and anti food IgG concentrations. Tight correlations to elevated CRP. PI3K, GSK and Inflammation? 21 Mountain Analytical 7
Does this Candida condition exist. Candida questionnaire and IgG titers. Increased titers with increased symptoms. THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 13, Number 10, 2007, pp. 1129 1133 Renal Cell Carcinoma and Survival Those with high IgG titers more likely to die and vice versa. Aspergillus and Sacchromyces also tested. Cancer Immunol Immunother (2010) 59:1141 1147 22 23 24 Mountain Analytical 8
Enzyme deficiencies Eg: lactose intolerance is a deficiency of lactase. Food additive sensitivity Food dyes, preservatives, emulsifiers, flavouring agents, fillers. Eg. methylcellulose, ice cream Naturally occurring chemicals in food Histamine, tyramine, phenylethylamine, salicylates, octopamine, glutamate. Other Psychological aversion. Food poisoning. 25 Overall, low IgG Immune suppressive drugs. Suppressed immune system IGdfii IgG deficiency syndrome. Leukemia / Autoimmune. Crohn s / UC. How do I interpret the non results? Look for patterns. Consider IgA test. 26 27 Mountain Analytical 9
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Can I test? 34 Leaky Gut everything they eat on a regular basis shows up, including others. 35 36 Mountain Analytical 12
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Patient complains of reactions to grass yet did not show up on skin prick test. Short half life (1 2 days max). Consider mini inhalant IgG panel Cheaper and longer half life. Consider oral immunotherapy as well as dietary restrictions. 43 44 45 Mountain Analytical 15
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Those consuming less milk, more symptoms, more IgG. Among the symptomatic: Constipation relationship IgG. Diarrhea no relationship IgG. Minor association with dyspepsia. IgA no significant findings. IgA and IgG levels all declined with age. World J Gastroenterol 2009 October 21; 15(39): 4915 4918 49 3 Groups IgE 1. System provoking cross reactions (birch fruit). 2. Cross reactions with little clinical symptoms (latex fruits syndrome). 3. In Vitro cross reactions (legume sensitizations). Allergy 1998. (Supp 46) 53: (58 61) www.dpcweb.com 50 Birch Fruit syndrome IgE Tomato, celery, apple, kiwi, carrot, zucchini, lentil, soybean, cherry, hazelnut, mango and more. Bird Egg syndrome IgE Mostly in adults. 51 Mountain Analytical 17
Latex allergy shows relationship to sensitization to banana, pear, avocado, chestnut, kiwi, papaya, tomato and potato. Compound in cereals that have cross reactivity with mammal and insect proteins. 52 Multiple sensitization is common. Double blind, placebo controlled challenges showed little clinical importance. Less than 5% reacted to more than one legume. Presumably very common. 53 54 Mountain Analytical 18
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