Abstract
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)γ 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. IFNγ 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.
Journal Section:
Original Paper
References
1.
Hugot JP, et al: Prevalence of CARD15/NOD2 mutations in Caucasian healthy people. Am J Gastroenterol 2007;102:1259–1267.
[PubMed]
2.
Ogura Y, et al: A frameshift mutation in NOD2 associated with susceptibility to Crohn’s disease. Nature 2001;411:603–606.
[PubMed]
3.
Rogler G, Andus T: Cytokines in inflammatory bowel disease. World J Surg 1998;22:382–389.
[PubMed]
4.
Regueiro M, et al: Cigarette smoking and age at diagnosis of inflammatory bowel disease. Inflamm Bowel Dis 2005;11:42–47.
[PubMed]
5.
Kane SV, Flicker M, Katz-Nelson F: Tobacco use is associated with accelerated clinical recurrence of Crohn’s disease after surgically induced remission. J Clin Gastroenterol 2005;39:32–35.
[PubMed]
6.
Picco MF, Bayless TM: Tobacco consumption and disease duration are associated with fistulizing and stricturing behaviors in the first 8 years of Crohn’s disease. Am J Gastroenterol 2003;98:363–368.
[PubMed]
7.
Hafner S, et al: The role of domestic hygiene in inflammatory bowel diseases: hepatitis A and worm infestations. Eur J Gastroenterol Hepatol 2008;20:561–566.
[PubMed]
8.
Papp M, Altorjay I, Lakatos PL: Relevance of serologic studies in inflammatory bowel diseases (in Hungarian). Orv Hetil 2007;148:887–896.
[PubMed]
9.
Ferguson LR, et al: Genes, diet and inflammatory bowel disease. Mutat Res 2007;622:70–83.
[PubMed]
10.
Mekkel G, et al: Increased IgE-type antibody response to food allergens in irritable bowel syndrome and inflammatory bowel diseases (in Hungarian). Orv Hetil 2005;146:797–802.
[PubMed]
11.
Crowe SE, Perdue MH: Gastrointestinal food hypersensitivity: basic mechanisms of pathophysiology. Gastroenterology 1992;103:1075–1095.
[PubMed]
12.
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;27:325–332.
[PubMed]
13.
el Rafei A, et al: Diagnostic value of IgG4 measurements in patients with food allergy. Ann Allergy 1989;62:94–99.
[PubMed]
14.
Host A, et al: Prospective estimation of IgG, IgG subclass and IgE antibodies to dietary proteins in infants with cow milk allergy. Levels of antibodies to whole milk protein, BLG and ovalbumin in relation to repeated milk challenge and clinical course of cow milk allergy. Allergy 1992;47:218–229.
[PubMed]
15.
Barnes RM, et al: Human serum antibodies reactive with dietary proteins. IgG subclass distribution. Int Arch Allergy Appl Immunol 1988;87:184–188.
[PubMed]
16.
Lessof MH, Kemeny DM, Price JF: IgG antibodies to food in health and disease. Allergy Proc 1991;12:305–307.
[PubMed]
17.
Husby S, et al: Oral tolerance in humans. T cell but not B cell tolerance after antigen feeding. J Immunol 1994;152:4663–4670.
[PubMed]
18.
Haddad ZH, et al: Detection and kinetics of antigen-specific IgE and IgG immune complexes in food allergy. Ann Allergy 1983;51:255.
[PubMed]
19.
Husby S, 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;77:416–422.
[PubMed]
20.
Jonuleit H, Adema G, Schmitt E: Immune regulation by regulatory T cells: implications for transplantation. Transpl Immunol 2003;11:267–276.
[PubMed]
21.
Spoettl T, et al: Serum soluble TNF receptor I and II levels correlate with disease activity in IBD patients. Inflamm Bowel Dis 2007;13:727–732.
[PubMed]
22.
Podolsky DK: Inflammatory bowel disease. N Engl J Med 2002;347:417–429.
[PubMed]
23.
Beissert S, Schwarz A, Schwarz T: Regulatory T cells. J Invest Dermatol 2006;126:15–24.
[PubMed]
24.
Wing K, et al: CD4 T cell activation by myelin oligodendrocyte glycoprotein is suppressed by adult but not cord blood CD25+ T cells. Eur J Immunol 2003;33:579–587.
[PubMed]
25.
Van Den Bogaerde J, et al: Gut mucosal response to food antigens in Crohn’s disease. Aliment Pharmacol Ther 2002;16:1903–1915.
[PubMed]
26.
Zeger SL, Liang KY: Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986;42:121–130.
[PubMed]
27.
Jones VA, et al: Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;2:1115–1117.
[PubMed]
28.
Nanda R, et al: Food intolerance and the irritable bowel syndrome. Gut 1989;30:1099–1104.
[PubMed]
29.
Niec AM, Frankum B, Talley NJ: Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184–2190.
[PubMed]
30.
Burden S: Dietary treatment of irritable bowel syndrome: current evidence and guidelines for future practice. J Hum Nutr Diet 2001;14:231–241.
[PubMed]
31.
Darroch CJ, Barnes RM, Dawson J: Circulating antibodies to Saccharomyces cerevisiae (bakers’/brewers’ yeast) in gastrointestinal disease. J Clin Pathol 1999;52:47–53.
[PubMed]
32.
Elson CO, et al: Immuno-bacterial homeostasis in the gut: new insights into an old enigma. Semin Immunol 2001;13:187–194.
[PubMed]
33.
Breese E, et al: Interleukin-2- and interferon-gamma-secreting T cells in normal and diseased human intestinal mucosa. Immunology 1993;78:127–131.
[PubMed]
34.
Earle KE, et al: In vitro expanded human CD4+CD25+ regulatory T cells suppress effector T cell proliferation. Clin Immunol 2005;115:3–9.
[PubMed]
35.
Nakamura K, Kitani A, Strober W: Cell contact-dependent immunosuppression by CD4(+)CD25(+) regulatory T cells is mediated by cell surface-bound transforming growth factor beta. J Exp Med 2001;194:629–644.
[PubMed]
36.
Saitoh O, et al: Fecal eosinophil granule-derived proteins reflect disease activity in inflammatory bowel disease. Am J Gastroenterol 1999;94:3513–3520.
[PubMed]
37.
Atkinson W, et al: Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut 2004;53:1459–1464.
[PubMed]
38.
Baklien K, Brandtzaeg P: Comparative mapping of the local distribution of immunoglobulin-containing cells in ulcerative colitis and Crohn’s disease of the colon. Clin Exp Immunol 1975;22:197–209.
[PubMed]
39.
Baklien K, Brandtzaeg P: Immunohistochemical characterization of local immunoglobulin formation in Crohn’s disease of the ileum. Scand J Gastroenterol 1976;11:447–457.
[PubMed]
© 2010 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2010
You do not currently have access to this content.
