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Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend
Aktuelle Ernahrungsmedizin | Year: 2010

Due to current scientific understanding IgG and IgG4 antibodies to foods should not be missinterpreted as an indicator for disease causing mechanisms than rather as a sign of a normal (physiological) human immune response after repeated exposure to food components. Therefore, the allergen specific measurement of IgG or IgG4 antibodies to foods is useless for the work up and diagnosis of various types of food hypersensitivity. This is also true for chronic diseases and health complaints, falsly believed to be caused by an underlying food hypersensitivity, which has not yet been diagnosed. These health problems include chronic inflammatory bowel diseases like irritable bowel disease, Crohn's disease, colitis ulcerosa, inflammatory skin diseases like acne, atopic eczema, psoriasis and general symptoms like migraine, chronic fatigue, obesity and numerous others. The commonly used argumentation for IgG measurements often falsly exchanges cause and effect. More specifically, elevated physiological IgG concentrations to foods are often blamed as a cause for inflammatory responses, instead of being interpreted as a consequence of such pathology. For none of these above mentioned diseases and health complains scientific evidence based on valid, controlled studies has been established, indicating that the presence of serum IgG or IgG4 antibodies to foods might have a diagnostic value or could represent a pathological finding. Measurements of IgG antibodies to foods are therefore not recommended. This conclusion is not necessarily based on technical assay flaws, but rather rejecting the missleading interpretations of such test results, which are often abused as a reasoning to recommend unjustified and frequently drastic diets. These diets will increase the pressure of suffering, decrease the quality of life, promote uncertainty and even place these subjects at further health risks. At present there is no indication for IgG or IgG4 antibody tests to food items. This type of diagnostic procedure is strictly not recommened due to a lack of evidence from properly controlled studies. © Georg Thieme Verlag KG Stuttgart. Source

Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Bufe A.,Universitatsklinik Bergmannsheil | Ebner C.,Ambulatorium fur Allergie und Klinische Immunologie | Eigenmann P.,Hopitaux Universitaires Of Geneva | And 26 more authors.
Allergologie | Year: 2010

The present guideline on allergen-specific immunotherapy (SIT) was established by German, Austrian and Swiss allergy societies in conjunction with other scientific and medical societies (dermatology, ear-nose-throat, pediatrics, lung and airway diseases) and a German patient support group according to criteria of the Association of the Scientific Medical Societies in Germany (AWMF). Subcutaneous immunotherapy (SCIT) induces long-term tolerance to the applied allergens after completion due to numerous immunologic effects. Regarding immunologic mechanisms of sublingual immunotherapy (SLIT), no consistent concepts exist. In case of preparations with high doses, though, similar systemic immunologic effects have been observed as with SCIT. Allergen concentrations and products for SCIT or SLIT cannot be compared at present due to their heterogeneous composition and variable assay methods of their active components. Non-modified allergens are used as aqueous or physically coupled (depot) allergen extracts; chemically modified allergens (allergoids) are used as depot extracts for SCIT. Mainly non-modified allergen extracts for SLIT are used as aqueous solutions or tablets. Results from controlled studies differ in extent and in quality, requiring product-specific evaluation of SIT. Systematic reviews demonstrate considerable heterogeneity between study results of SIT, partially explained by different subject groups, the utilized allergen products, the duration of treatment, and the therapeutic dose. Efficacy of SCIT has been demonstrated for pollen and house dust mite allergens in many controlled studies in patients with allergic rhinoconjunctivitis, and for animal dander (cat) and mold allergens (Alternaria, Cladosporium) in few studies. SCIT has been well studied in controlled asthma (according to new GINAguidelines, 2008) and intermittent and mild persisting IgE-mediated allergic asthma (according to former GINA guidelines, 2005) and is recommended as a therapeutic option besides allergen avoidance and pharmacotherapy, particularly in case of concomitant allergic rhinoconjunctivitis. Secondary preventive aspects, especially less novel allergic sensitizations and reduced development of bronchial asthma, are important reasons for an early start of SCIT during childhood and adolescence. Diagnostic allergy work-up, indication and selection of appropriate allergens for SCIT are, in general, made by a physician with allergy training within his/her specialization or carrying a certified (sub)speciality in allergy. SCIT is indicated in patients with IgE-mediated sensitizations and corresponding clinical symptoms to allergens, which do not or insufficiently permit allergen avoidance and which are available as suitable, efficacious extracts. Contraindications have to be considered on an individual basis. Injections of SCIT are administered by a physician experienced in this therapy and who is able to perform emergency treatment in case of an allergic adverse event. A preceeding patients information is mandatory and should be documented. The therapy should last 3 years. Children tolerate the SCIT well and benefit notably from its immunomodulatory effects. Severe, potentially life-threatening systemic adverse events can occur after SCIT, being very rare in case of complete adherence to safety standards. Most adverse events are mild to moderate and easily treatable. Risk factors for and results of unwanted systemic effects can effectively be minimized by training the staff members involved, adhering to safety standards and immediate emergency treatment. In case of systemic reactions due to hymenoptera (bee, wasp) venom hypersensitivity, SCIT has excellent efficacy and should be continued for at least 3-5 years. An extended, sometimes lifelong SCIT is necessary in some patients. Efficacy of SLIT in grass pollen-induced allergic rhinoconjunctivitis has been proven in several large-scale, controlled clinical studies. Applying other allergen sources (house dust mites, animal dander, molds), less and in part methodologically insufficient studies with contradictory results exist so far. Efficacy of SLIT in allergic bronchial asthma has not enough evidence until now. SLIT with efficacious products is an option for adults with allergic rhinoconjunctivitis due to pollen allergens, particularly if SCIT is not suitable. In case of house dust mite allergy or symptoms due to other allergen sources and allergic asthma due to inhalants, SLIT does not substitute SCIT. SLIT can be indicated in children and adolescents, if SCIT is not an option, using a preparation with proven clinical efficacy in this age group. SLIT is started by a physician experienced in the therapy of allergic diseases (see guideline wording) and who is able to perform emergency treatment in case of an allergic adverse event. According to the leaflet of the product manufacturer, the patient should be informed about the therapy, usually lasting 3 years as pre- and coseasonal or perennial regimen. During this course consultations should take place at least every 3 months. Apart from very frequently to frequently occurring dose-dependent unwanted local oral and pharyngeal symptoms, systemic reactions, mostly of mild nature, have rarely been described after SLIT.With regard to anaphylactic and other severe systemic reactions SLIT demonstrates a superior safety profile compared to SCIT. Various research fields like allergen characterization, routes of application, adjuvants, updosing regimen and preventive aspects demonstrate new developments in SIT being currently examined for clinical efficacy. © 2010 Dustri-Verlag Dr. Karl Feistle. Source

Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Wassmann-Otto A.,Ernahrungsberatung und Therapie | Monnikes H.,Martin Luther Krankenhaus
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2016

Immunologically mediated hypersensitivity to foods is defined as food allergy, mainly due to immunglobulins of class E (IgE) triggering immediate reactions (type I hypersensitivity) with possible involvement of mucosa, skin, airways, intestinal tract, and the vascular system. Primary food allergy is based on (early) IgE sensitization against animal (e. g., cow’s milk, hen’s eggs) or plant proteins (e. g. peanut, hazelnut or wheat). In the case of secondary food allergies, IgE against pollen proteins (e. g., birch) reacts to structurally related food proteins (with cross-reactions to stone and pit fruits). Non-immunological food intolerance reactions are mostly based on carbohydrate malassimilation (e. g., lactose intolerance, fructose malabsorption) and are rarely due to pseudo-allergies (e. g., flavors, dyes, preservatives) primarily in patients with chronic urticaria. Common intestinal symptoms are mainly due to functional disorders (e. g., irritable bowel disease), rarely because of inflammatory intestinal diseases (e. g., celiac disease). Histamine intolerance, gluten hypersensitivity, and so-called food type III hypersensitivities are controversial diagnoses. The aforementioned disease entities/models are of variable importance for the affected individuals, the public health system, and society in general. © 2016, Springer-Verlag Berlin Heidelberg. Source

Treudler R.,University of Leipzig | Kramer S.,University of Leipzig | Kleine-Tebbe J.,Allergie und Asthma Zentrum Westend | Simon J.-C.,University of Leipzig
Allergo Journal | Year: 2010

In Europe, soy consumption has markedly increased over the last years. In parallel, there has been an increasing number of reports upon immediate-type allergy to soy proteins. This allergy may be the result of a primary, gastrointestinal sensitization. In adults, however, inhalative sensitization to birch and a secondary, associated soy allergy is more frequent. This allergy is due to cross-reaction between soy allergen Gly m 4 and the main birch pollen allergen Bet v 1. For diagnosis of soy allergy, standard test preparations may fail, so that prick-to-prick test with native products and assays for IgE to Gly m 4 should be included. Therapy should include avoidance of high-protein soy products. A multicenter study (BASALIT), that started in the beginning of 2010, will investigate, if immunotherapy to Bet v 1 can reduce symptoms of birch pollen-associated soy allergy. Source

Lepp U.,Herz Lungen Praxis Stade | Ballmer-Weber B.,Universitatsspital Zurich | Beyer K.,Charite - Medical University of Berlin | Erdmann S.,Praxis fur Dermatologie | And 16 more authors.
Allergo Journal | Year: 2010

In food allergy, therapeutic intervention is only indicated after the proof of clinical relevance. Until now, the only proven therapy is the avoidance of the offending food. The complexity of food allergy requires trained nutritionists who give patients individual instructions for targeted elimination. The close interaction between nutritionist und physician avoids malnutrition and/or the development of eating disorders. As symptomatic food allergy may be "lost" over time, food challenges can repeated one to two years after avoidance. High-risk patients should be given autoinjectable epinephrine, antihistamine and corticosteroid for self-medication. Pollen immunotherapy in patients with pollen-related food allergy may be considered, if there are additional pollen-related respiratory symptoms. Subcutaneous specific immunotherapy with food extracts or oral immunotherapy with native food as sublingual immunotherapy should only be used in controlled studies. As future options, the therapy with anti-IgE antibodies, probiotics, Chinese herbs FAHF-2, and the use of recombinant allergens for immunotherapy are discussed. So-called rotation diet or bioenergetic procedures are not recommended. Source

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