Zar Sameer, Benson Martin J, Kumar Devinder
OGEM Department, St Georges Hospital Medical School, Blackshaw Road, London, UK.
Am J Gastroenterol. 2005 Jul;100(7):1550-7. doi: 10.1111/j.1572-0241.2005.41348.x.
INTRODUCTION: Food hypersensitivity is a common perception among irritable bowel syndrome (IBS) patients. Data from dietary elimination and food challenge studies support an etiopathological role of diet in IBS, but there are no well-established tests to identify food hypersensitivity. AIM: To compare IgG4 and IgE titers to common food antigens in IBS and controls. METHOD: One hundred and eight IBS [52 diarrhea-predominant (D-IBS); 32 constipation-predominant (C-IBS); 24 alternating (Alt-IBS)], and 43 controls were included in the study. IgG4 and IgE titers and skin prick testing (SPT) to 16 common foods including milk, eggs, cheese, wheat, rice, potatoes, chicken, beef, pork, lamb, fish, shrimps, soya bean, yeast, tomatoes, and peanuts were measured. RESULTS: IBS had significantly higher IgG4 titers (mug/L) to wheat (395 IQR +/- 1,011 vs 0 IQR +/- 285, p < 0.001), beef (1,079 IQR +/- 930 vs 617 IQR +/- 435, p < 0.001), pork (481 IQR +/- 379 vs 258 IQR +/- 496, p < 0.001), and lamb (241 IQR +/- 460 vs 167 IQR +/- 232, p= 0.009) compared to controls. These differences were maintained across all three subgroups. The antibody titers to potatoes, rice, fish, chicken, yeast, tomato, and shrimps were not significantly different. No significant difference in IgE titers was observed between IBS and controls. SPT was positive for only a single antigen in 5 of 56 patients tested with the same panel of foods. No correlation was seen between the pattern of elevated IgG4 antibody titers and patients' symptoms. CONCLUSION: Serum IgG4 antibodies to common foods like wheat, beef, pork, and lamb are elevated in IBS patients. In keeping with the observation in other atopic conditions, this finding suggests the possibility of a similar pathophysiological role for IgG4 antibodies in IBS.
引言:食物过敏是肠易激综合征(IBS)患者中常见的一种认知。饮食排除和食物激发试验的数据支持饮食在IBS发病机制中的作用,但尚无成熟的检测方法来识别食物过敏。 目的:比较IBS患者和对照组中针对常见食物抗原的IgG4和IgE滴度。 方法:本研究纳入了108例IBS患者[52例腹泻型(D-IBS);32例便秘型(C-IBS);24例交替型(Alt-IBS)]和43例对照。检测了针对16种常见食物(包括牛奶、鸡蛋、奶酪、小麦、大米、土豆、鸡肉、牛肉、猪肉、羊肉、鱼、虾、大豆、酵母、西红柿和花生)的IgG4和IgE滴度以及皮肤点刺试验(SPT)。 结果:与对照组相比,IBS患者针对小麦(395四分位间距±1011 vs 0四分位间距±285,p<0.001)、牛肉(1079四分位间距±930 vs 617四分位间距±435,p<0.001)、猪肉(481四分位间距±379 vs 258四分位间距±496,p<0.001)和羊肉(241四分位间距±460 vs 167四分位间距±232,p = 0.009)的IgG4滴度(mug/L)显著更高。所有三个亚组均保持这些差异。针对土豆、大米、鱼、鸡肉、酵母、西红柿和虾的抗体滴度无显著差异。IBS患者和对照组之间的IgE滴度无显著差异。在使用相同食物组进行检测的56例患者中,只有5例的SPT对单一抗原呈阳性。IgG4抗体滴度升高模式与患者症状之间无相关性。 结论:IBS患者中针对小麦、牛肉、猪肉和羊肉等常见食物的血清IgG4抗体升高。与其他特应性疾病中的观察结果一致,这一发现提示IgG4抗体在IBS中可能具有类似的病理生理作用。
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