Shakeri-Leidenmühler Soheila, Lukschal Anna, Schultz Cornelia, Bohdjalian Arthur, Langer Felix, Birsan Tudor, Diesner Susanne C, Greisenegger Elli K, Scheiner Otto, Kopp Tamara, Jensen-Jarolim Erika, Prager Gerhard, Untersmayr Eva
Department of Surgery, Medical University of Vienna, Vienna, Austria.
Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, E3Q, 1090, Vienna, Austria.
Obes Surg. 2015 Dec;25(12):2268-75. doi: 10.1007/s11695-015-1689-4.
Impairment of gastric digestion due to pH elevation increases the risk for food allergy induction. As patients after Roux-en-Y gastric bypass (RYGB) surgery have lower gastric acidity and less gastric gland secretion, we aimed to analyse in a prospective study the effect of limiting gastric digestion capacity by surgical intervention on the immune response towards allergens.
Nine patients undergoing RYGB surgery for morbid obesity and one control patient having undergone surgery for treatment of an incisional hernia were enrolled in the study. Before and 1, 3, 6, 9 and 12 months after surgery, blood was collected for analysis of specific IgE antibodies, and patients were subjected to skin prick testing with 16 food and 18 aeroallergens.
Skin prick test results revealed an increase of positive reactions indicating sensitisations towards the tested food and aeroallergens in 77.8 and 88.9 % of the patients, respectively, after surgical elimination of gastric digestion. These results were in line with elevated titers of food- and aeroallergen-specific IgE antibodies in 7 out of 9 (7/9) and 5/9 patients, respectively, after RYGB surgery. Serum cytokine levels revealed a mixed response for IFN-γ and were mostly beneath detection limit for IL-4.
A change of IgE reactivity pattern occurred after impairment of gastric digestion due to surgical elimination underlining the important gastric gatekeeping function during oral sensitisation. Even though this study indicates an increased allergy risk for gastric bypass patients, further studies are needed to investigate in-depth the immunological changes associated with RYGB surgery.
由于pH值升高导致胃消化功能受损会增加食物过敏诱发的风险。由于接受Roux-en-Y胃旁路术（RYGB）的患者胃酸较低且胃腺分泌较少，我们旨在通过一项前瞻性研究分析手术干预限制胃消化能力对过敏原免疫反应的影响。
本研究纳入了9例因病态肥胖接受RYGB手术的患者和1例因切口疝接受手术治疗的对照患者。在手术前以及术后1、3、6、9和12个月采集血液，分析特异性IgE抗体，并对患者进行16种食物和18种气传过敏原的皮肤点刺试验。
皮肤点刺试验结果显示，在手术消除胃消化功能后，分别有77.8%和88.9%的患者对测试食物和气传过敏原的阳性反应增加，表明出现致敏。这些结果与RYGB手术后9例患者中有7例（7/9）、5/9例患者的食物和气传过敏原特异性IgE抗体滴度升高一致。血清细胞因子水平显示IFN-γ反应混合，IL-4大多低于检测限。
手术消除导致胃消化功能受损后，IgE反应模式发生改变，突出了口服致敏期间胃的重要把关功能。尽管本研究表明胃旁路手术患者的过敏风险增加，但仍需要进一步研究深入调查与RYGB手术相关的免疫变化。
