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Vol. 155, No. 1, 2011
Issue release date: April 2011
Int Arch Allergy Immunol 2011;155:52–56

Food-Specific IgG4 Lack Diagnostic Value in Adult Patients with Chronic Urticaria and Other Suspected Allergy Skin Symptoms

Antico A. · Pagani M. · Vescovi P.P. · Bonadonna P. · Senna G.
aAllergy Unit, Department of Internal Medicine, Azienda Istituti Ospedalieri C. Poma, Mantova, and bAllergy Unit, Azienda Ospedale Maggiore, Verona, Italy

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Background: Specific IgG4 dosing against food is proposed to the public by a lot of commercial laboratories as a reliable method to diagnose food intolerance. Actually, few data on IgG4 responses to foods in adults are available in the literature. In this study we evaluated the clinical utility of specific IgG4 dosing against food in adult patients with suspected food allergy/intolerance. Methods: A case series of 73 adult patients with suspected food allergy and clinical manifestations of chronic urticaria or other allergy-supposed skin symptoms were tested for specific IgG4 against foods. An open food challenge was carried out for all IgG4-positive food. All positive open tests were controlled by double-blind placebo-controlled food challenge. Results: Forty-five patients (62%) were IgG4 positive for a number of foods, mainly egg, milk, casein and wheat. None of the patients with IgG4-positive testing showed adverse reactions, neither immediate nor delayed, to the corresponding food. Conclusions: In adult patients, testing for specific IgG4 lacks clinical utility for the diagnosis of food allergy or intolerance. Dosing of IgG4 should not be part of the diagnosis and therapy of adult patients with allergy-like skin diseases.

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  1. Measurement of specific and nonspecific IgG4 levels as diagnostic and prognostic tests for clinical allergy. AAAI Board of Directors. J Allergy Clin Immunol 1995;95:652–654.
  2. Senna G, Passalacqua G, Lombardi C, Antonicelli L: Position paper: controversial and unproven diagnostic procedures for food allergy. Eur Ann Allergy Clin Immunol 2004;36:139–145.
  3. Senna G, Bonadonna P, Schiappoli M, Leo G, Lombardi C, Passalacqua G: Pattern of use and diagnostic value of complementary/alternative tests for adverse reactions to food. Allergy 2005;60:1216–1217.
  4. Stapel SO, Asero R, Ballmer-Weber BK, Knol EF, Strobel S, Vieths S, Kleine-Tebbe J, EAACI Task Force: Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy 2008;63:793–796.
  5. Dreborg S, Foucard T: Allergy to apple, carrot and potato in children with birch pollen allergy. Allergy 1983;38:167–172.
  6. Dreborg S, Backman A, Basomba A, Bousquet J, Dieges P, Malling HJ, EAACI Subcommittee on Skin Tests: Methods for skin testing. Allergy 1989;44(suppl 10):22–30.
  7. Malling HJ: Methods of skin testing. EAACI position paper. Allergy 1993;48(suppl 14): 55–56.

    External Resources

  8. Aalberse RC, Van Milingen F, Tan KY, Stapel SO: Allergen-specific IgG4 in atopic disease. Allergy 1993;48:559–569.
  9. Lemon-Mulé H, Sampson HA, Sicherer SH, Sheffler WG, Noone S, Nowak-Wegrzyn A: Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 2008;122:977–983.
  10. Skripak JM, Nash SD, Rowley H, et al: A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow’s milk allergy. J Allergy Clin Immunol 2008;122:1154–1160.
  11. Noh G, Ahn HS, Cho NY, Lee S, Oh JW: The clinical significance of food specific IgE/IgG4 in food specific atopic dermatitis. Pediatr Allergy Immunol 2007;18:63–70.
  12. Sletten GB, Halvorsen R, Egaas E, Halstensen TS: Changes in humoral responses to β-lactoglobulin in tolerant patients suggest a particular role of I gG4 in delayed, non-IgE-mediated cow’s-milk allergy. Pediatr Allergy Immunol 2006;17:435–443.
  13. Parish WE: Short-term anaphylactic IgG in human sera. Lancet 1970;2:591–592.
  14. Fagan DL, Slaughter CA, Capra JD, Sullivan TJ: Monoclonal antibodies to immunoglobulin G4 induce histamine release from human basophiles in vitro. J Allergy Clin Immunol 1982;70:399–404.
  15. Gwynn CM, Ingram J, Almousawi T, Stanworth DR: Bronchial provocation tests in atopic patients with allergen specific IgG4 antibodies. Lancet 1982;1:254–256.
  16. Shakib F, Brown HM, Phelps A, Redhead R: Study of IgG subclass antibodies in patients with milk intolerance. Clin Allergy 1986;16:451–458.
  17. Brouwer R, Biersteker K, Bongers P, Remijn R, Houthujis D: Respiratory symptoms, lung function, and IgG4 level against pig antigens in a sample of Dutch pig farmers. Am J Ind Med 1986;10:283–285.
  18. Yamashita N, Ito K, Nakagawa T, Haida M, Okudaira H, Nakada S, et al: IgG and IgE antibodies to Chironomidae in asthmatic patients. Clin Exp Immunol 1987;68:93–99.
  19. Barnes RM, Harvey MM, Blears J, Finn R, Johnson PM: IgG subclass oh human serum antibodies reactive with dietary proteins. Int Arch Allergy Appl Immunol 1986;81:141–147.
  20. Barnes RM, Johnson PM, Harvey MM, Blears J, Finn R: Human serum antibodies reactive with dietary proteins. IgG subclasses distribution. Int Arch Allergy Appl Immunol 1988;87:184–188.
  21. Homburger HA, Mauer K, Sachs MI, O’Connel EJ, Jacob GL, Caron J: Serum IgG4 concentrations and allergen-specific IgG4 antibodies compared in adults and children with asthma and non-allergic subjects. J allergy Clin Immunol 1986;77:427–434.
  22. Lee TH, Durham SR, Phelps A, Merreit TG, Kay AR: Allergen-specific IgG4 in bronchial asthma. Lancet 1982;2:1048–1049.
  23. Shakib F, Brown HM, Stanworth DR: Relevance of milk- and egg-specific IgG4 in atopic eczema. Int Arch Allergy Appl Immunol 1984;75:107–112.
  24. Atkinson W, Sheldon A, Shaath N, Whorwell PJ: Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial: Gut 2004;53:1459–1464.
  25. Hunter JO: Food elimination in IBS: the case for IgG testing remains doubtful. Gut 2005;54:1203.
  26. Calkhoven PG, Aalbers M, Koshte VL, Schilte PP, Yntema JL, Griffioen RW, et al: Relationship between IgG1 and IgG4 antibodies to food and the development of IgE to inhalant allergens. II. Increased levels of IgG antibodies to foods in children who subsequently develop IgE antibodies to inhalant allergens. Clin Exp Allergy 1991;21:99–107.
  27. Eysink PE, De Jong MH, Bindels PJ, Sharp-Van Der Linden VT, De Groot CJ, Stapel SO, et al: Relation between IgG antibodies to foods and IgE antibodies to milk, egg, cat, dog and/or mite in a cross-sectional study. Clin Exp Allergy 1999;29:604–610.
  28. Van der Zee JS, Aalberse RC: The role of IgG in immediate-type hypersensitivity. Eur Respir J 1991;13:91s–96s.
  29. Sudowe S, Rademaekers A, Kolsch E: Antigen dose-dependent predominance of either direct or sequential switch in IgE antibody responses. Immunology 1997;91:464–472.
  30. Platts-Mills T, Vaughan J, Squillac S, Woodfolk J, Sporik R: Sensitisation, asthma, and a modified Th2 response in children exposed to cat allergen: a population-based cross-sectional study. Lancet 2001;10:752–756.

    External Resources

  31. Aalberse RC, Platts-Mills TA: How do we avoid developing allergy: modifications of the Th2 response from a B-cell perspective. J Allergy Clin Immunol 2004;11:983–986.

    External Resources

  32. Varjonen E, Kalimo K, Savolainen J, Vainio E: IgA and IgG binding components of wheat, rye, barley and oats recognized by immunoblotting analysis with sera from adult atopic dermatitis patients. Int Arch Allergy Immunol 1996;111:55–63.
  33. Tomicic S, Norrman G, Falth-Magnusson K, Jenmalm MC, Devenney I, Fageras Bottcher M: High levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life. Pediatr Allergy Immunol 2008;20:35–41.

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