Cytokine Profile and Immunoglobulin E-mediated Serological Food Hypersensitivity in Patients With Irritable Bowel Syndrome With Diarrhea

( Ryo Katsumata ),( Manabu Ishii ),( Suni Lee ),( Yukiko Handa ),( Takahisa Murao ),( Minoru Fujita ),( Hiroshi Matsumoto ),( Takemi Otsuki ),( Akiko Shiotani ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2018 Journal of Neurogastroenterology and Motility (JNM Vol.24 No.3

Background/Aims Food interaction, including food hypersensitivity, plays a key role in the pathogenesis of irritable bowel syndrome with diarrhea (IBS-D). Since only a few studies have been reported about the relationship between food hypersensitivity and IBS-D, we elucidate the prevalence of serological food hypersensitivity in patients with IBS-D and the characteristics of gastrointestinal symptoms and serum cytokine profiles in patients with IBS-D and serological food hypersensitivity. Methods Immunoglobulin E (Ig E)-mediated serological food hypersensitivity and serum cytokine levels were evaluated using the multiple allergen simultaneous test evaluating food allergen-specific serum IgE and Luminex Milliplex Panel containing multiple fluorescencelabeled beads. Class 2 or above was considered as IgE-mediated food hypersensitivity positive. The gastrointestinal symptom rating scale was used to evaluate symptoms. Results We enrolled 92 subjects, including 60 with IBS-D and 32 healthy controls. The percentages of patients with IgE-mediated serological food hypersensitivity were not significantly different between the groups (controls = 28.1% and IBS-D = 33.3%). Serum IL-1β, IL- 6, IL-8, macrophage inflammatory protein-1alpha, and TNF-α levels were higher in patients with IBS-D than in controls. Serum concentration of TNF-α (43.4 vs 21.8 pg/mL, P = 0.009) was higher in patients with IBS-D without IgE-mediated serological food hypersensitivity than those with food hypersensitivity. Conclusions One-third of Japanese patients with IBS-D showed IgE-mediated serological food hypersensitivity. The serum cytokine profile differed and was characterized by lower inflammatory cytokine levels in IBS-D with IgE-mediated serological food hypersensitivity. Serological test regarding IgE-mediated food hypersensitivity can detect a certain cluster of IBS-D. (J Neurogastroenterol Motil 2018;24:415-421)

Food Hypersensitivity in Patients with Childhood Atopic Dermatitis in Korea

( Hye One Kim ),( Soo Ick Cho ),( Jin Hye Kim ),( Bo Young Chung ),( Hee Jin Cho ),( Chun Wook Park ),( Cheol Heon Lee ) 대한피부과학회 2013 Annals of Dermatology Vol.25 No.2

It is well known that atopic dermatitis (AD) is related to food hypersensitivity, although its prevalence varies among several studies according to age group, severity, country, survey time, and test method. Objective: To examine the prevalence and status of food hypersensitivity among childhood AD patients in Korea. Methods: A total of 95 patients were enrolled in the study. The history of food hypersensitivity was collected by interviews. The severity of AD was evaluated by eczema area and severity index (EASI). We took blood samples to measure serum total and food-specific immunoglobulin E (IgE) levels. Based on the histories and serum IgE levels, open oral food challenge (OFC) testing was performed to confirm food hypersensitivity. Results: Forty- two (44.2%) of the 95 AD patients had histories of food hypersensitivity. They reported that the most common suspicious foods were egg (n=13, 13.7%), pork (n=9, 9.5%) and cow milk (n=8, 8.4%). The mean EASI score was 16.05±9.76. Thirty-nine (41.1%) of the 95 patients showed elevated serum food-specific IgE levels. The specific IgE levels were elevated for egg (n=17, 17.9%), milk (n=12, 12.6%), peanut (n=10, 10.5%) and wheat (n=8, 8.4%). Fifty-one (53.8%) of 95 patients underwent open OFC, and only 7 (13.7%) of these patients showed positive reactions. Conclusion: The overall prevalence of food hypersensitivity in patients with childhood AD in Korea was 8.3% (7/84). The most common foods causing food hypersensitivity were egg and milk. Among the foods causing hypersensitivity, AD patients in Korea often underestimated peanut, while they overestimated pork.

P010 : Food hypersensitivity in patients with atopic dermatitis in Korea

( Jin Hye Kim ),( Yong Se Cho ),( Yun Sun Byun ),( Yoon Seok Yang ),( Bo Young Chung ),( Hye One Kim ),( Hee Jin Cho ),( Chun Wook Park ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: It is well known that atopic dermatitis (AD) is related to food hypersensitivity, although its prevalence varies among several studies. Objectives: To examine the prevalence and status of food hypersensitivity among AD patients in Korea. Methods: The history of food hypersensitivity was collected by interviews. We took blood samples to examine food-specific immunoglobulin E (IgE) levels. Based on patients`` histories and serum IgE levels, open oral food challenge (OFC) testing were performed. Results: 49 (37.7%) of the 130 childhood AD patients and 33 (25.4%) of 130 adult AD patients had histories of food hypersensitivity. The most common suspicious foods in childhood AD were egg, pork and cow milk. In adult AD patients, the most common suspicious foods were instant food, wheat, ramen, beef, pork, chocolate. According to open OFC testing, nine childhood patients showed positive responses. The most common offending food were egg and milk (n=3 each), followed by pork, beef, peanut (n=1 each). In adult AD patients, only one patient showed positive response to pork. Conclusion: The overall prevalence of food hypersensitivity in childhood AD patients was 6.9%, and 0.8% in adult AD patients as assessed by open OFC testing. The number of patients with actual food hypersensitivity was lower than the number of patients reporting a history of food hypersensitivity. Therefore, dietary restriction must be conducted after confirming food hypersensitivity by medical professionals.

기능성 위장관 질환에서의 음식 과민성과 음식 불내증의 진단

이홍섭 ( Hong Sub Lee ),이광재 ( Kwang Jae Lee ) 대한내과학회 2019 대한내과학회지 Vol.94 No.5

Patients with a functional gastrointestinal disorder (FGID) frequently report abdominal discomfort and bloating after ingesting specific foods. However, evidence on the relationship between foods and symptoms is lacking. In addition, the diagnosis of food hypersensitivity and food intolerance does not seem to be established yet. Food hypersensitivity can be divided into immunologically mediated and non-immunologically mediated forms. The immunologically mediated forms are specifically termed food allergies, whereas the non-immunologically mediated forms are referred to as food intolerances. Various diagnostic tools are required to make an accurate diagnosis of a food allergy or a food intolerance. First, a thorough examination of the history and basic tests to rule out other organic diseases are needed. Next, diagnostic tests for immunoglobulin E-mediated food allergies are required and diseases, such as celiac disease and lactose intolerance, should be differentiated. A diagnosis for non-celiac gluten sensitivity (NCGS) is also required. A double blind, randomized, placebo-controlled, dietary challenge test can be used for diagnosing NCGS and food intolerance. Diagnostic tests for food intolerance, in which scientific evidence is lacking, may result in a misdiagnosis of food hypersensitivity or food intolerance in patients with a FGID. Therefore, an accurate diagnosis of food hypersensitivity or food intolerance based on reliable tests is required. (Korean J Med 2019;94:438-442)

P022 : Food hypersensitivity in patients with chronic urticaria in Korea

( Yong Se Cho ),( Yun Sun Byun ),( Yoon Seok Yang ),( Jin Hye Kim ),( Bo Young Chung ),( Hee Jin Cho ),( Chun Wook Park ),( Hye One Kim ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: The etiology of chronic urticaria (CU) remains unknown in most patients. Possible causes in some cases include food, but the role of hypersensitivity to food antigens in patients with CU remains controversial. Objectives: The aim of this study was to evaluate the association between food hypersensitivity and CU in 350 Korean participants. Methods: Patients with CU were assessed for a previous history of food hypersensitivity that caused symptoms of CU. Blood samples were taken from the patients to measure food allergen-specific IgE. Based on history and laboratory results, open oral food challenge (OFC) tests were performed. Results: Of 350 participants, 46 (13.1%) claimed to have experienced previous food hypersensitivity. Pork (n=16) were the main foods mentioned, followed by beef (n=7), shrimp (n=6) and mackerel (n=6). We found that 73 participants (20.8%) had elevated levels of food-specific IgE, with pork (n=49), wheat (n=25), and beef (n=23) being the most common. However, when the open OFC tests were conducted in 102 participants with self-reported food hypersensitivity or raised levels of food-specific IgE, only four participants showed a positive reaction to pork. Conclusion: Although some participants claimed to have a history of CU related to food intake, when an open OFC test was conducted, few of them had positive results. We therefore conclude that food allergy is an uncommon cause of chronic CU.

식품알레르기 진단과 관리

안강모 ( Kang Mo Ahn ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.3

Food allergy is an adverse food reaction as a result of immune mechanisms and is a key component in food safety issue. The prevalence of food allergy is known to be up to 6% of children and 3∼4% of adults. A nationwide cross-sectional questionnaire survey of Korean children in 1995 and 2000 revealed that there was a tendency of the prevalence of food allergy to increase. The most common allergen was egg, followed by milk, fish, and seafoods, such as crab, lobster and shellfish. However, this does not seem to reflect the true prevalence because diagnosis of food allergy was based on questionnaires but not food challenge tests but. Various symptoms are manifested in patients with food allergy depending on whether IgE- or non-IgE-mediated mechanisms are involved. The gold standard for diagnosing food allergy is double-blind placebo-controlled food challenge test (DBPCFC), which is both time- and effort-consuming. In clinical practice, a convincing history and positive specific IgE are very important for the diagnosis of IgE-mediated food allergy, and quantification of food-specific IgE is considered a useful test in some foods, such as egg, milk, peanut and fish in the pediatric population. The patients and their caregivers need to be educated about the way to avoid exposure to food allergens. However, recent progress in understanding of the immunopathogenesis of food allergy will lead to novel therapeutic approaches in the future. (Korean J Asthma Allergy Clin Immunol 2011;31:163-169)

한국인 음식물 의존성 운동유발 아나필락시스의 임상적 특성 분석

정수지 ( Soo Jie Chung ),심지수 ( Jisu Shim ),김형준 ( Hyung-jun Kim ),손경희 ( Kyoung-hee Sohn ),강성윤 ( Sung-yoon Kang ),강민규 ( Min-gyu Kang ),박한기 ( Han-ki Park ),강혜련 ( Hye-ryun Kang ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.6

Purpose: Food-dependent exercise-induced anaphylaxis (FDEIA) is a rare subtype of food allergy in which both sensitization to food allergen and exercise as a trigger contribute to its development. However, its pathogenesis is still under investigation. This study compared clinical features, the causative foods, and the degree of sensitization to food between FDEIA and food anaphylaxis to characterize FDEIA more clearly. Methods: We retrospectively reviewed the medical records of patients who were diagnosed with FDEIA (n=89) or food anaphylaxis (n=115) between 2003 and 2015 at Seoul National University Hospital. Results: Subjects with FDEIA more frequently had urticaria than those with food anaphylaxis (88.8% vs. 76.5%, P=0.024). Whereas patients with FDEIA had less laryngeal edema than those with food anaphylaxis (12.4% vs. 30.4%, P=0.02). Wheat (67.4%) was the most common causative food allergen in FDEIA, whereas seafood (40.9%) was the most common culprit food allergen in food anaphylaxis. Also, subjects with FDEIA showed a lower atopic index score than those with food anaphylaxis (0.55±1.07 vs. 1.21±1.82, P=0.006). Conclusion: There were significant differences in clinical manifestation, causative food allergens and the degree of sensitization to food between FDEIA and food anaphylaxis. (Allergy Asthma Respir Dis 2016:4:436-441)

음식 불내성의 기능의학적 접근

이상훈(Sang-Hoon Lee),김상만(Sang Man Kim) 대한기능의학회 2022 Journal of Korean Institute for Functional Medicin Vol.5 No.2

음식 불내성(food intolerance)은 음식 섭취 후 신체에 발생하는 음식 이상 반응(adverse food reaction)의 하나로 특정 음식을 소화, 흡수하거나 대사시키는데 어려움이 있는 경우를 뜻하며 음식 민감성(food sensitivity)이라고도 불린다. 이러한 음식 불내성으로 인해 소화, 흡수가 잘 되지 않은 음식은 복통, 소화불량, 복부 팽만감, 가스, 변비나 설사 등 다양한 증상을 일으킬 수 있다. 음식 이상 반응은 크게 면역 매개 반응(immune mediated reaction)과 비면역 매개 반응(nonimmune mediated reaction)으로 나뉘며, 면역 매개 반응의 대표적인 예가 주로 면역글로불린 E (IgE)나 호산구(eosinophil)에 의해 발생하는 음식알러지(food allergy)이고, 비면역 매개 반응이 바로 음식불내성이다. 음식 불내성은 인구의 약 15-20%에서 보고된다는 연구 결과가 있을 정도로 흔하며, 특히 과민성 장증후군(irritable bowel syndrome)의 경우 절반 이상의 환자들이 다양한 음식에 대해 불내성을 나타낸다는 보고가 있다. 또한 기능의학적으로도 음식 불내성은 위장관 건강(gut health) 뿐만 아니라 만성 피로, 부신 기능 저하, 히스타민 불균형 등 다양한 임상적 불균형과 연관이 있을 것으로 여겨진다. 하지만 아직 음식 불내성의 개념을 잘 모르는 의료인이 많으며 음식 불내성의 진단, 치료법 또한 확실히 정립되지 않아 임상적 활용에 어려움이 있다. 이에 저자들은 현재까지 나온 음식 불내성의 기전 및 진단, 치료에 대한 내용을 정리하고 음식 불내성을 기능의학적으로 어떻게 적용하면 좋을지에 대해 고찰해 보고자 한다. Food intolerances are defined as difficulty digesting or metabolizing a particular food. They are a subset of adverse food reactions. Adverse food reactions include immune-mediated food allergies and non-immune-mediated food intolerances. Food intolerances are estimated to affect up to 15-20% of the population, but understanding of diagnosis and management is complicated and controversial, and given presentation and mechanisms associated also vary greatly. In addition, food intolerances can be associated with various clinical imbalances of functional medicine, such as dysbiosis, leaky gut syndrome, histamine imbalance, and functional adrenal insufficiency. This review aims to provide a scientific update and clinical application of food intolerances in the perspective of functional medicine.

Diagnostic utility of food-specific Igg4 in chronic urticaria with suspected food intolerance

( Byeol Han ),( Tai-kyung Noh ),( Tae Young Han ),( Jeong Don Chae ),( June Hyunkyung Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Testing for food-specific IgG4 can be a valuable diagnostic method especially for patients with chronic urticaria and suspected delayed food hypersensitivity. Objectives: To assess the diagnostic utility of food-specific IgG4 in patients with chronic urticaria due to suspected food intolerance, and to evaluate the effect of a food elimination diet based on the food-specific IgG4 findings in improvement of urticarial symptom. Methods: Baseline Urticaria Severity Score (USS), Urticaria Activity Score 7 (UAS7), food-specific serum IgG4 assays, and serum cytokine measurement were analyzed in a total of 41 patients with chronic urticaria suspected of harboring food intolerance. After an elimination diet by avoiding food items based on the food-specific IgG4 findings for 4 weeks, USS and UAS7 were reassessed. Results: Of the 41 patients, 35 patients had food-specific IgG4. After the 4-week food elimination diet period, the mean USS and UAS7 were decreased from that at baseline, from 12.2 and 18.4 to 9.4 and 11.6, respectively. Twenty patients (48.8%) who showed a decrease of >30% in both the USS and UAS7 were classified as the improvement group. The number of food-specific allergens against which IgG4 was secreted (nIgG4) was higher in the improvement group than no improvement group. Conclusion: This study suggests evidence of the diagnostic utility of food-specific IgG4 to identify the aggravating factor in cases of chronic urticaria with suspected food intolerance.

식품알레르기

이재천,김철우 제주대학교 의과학연구소 2022 The Journal of Medicine and Life Science Vol.19 No.3

Food allergy is one of the adverse food reactions, which is developed by immunological reactions. Food allergy is increasing in prevalence among children and adults. In the diagnosis, food challenge is confirmative with history and laboratory tests. Avoidance of culprit food is the only preventive method, especially in patients with severe symptoms. In some food allergies, crossreactivity among allergens should be considered. Latex-fruit/vegetable syndrome and pollen food allergy syndrome are well-understood phenotypes of food allergy related to cross reaction. Red meat allergy is recently described as one of tick-borne diseases. In a rare phenotype of food-dependent exercise-induced anaphylaxis, factors affecting the absorption of food allergen are important in its pathophysiology.