Immunoglobulin G (IgG) antibodies to specific allergens have not been proved to be involved in pathogenesis of disease. The presence of IgG against otherwise innocuous antigens (such as foods) in serum simply indicates that the individual has been exposed to antigens that are recognized as foreign entities by the immune system. The presence of food-specific IgG alone cannot be taken as evidence of allergy or autoimmune disease and only indicates immunologicsensitization by the food in question. Consequently, thequantitative IgG test should only be ordered by specialists who recognize the limitations of the test.
What is wheat and gluten?
Wheat is the most widely consumed food grain in the world. The wheat kernel contains approximately 8-15% protein content of which 85%–90% is gluten. Gluten is made up of insoluble gliadins as well as high and low molecular weight glutenins, which are responsible for IgE-mediated reactions in wheat allergy, affecting an estimated 0.4% of the world’s population. Symptoms of wheat allergy usually develop within minutes to hours after ingestion and affect the GI tract (vomiting, colic, diarrhea), skin (urticaria, eczema), respiratory tract (upper respiratory, asthma), or include systemic anaphylactic reactions. Symptoms can also manifest as baker’s asthma (from inhaled flour), atopic dermatitis (from skin exposure), urticaria (forming hives after skin exposure), or wheat-dependent exercise-induced anaphylaxis).
Gluten can be found in many other food types, including processed meat, reconstituted seafood, vegetarian meat substitutes, candies, ice cream, butter, seasonings, stuffings, marinades and dressings, as well as coatings in medications and confectionary.
Proteins similar to gliadin in wheat are found in other grains, existing as secalin in rye, hordein in barley, and avenins in oats, where they are collectively referred to as “gluten.” Additionally, the derivatives of these grains such as triticale and malt also contain gluten. The gluten found in all of these grains has been identified as the component capable of triggering the immune-mediated disorder, celiac disease. The albumin/globulin protein group in wheat is mostly responsible for allergic reactions including wheat allergy and occupational Baker’s asthma/rhinitis. Wheat allergic subjects can also be sensitized to high and low molecular weight glutenins. The (omega-5) gliadin fraction of gluten is the most common allergen implicated in food-dependent, exercise-induced anaphylaxis.
When IgG reactions are predominant, it is an indication of gluten immune response and possible autoimmunity due to lack of digestive enzymes and/or other factors. High values of Gluten IgG could be related to Gluten sensitivity due to lack of digestive enzymes.
Gluten intolerance, also known as non-celiac gluten sensitivity, has similar symptoms to celiac disease. Although both conditions cause the body to have a negative response to gluten, the two types of responses do not have the same longevity or consequence. When a celiac person ingests gluten, his or her immune system will attack against its own body’s tissue. Whereas, if a person is gluten intolerant, the consumption of gluten will cause short-term bloating and belly pain. Unlike celiac disease, gluten intolerance doesn’t usually cause long-term harm to the body.
Possible treatment option:
Gluten-free diet // Temporary elimination diet.
Temporary elimination diets remove and reintroduce potentially problematic foods from the diet to see if you still experience symptoms.
Follow these four steps of an Elimination diet:
A person’s individual symptoms are combined with the IgG Food Antibody Assessment results to determine which food(s) to temporarily remove from the diet. Additional foods that were not tested can be included in the elimination diet based on your clinical history. Your healthcare provider will assist you in deciding which foods to eliminate. The average time frame for an elimination diet is 1 to 3 months. Planning for a successful elimination diet includes making appropriate preparations. Important preparation steps include: • Removing offending foods from the home and adjusting grocery needs accordingly. • Reviewing resources to assist with meal preparation, such as recipe books or reputable websites. Many clinicians recommend their patients record what foods are consumed in a food journal to help track the progress of the diet. This includes what foods are eaten, what date/time these foods are eaten, and any notable changes in your symptoms. A sample journal is provided at the end of this handout for your own use. You may wish to make several copies of this page to use throughout the elimination diet. Lastly, it is important to determine a start and end date with your healthcare provider.
It is essential that you completely avoid the foods your healthcare provider recommended you eliminate and/or that elicited a strong reaction via IgG Food Antibody Assessment. If you are unable to eliminate all reactive foods from the diet, focus on the foods that elicited a stronger reaction. Foods are grouped by botanical food families which are very similar in protein structure. Therefore, if you are sensitive to one member of a food family, you may also experience adverse reactions to other members of the same food family. For example, if you experience adverse reactions to bananas, you may also experience an adverse reaction to plantains. Review ingredients in prepared and prepackaged items to ensure minimal or no exposure to reactive foods. There may be alternate ways that some foods are listed on ingredient labels. For example, some food products may list eggs as mayonnaise or albumin. If you are instructed to avoid eggs for the elimination diet, you should also avoid mayonnaise and products listing albumin. Please refer to the chart below as an additional resource to help identify alternative names for foods.
Eliminated foods are reintroduced one food at a time while monitoring for any adverse food reactions. You are encouraged to consume the test food several times throughout the day for one day. Meanwhile, keep track in your journal which food is being reintroduced and any adverse reactions over the following three days. It is recommended you consume pure sources of the food. For example, if you are reintroducing eggs, eat scrambled eggs rather than mayonnaise which has been processed and contains other ingredients. If you experience an adverse reaction, the food should be immediately removed for the duration of the elimination diet. Your clinician may want you to wait until the adverse reaction resolves before moving on to another food. Common symptoms that may indicate an IgG food reaction include headache, itching, bloating, fatigue, diarrhea, constipation, joint pain, indigestion, or worsening of your chronic health complaints. If the food does not cause symptoms during the reintroduction phase, it can be added back into the diet. Continue the process with each food that was previously eliminated.
4. Long-term management:
An elimination diet based on food sensitivity testing is part of a comprehensive approach to overall gastrointestinal health. Based on your test results and symptoms, a long-term plan is usually developed utilizing the results of the reintroduction phase. Your healthcare provider may also consider treating increased intestinal permeability based on the results of your immunology food profile. The goal of addressing intestinal permeability is to strengthen the gut barrier. This will reduce the amount of partially digested food proteins that enter the bloodstream, causing an adverse immune reaction. There are several nutrients that have been found to support intestinal barrier function and decrease inflammation, including:
Botanicals that can also assist with intestinal health are slippery elm, deglycyrrhizinated licorice (DGL), aloe vera extract, and marshmallow root.
Wheat and wheat products may be listed on food labels as:
Foods likely to contain wheat:
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