IgG Food Antibodies

What is the difference between IgE and IgG-mediated reactions?

The key differences between IgE allergies and IgG sensitivities are summarized below:

When should testing for IgG Food Antibodies be considered?

Testing for adverse food reactions is useful for individuals who suspect that a food is responsible for causing their symptoms, but can't quite identify which food(s). The presence of circulating antibodies may affect each patient differently. Circulating IgG food antibodies are not diagnostic for a specific condition, but indicate an immune response to that food. The immune response could be a normal response that would not necessarily cause symptoms. Therefore, test results should always be viewed in the context of the overall clinical picture. The role of IgG food antibody testing is still being researched, however, studies have shown the benefit of testing in certain conditions.¹

Conditions associated with IgG food sensitivity

• Irritable Bowel Syndrome (IBS)^2-4
• Major Depressive Disorder⁴
• Migraine headaches^5-7
• Skin rashes such as eczema⁸
• Joint aches⁹
• Autoimmune disease¹⁰
• Crohn's Disease¹¹
• Obesity¹²

The "Leaky Gut" Connection

The presence of circulating IgG antibodies to foods may be suggestive of increased intestinal permeability, also referred to as "leaky gut syndrome." When the tight junctions forming the barrier in the gut don't work properly, larger substances can "leak" through, causing an immune response. This immune response may result in the production of IgG antibodies to foods.⁴ There are multiple dietary and lifestyle factors that contribute to increased intestinal permeability. These factors include alcohol,¹³ stress,^14,15 chronic NSAID use,¹⁶ Western-type diet (high consumption of red meat, animal fat, high sugar, and low fiber food),¹⁷ and prolonged and strenuous exercise.^18-20

Ordering the test

The IgG Food Antibody Panel can be ordered as a stand-alone test or bundled with other profiles. Often times, clinicians will bundle several smaller profiles in order to see a more complete picture of the patient's immune-mediated response. Profiles that can be bundled include:

The video below explains how these tests can be bundled.

What advantage does the IgG Food Antibody test offer compared to other diagnostics?

IgG food antibodies can result in a delayed response to a food.¹ Whereas IgE antibodies can result in immediate-hypersensitivity to a substance. It is generally easier for patients and clinicians to identify a food that causes an immediate response. A delayed-response to food may be more challenging to determine, and testing can be helpful. The IgG Food Antibody test assesses total IgG (1-4) versus only testing for IgG4. This offers a more complete assessment, however, IgG4 testing is available for clinicians interested in that specific component of IgG.

The body of scientific evidence continues to build regarding correlation with clinical symptoms and conditions for IgG testing (see conditions above). Furthermore, a study comparing methodologies showed that "IgG ELISA testing is more reliable and consistent than cell size testing for identifying food sensitivities."²¹ Examples of cell size testing or cytotoxic testing include mediator release testing (MRT), antigen leukocyte antibody testing (ALCAT) and lymphocyte response assays.

Other types of adverse food reactions that are not mediated by the immune system are referred to as food intolerances. Food intolerances include lactose intolerance due to lactase enzyme deficiency in the gut; testing is available for suspected lactose intolerance. Testing is not available for all food intolerances. These include vasoactive amines like histamine and tyramine, food additives and preservatives (nitrites, sulfites, MSG, aspartame), salicylates, nightshades, lectins, FODMAPs, oxalates, etc. Since testing is not available for every type of adverse food reaction, the elimination/rechallenge diet remains the gold standard for identification of symptom-producing foods.

Genova's Methodology

IgG Antibody Testing

In testing food antibodies, Genova uses the sandwich ELISA method to offer semi-quantitative serum levels of IgG antibodies to foods. The relative degrees of IgG present for each food are reported using a semi-quantitative level:

• negative (none detected)
• VL (very low)
• Low (+1)
• Moderate (+2)
• High (+3)

In making these assessments, Genova looks at partial proteins, known as epitopes, in order to assess IgG antibody responses. Epitopes are designed to reveal that portion of the protein which most defines the specific food. There are no standardized, FDA-cleared laboratory assays for the detection of IgG antibodies to food antigens available in the US market. Genova uses commercially-prepared antigens for the IgG food antibody assessment. Levels of IgG reactivity are standardized to World Health Organization International Standard: Immunoglobulins G, A and M, Human Serum NIBSC code: 67/086.

IgE Antibody Testing

Genova utilizes the FDA-cleared Siemans Immulite^® 2000 Total IgE and 3gAllergy Specific IgE Universal Kits. Immulite^® 2000 Total IgE is a solid-phase Chemiluminescent assay. Immulite^® 3gAllergy Specific IgE is a solid phase, two-step, chemiluminescent immunoassay that exploits liquid phase kinetics in a bead format. Siemens proprietary liquid allergens are the key to making IMMULITE^® 2000 Immunoassay allergy tests sensitive, specific, and reliable. The soluble polymer/copolymer support for the allergens increases the number of binding sites and their accessibility to allergen-specific IgE antibodies. Enzyme-enhanced chemiluminescent signal detection provides increased sensitivity and the proprietary wash technique enhances specificity.

What can clinicians and patients expect from IgG Food Antibody testing?

In general, clinical management of the patient with food sensitivities involves elimination or rotation of the highly reactive food(s). Often times, clinicians and patients notice improvement of symptoms after diet modification. Patients may be able to tolerate the food in small amounts, without symptoms, after several weeks or months of elimination. Increased intestinal permeability (leaky gut) may simultaneously be addressed with diet, botanicals, and nutraceuticals, as well as modifying the contributing factors.

Please visit our IgG, IgE, and Celiac Tests Prep page prior to ordering the test to learn about medications that may impact test results, length of exposure to antigens, pediatric testing, and diseases that may affect antibody levels.

References

1. Mullin G, et.al. Testing for Food Reactions: The Good, the Bad, and the Ugly. Nutr in Clin Pract. 2010; 25(2):192-198.
2. Atkinson W, et. al. Food Elimination Based on IgG Antibodies in Irritable Bowel Syndrome: A Randomized Controlled Trial. Gut. 2004;53:1459-1464.
3. Drisko J, et. al. Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics. J Amer Col Nutr. 2006;25(6):514-522.
4. Karakula-Juchnowicz H, et.al. The food-specific serum IgG reactivity in major depressive disorder patients, irritable bowel syndrome patients and healthy controls. Nutrients. 2018 Apr;10(5):pii:E548.
5. Mitchell N, et. al. Randomized Controlled Trial of Food Elimination Diet Based on IgG Antibodies for the Prevention of Migraine-Like Headaches. Nutr J. 2011 May;10:85.
6. Alpay K, et. al. Diet Restriction in Migraine, Based on IgG Against Foods: A Clinical Double-Blind, Randomized, Cross-Over Trial. Cephalgia. 2010 Jul;30(7):829-37.
7. Aydinlar E, et.al. IgG-Based Elimination Diet in Migraine Plus Irritable Bowel Syndrome. Headache. 2013;53:514-525.
8. Shakib F, et. al. Study of IgG Sub-Class Antibodies in Patients with Milk Intolerance. Clin Allergy. 1986;16(5):451-458.
9. Panush RS. Food Induced ("Allergic") Arthritis: Clinical and Serologic Studies. J Rheumatol. 1990 Mar;17(3):291-4.
10. Coucke F. Food intolerance in patients with manifest autoimmunity. Observational study. Autoimmune Rev. 2018 Nov;17(11):1078-1080.
11. Bentz S, et. al. Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double-blind cross-over diet intervention study. Digestion. 2010;81(4):252-64.
12. Wilders-Truschnig M, et. al. IgG antibodies against food antigens are correlated with inflammation and intima media thickness in obese juveniles. Exp Clin Endocrinol Diabetes. 2008 Apr;116(4):241-5.
13. Purohit V, Bode JC, Bode C, et al. Alcohol, intestinal bacterial growth, intestinal permeability to endotoxin, and medical consequences: summary of a symposium. Alcohol. 2008;42(5):349-361.
14. Vanuytsel T, van Wanrooy S, Vanheel H, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014;63(8):1293-1299.
15. Soderholm JD, Perdue MH. Stress and gastrointestinal tract. II. Stress and intestinal barrier function. Am J Physiology Gastro Liver Physiology. 2001;280(1):G7-g13.
16. Bjarnason I, Takeuchi K. Intestinal permeability in the pathogenesis of NSAID-induced enteropathy. J Gastro. 2009;44 Suppl 19:23-29.
17. Bibbo S, Ianiro G, Giorgio V, et al. The role of diet on gut microbiota composition. Eur Rev Med Pharm Sci. 2016;20(22):4742-4749.
18. Davison G, Marchbank T. Zinc carnosine works with bovine colostrum in truncating heavy exercise-induced increase in gut permeability in healthy volunteers. Am J Clin Nutr. 2016;104(2):526-536.
19. Lamprecht M, Bogner S, Schippinger G, et al. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Internat Soc Sports Nutr. 2012;9(1):45.
20. Pires W, Veneroso CE, Wanner SP, et al. Association Between Exercise-Induced Hyperthermia and Intestinal Permeability: A Systematic Review. Sports Med. 2017;47(7):1389-1403.
21. Hodsdon W and Zwickey H. NMJ Original Research: Reproducibility and Reliability of Two Food Allergy Testing Methods. Nat Med J. 2010;2(3):1-13.

NOTES:
^† When ordering the IgG Food Antibodies test, it will be listed as “Allergy Antibody” on the Order Menu.
* IgG Food Antibody Assessment is not available in New York.