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Patel PK, Tanpowpong P, Sriaroon P, Lockey RF. Nonallergic Diseases Associated With Foods. J Allergy Clin Immunol Pract 2024; 12:607-619. [PMID: 37783385 DOI: 10.1016/j.jaip.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Clinicians are faced with evaluating real and alleged reactions to foods that may be allergic or nonallergic. Pathogenesis, diagnosis, and treatment of various non-IgE-mediated diseases are discussed in this review. These food-related conditions range from mild to severe. Referral for an allergy workup may be pursued despite the lack of IgE-mediated symptoms. Diagnostic testing is available for defined non-IgE-mediated food diseases that are either immunologic or nonimmunologic. These include celiac disease and related disorders, carbohydrate maldigestion, pancreatic insufficiency, and histamine intolerance. In contrast, there is a paucity of definitive studies to prove food intolerance diseases. There are no definitive diagnostic criteria or testing for nonceliac gluten sensitivity. Functional gastrointestinal disorders, such as irritable bowel syndrome, are better stratified diagnostically but still lack reliable testing. Both nonceliac gluten sensitivity and irritable bowel syndrome are linked to dietary triggers including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Therefore, dietary alteration alone may be diagnostic and therapeutic when all other conditions are ruled out. These conditions are important considerations when evaluating a patient with history of a food reaction. There is little evidence that foods are causative in other ailments such as acne, migraines, and nasal congestion and hypersecretion.
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Affiliation(s)
- Priya K Patel
- Department of Pediatric Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla; Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Pornthep Tanpowpong
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panida Sriaroon
- Department of Pediatric Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla; Division of Allergy and Immunology, Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Richard F Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
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2
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Kolb N, Alf V, Cappello R, Matiasek K, Rosati M. Novel association of gluten sensitivity with immune-mediated neuromuscular syndrome in a dog. Neuromuscul Disord 2022; 32:903-907. [PMID: 36418199 DOI: 10.1016/j.nmd.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2022] [Accepted: 06/20/2022] [Indexed: 12/31/2022]
Abstract
Gluten-related disorders in humans comprise different entities, including coeliac disease. Patients typically have measurable titers of anti-gliadin IgG or IgA (AGAs) and anti-transglutaminase-2 IgA (TG2). In addition to intestinal symptoms, human patients often show various neurological complications. In dogs, the neurological manifestation is rarely reported. Here we describe the muscle and nerve biopsies of an 11-year-old, male Border Terrier presenting with lower motor neuron signs submitted for histological examination. Examination of the biopsies showed an oligofocal lymphohistiocytic and plasmocytic myositis and a diffuse neuropathy of mixed nodo-paranodal and demyelinating type. Suspecting a neuromuscular form of breed-related gluten hypersensitivity, measurements of AGAs and TG2 antibodies were performed. Both titers ranged above control values. Hence, a gluten-related neuromyopathy was diagnosed. A gluten-free diet was prescribed and a complete disappearance of clinical signs was observed. Gluten-related disorders should be considered as a differential diagnosis in dogs with intestinal and neuromuscular signs.
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Affiliation(s)
- Ninja Kolb
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Vanessa Alf
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Rodolfo Cappello
- North Downs Specialist Referrals, The Brewerstreet Dairy Business Park, Bletchingley, United Kingdom
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Marco Rosati
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany.
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Zhu X, Zhao XH, Zhang Q, Zhang N, Soladoye OP, Aluko RE, Zhang Y, Fu Y. How does a celiac iceberg really float? The relationship between celiac disease and gluten. Crit Rev Food Sci Nutr 2022; 63:9233-9261. [PMID: 35435771 DOI: 10.1080/10408398.2022.2064811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Celiac disease (CD) is an autoimmune intestinal disease caused by intolerance of genetically susceptible individuals after intake of gluten-containing grains (including wheat, barley, etc.) and their products. Currently, CD, with "iceberg" characteristics, affects a large population and is distributed over a wide range of individuals. This present review summarizes the latest research progress on the relationship between CD and gluten. Furthermore, the structure and function of gluten peptides related to CD, gluten detection methods, the effects of processing on gluten and gluten-free diets are emphatically reviewed. In addition, the current limitations in CD research are also discussed. The present work facilitates a comprehensive understanding of CD as well as gluten, which can provide a theoretical reference for future research.
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Affiliation(s)
- Xiaoxue Zhu
- College of Food Science, Southwest University, Chongqing, China
- National Demonstration Center for Experimental Food Science and Technology Education, Southwest University, Chongqing, China
| | - Xin-Huai Zhao
- School of Biological and Food Engineering, Guangdong University of Petrochemical Technology, Maoming, P. R. China
| | - Qiang Zhang
- School of Biological and Food Engineering, Guangdong University of Petrochemical Technology, Maoming, P. R. China
| | - Na Zhang
- Key Laboratory of Food Science and Engineering of Heilongjiang Province, College of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Olugbenga P Soladoye
- Agriculture and Agri-Food Canada, Government of Canada, Lacombe Research and Development Centre, Lacombe, Alberta, Canada
| | - Rotimi E Aluko
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yuhao Zhang
- College of Food Science, Southwest University, Chongqing, China
- National Demonstration Center for Experimental Food Science and Technology Education, Southwest University, Chongqing, China
| | - Yu Fu
- College of Food Science, Southwest University, Chongqing, China
- National Demonstration Center for Experimental Food Science and Technology Education, Southwest University, Chongqing, China
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Vuletic B, Kocovic A, Mladenovic M, Lekovic Z, Radlovic V, Stojanovic B, Djonovic N, Radlovic N. Gluten-related disorders. SRP ARK CELOK LEK 2021. [DOI: 10.2298/sarh200828100v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Gluten-related disorders are a heterogeneous group of clinical entities
caused by intolerance of wheat, rye, and barley flour components. They occur
in 3-5% of genetically predisposed persons and based on pathogenic and
clinical features are classified into celiac disease, non-celiac gluten
sensitivity, and wheat allergy. There are also specific entities such as
dermatitis herpetiformis or gluten ataxia, which can occur either within the
celiac disease or independently. This article based on the current knowledge
shows the basic details of the pathogenesis, clinical expression, diagnosis,
and treatment of these disorders.
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Abstract
Celiac disease is a complex immune-mediated gluten-sensitive enteropathy with protean clinical manifestations. It is manifest in genetically predisposed individuals who ingest gluten in varying amounts. In broad terms, it is thought to affect 1% of the population in the USA. More specifically, the prevalence increases drastically from 1:133 in patients not-at-risk, to 1:56 in symptomatic patients, to 1:39 in patients with a second-degree relative with the diagnosis, and to 1:22 in patients with a first-degree relative with the diagnosis. It may be associated with several immune-mediated phenomena, autoimmune diseases, and complicated by vitamin and other trace element deficiencies, bone disease, and malignancy. Our understanding of celiac disease has evolved rapidly over the past two decades. This has led to several lines of enquiry on the condition and potential treatment options. More recently, several entities including gluten intolerance, non-celiac gluten sensitivity, and seronegative celiac disease have been described. These conditions are distinct from allergies or intolerance to wheat or wheat products. There are challenges in defining some of these entities since a large number of patients self-report these conditions. The absence of confirmatory diagnostic tests poses an added dilemma in distinguishing these entities. The differences in spectrum of symptoms and highlights of the variability between the pediatric and adult populations have been studied in some detail. The role of screening for celiac disease is examined in both the general population and "at risk" populations. Diagnostic strategies including the best available serologic testing, utility of HLA haplotypes DQ2 and DQ8 which are seen in over 90% of patients with celiac disease as compared with approximately 40% of the general population, and endoscopic evaluation are also reviewed. Comprehensive nutritional management after diagnosis is key to sustained health in patients with celiac disease. Simple algorithms for care based on a comprehensive multidisciplinary approach are proposed. Refractory and non-responsive celiac diseases in the setting of a gluten-free diet are examined as are novel non-dietary therapies. Finally, the association of other disease states including psychiatric illness, infertility, lymphoproliferative malignancy, and mortality is explored with special attention paid to autoimmune and atopic disease.
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Affiliation(s)
- Brian P McAllister
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Mail Code HU33, 500 University Drive, UPC Suite 2400, Hershey, PA, 17033-0850, USA
| | - Emmanuelle Williams
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Mail Code HU33, 500 University Drive, UPC Suite 2400, Hershey, PA, 17033-0850, USA
| | - Kofi Clarke
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Mail Code HU33, 500 University Drive, UPC Suite 2400, Hershey, PA, 17033-0850, USA.
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Affiliation(s)
- Janne Burman
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kati Palosuo
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaarina Kukkonen
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna Pelkonen
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Pilolli R, Gadaleta A, Di Stasio L, Lamonaca A, De Angelis E, Nigro D, De Angelis M, Mamone G, Monaci L. A Comprehensive Peptidomic Approach to Characterize the Protein Profile of Selected Durum Wheat Genotypes: Implication for Coeliac Disease and Wheat Allergy. Nutrients 2019; 11:E2321. [PMID: 31581419 PMCID: PMC6835779 DOI: 10.3390/nu11102321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
The wheat varietal selection undertaken by breeders in recent decades has been tailored mainly to improve technological and productivity-related traits; however, the latter has resulted in a considerable impoverishment of the genetic diversity of wheat-based products available on the market. This pitfall has encouraged researchers to revalue the natural diversity of cultivated and non-cultivated wheat genotypes in light of their different toxic/immunogenic potential for celiac disease and wheat-allergic patients. In the present investigation, an advanced proteomic approach was designed for the global characterization of the protein profile of selected tetraploid wheat genotypes (Triticum turgidum). The approach combined proteins/peptides sequence information retrieved by specific enzymatic digestions (single and dual proteolytic enzymes) with protein digestibility information disclosed by means of in-vitro simulated human gastroduodenal digestion experiments. In both cases, the peptide pools were characterized by discovery analysis with liquid chromatography high-resolution tandem mass spectrometry, and specific amino acid sequences were identified via commercial software. The peptide list was screened for in silico toxicity/immunogenicity risk assessment, with the aid of various open-source bioinformatics tools for epitopes matching. Given the global information provided by the designed proteomic approach, the in silico risk assessment not only tackled toxicity implication for celiac disease patients, but also scouted for immunogenic sequences relevant for wheat allergic patients, achieving a comprehensive characterization of the protein profile of the selected genotypes. These latter were assessed to encrypt a variable number of toxic/immunogenic epitopes for celiac disease and wheat allergy, and as such they could represent convenient bases for breeding practices and for the development of new detoxification strategies.
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Affiliation(s)
- Rosa Pilolli
- Institute of Sciences of Food Production, CNR-ISPA, 70126 Bari, Italy.
| | - Agata Gadaleta
- Institute of Sciences of Food Production, CNR-ISPA, 70126 Bari, Italy.
- DiSAAT, Università degli Studi di Bari Aldo Moro, 70126 Bari, Italy.
| | | | | | | | - Domenica Nigro
- DiSSPA, Università degli Studi di Bari Aldo Moro, 70126 Bari, Italy.
| | - Maria De Angelis
- DiSSPA, Università degli Studi di Bari Aldo Moro, 70126 Bari, Italy.
| | | | - Linda Monaci
- Institute of Sciences of Food Production, CNR-ISPA, 70126 Bari, Italy.
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Hamid A, Mallick SA, Moni G, Sachin G, Haq MRU. Amelioration in gliadin antigenicity and maintenance of viscoelastic properties of wheat ( Triticum aestivum L.) cultivars with mixed probiotic fermentation. J Food Sci Technol 2019; 56:4282-4295. [PMID: 31477999 PMCID: PMC6706494 DOI: 10.1007/s13197-019-03898-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 03/01/2019] [Accepted: 06/24/2019] [Indexed: 01/12/2023]
Abstract
Sourdough fermentation of twenty wheat cultivars was carried out using mixed probiotic culture (Lactobacillus acidophilus UNI, Lactobacillus brevis LR/5 and Lactobacillus plantarum ATCC 8014). The gliadin antigenicity was expressed in terms of its content in twenty different wheat cultivars. The gliadin proteins were characterized by SDS-PAGE and structural changes analyzed on FTIR spectrophotometer. Moreover, changes in the viscoelastic character of fermented and non-fermented dough were studied by rheometry. The results showed a remarkable reduction in antigenicity by 60% (average) in all wheat cultivars on sourdough fermentation. This reduction may be due to the synergistic effect of protease secretion by mixed lactobacilli, responsible for gliadin degradation. These changes in gliadins by mixed culture proteolysis were confirmed on SDS-PAGE on observing new gliadin-derived low molecular weight peptides. The results were further validated by FTIR spectroscopy where structural changes of gliadins were analyzed in the fermented dough. The rheological data indicated a higher storage modulus (G') compared to loss modulus (G″) in both control and fermented flour of all wheat cultivars, however, with a lower efficacy in sourdoughs. The present study thus establishes that mixed culture sourdough fermentation decreases the antigenic potential of gliadins without any change in the rheology and thereby maintaining the baking or viscoelastic properties of the wheat flour.
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Affiliation(s)
- Asima Hamid
- Division of Biochemistry, Faculty of Basic Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology-Jammu, Main Campus, Chatha, Jammu and Kashmir India
| | - S. A. Mallick
- Division of Biochemistry, Faculty of Basic Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology-Jammu, Main Campus, Chatha, Jammu and Kashmir India
| | - Gupta Moni
- Division of Biochemistry, Faculty of Basic Sciences, Sher-e-Kashmir University of Agricultural Sciences and Technology-Jammu, Main Campus, Chatha, Jammu and Kashmir India
| | - Gupta Sachin
- Division of Plant Pathology, Faculty of Agriculture, Sher-e-Kashmir University of Agricultural Sciences and Technology-Jammu, Main Campus, Chatha, Jammu and Kashmir India
| | - Mohammad Raies Ul Haq
- Department of Biochemistry, Cluster University Srinagar, Srinagar, Jammu and Kashmir India
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Terryberry J, Tuomi J, Perampalam S, Peloquin R, Brouwer E, Schuppan D, Guandalini S. Diagnostic accuracy of a fully automated multiplex celiac disease antibody panel for serum and plasma. ACTA ACUST UNITED AC 2019; 57:1207-17. [DOI: 10.1515/cclm-2019-0088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/20/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Background
An automated multiplex platform using capillary blood can promote greater throughput and more comprehensive studies in celiac disease (CD). Diagnostic accuracy should be improved using likelihood ratios for the post-test probability of ruling-in disease.
Methods
The Ig_plex™ Celiac Disease Panel on the sqidlite™ automated platform measured IgA and IgG antibodies to tTG and DGP in n = 224 CD serum or plasma samples. Diagnostic accuracy metrics were applied to the combined multiplex test results for several CD populations and compared to conventional single antibody ELISA tests.
Results
With multiple positive antibody results, the post-test probability for ruling-in untreated and treated CD increased to over 90%. The number of samples positive for more than one antibody also increased in untreated CD to ≥90%. Measurement of all four CD antibodies generate cut-off dependent accuracy profiles that can monitor response to treatment with the gluten-free diet (GFD). Higher positive tTG and DGP antibodies are seen more frequently in confirmed CD without (81%–94%) than with GFD treatment (44%–64%). In CD lacking biopsy confirmation, overall agreement of plasma to serum was ≥98% for all antibodies, and 100% for venous to capillary plasma.
Conclusions
The Ig_plex Celiac Disease Panel increases the likelihood of confirming CD based on the post-test probability of disease results for multi-reactive markers. Specific positivity profiles and cut-off intervals can be used to monitor GFD treatment and likely disease progression. Using serum, venous and capillary plasma yield comparable and accurate results.
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