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A prospective audit of food intolerance among migraine patients in primary care clinical practice
Abstract
This prospective audit was set up to investigate whether migraine sufferers have evidence of IgG-based food intolerances and whether their condition can be improved by the withdrawal from the diet of specific foods identified by intolerance testing. Migraine patients were recruited from primary care practices and a blood sample was taken. Enzyme-linked immunosorbent assays (ELISA) were conducted on the blood samples to detect food-specific IgG in the serum. Patients identified with food intolerances were encouraged to alter their diets to eliminate appropriate foods and were followed up for a 2-month period. Endpoints included identification of the specific foods that the patients were intolerant to, assessing the proportion of patients who altered their diet and the benefit obtained by these patients at 1 and 2 months. Patients reported the level of benefit on a 6-point scale, where 0 = no benefit and 5 = high benefit. Sixty one patients took part in the audit and 39 completed 2 months of investigation. The mean number of foods identified in the IgG test was 5.3 for all participants and 4.7 for those successfully altering their diet. About 90% of patients changed their diet to a greater or lesser extent following the identification of possible food intolerances. A marked proportion of the migraine patients benefited from the dietary intervention, approximately 30% and 40% reporting considerable benefit at 1 and 2 months, respectively. Also, over 60% of patients who reintroduced the suspect foods back into their diets reported the return of their migraine symptoms. This investigation demonstrated that food intolerances mediated via IgG may be associated with migraine and that changing the diet to eradicate specific foods may be a potentially effective treatment for migraine. Further clinical studies are warranted in this area.
... It is estimated that nearly 30 million Americans suffer from migraine headaches and often times, proper treatment can be challenging, which is why additional diagnostic tools may prove beneficial for better treatment outcomes [6•]. Evidence suggests that IgG-based food sensitivities and intolerances are linked to migraine headaches [9]. Often times, patients report that their headaches occur and may be triggered by the consumption of various foods such as cheese, chocolate, citrus fruits, and red wine [10][11][12]. ...
... Though the exact pathophysiology has not been established, the IgG-mediated food allergy hypothesis believes that an increase in IgG antibodies and cytokines result in an inflammatory response which then is believed to play a role in migraine attacks [14]. Food sensitivities and intolerances can be treated by utilizing a food elimination diet followed by a re-challenge protocol [9]. Elimination diet protocols are often lengthy, imprecise, and inefficient [9]. ...
... Food sensitivities and intolerances can be treated by utilizing a food elimination diet followed by a re-challenge protocol [9]. Elimination diet protocols are often lengthy, imprecise, and inefficient [9]. Commercially available IgG blood tests are available, though some questions remain regarding the effectiveness of such tests [5••]. ...
Purpose of Review
This literature review describes the relationship between IgG food sensitivities and their relation to migraine headaches.
Recent Findings
IgG food sensitivities have been linked to various symptoms and disorders. While food sensitivities and intolerances are recognized within the clinical medicine community, diagnosing these sensitivities and intolerances can be challenging because symptoms are usually delayed hours to days and may not occur after every exposure to the allergen. Some reports indicate that foods such as chocolate, cheese, cow’s milk, eggs, and red wine may be triggers for migraine headaches.
Summary
The pathophysiology of migraine headaches is not well understood. Some evidence supports the use of IgG food sensitivity testing to determine food sensitivities and intolerances. IgG food sensitivity testing may prove to be a beneficial tool for healthcare practitioners, especially for patients experiencing migraine headache symptoms. Utilizing IgG food sensitivity testing to create customizable dietary recommendations for patients may allow healthcare providers to treat migraine headaches without the use of medications.
... Le résultat de l'objectif principal est négatif pour l'étude en simple insu [81]. Les trois autres sont des études ouvertes entachées de biais dont deux non contrôlées [79,80,82]. Ces résultats inconsistants ne permettent pas de conclure à une utilité des IgG anti-aliments pour la prise en charge des migraines. ...
... Rees et al.[79] ont effectué une étude de preuve de concept financée par le laboratoire Yorktest qui commercialise les IgG anti-aliments au Royaume-Uni. Au cours de cette étude prospective ouverte, réalisée auprès de médecins généralistes, 61 patients souffrant de migraine, âgés de 21 à 68 ans (80 % de femmes) ont complété 2 questionnaires à l'inclusion et ont eu un dosage des IgG anti-aliments. ...
De plus en plus de personnes dans les pays développés attribuent à une intolérance alimentaire diverses manifestations cliniques de typestroubles gastro-intestinaux, douleurs articulaires voire polyarthrite rhumatoïde (PR), migraine ou fatigue chronique. Plusieurs auteurs ont rapportéune fréquence plus importante de la positivité des IgG anti-aliments chez les patients souffrant de syndrome de l’intestin irritable (SII), de maladiesinflammatoires chroniques de l’intestin (MICI) ou de PR comparés aux témoins sains. Depuis une décennie, ces dosages de recherche sontdisponibles en routine sur prescription médicale mais aussi en accès libre sans avis médical via internet. Ces dosages sont utilisés pour établir desrégimes d’éviction des aliments pour lesquels la recherche d’IgG est positive, dans l’espoir d’une amélioration des symptômes supposés être enrelation avec la consommation de ces aliments par le biais d’une réaction d’intolérance faisant intervenir les IgG. L’objectif de ce travail est derappeler les mécanismes impliqués dans les intolérances et allergies alimentaires, et le rôle physiologique des réponses immunitaires à IgG. Lestechniques de dosage des IgG anti-aliments commercialement disponibles sont passées en revue. Les principales études basées sur le dosage desIgG anti-aliments appliqué à diverses pathologies font l’objet d’une analyse critique, suivie d’une discussion. Il en ressort que l’intérêt clinique desdosages d’IgG anti-aliments est l’objet d’une vive polémique en raison de leur mauvaise valeur prédictive positive. Les recommandations établiessur la base de ces dosages sont susceptibles de faire prendre un risque au patient en retardant quelquefois le bon diagnostic ou en lui faisant suivreun régime alimentaire d’éviction le plus souvent inutile et parfois délétère pour sa santé. Les coûts directs liés aux dosages et indirects occasionnéspar les régimes d’éviction, souvent élevés, peuvent être évités au profit d’autres stratégies diagnostiques. En conclusion, dans l’état actuel des connaissances médicales, les dosages d’IgG anti-aliments ne devraient plus être pratiqués en routine pour établir un diagnostic d’intolérance ouallergie alimentaire à IgG, ni mettre en place un régime d’éviction. Leur utilisation devrait être réservée à des fins de recherche.
... Le résultat de l'objectif principal est négatif pour l'étude en simple insu [81]. Les trois autres sont des études ouvertes entachées de biais dont deux non contrôlées [79,80,82]. Ces résultats inconsistants ne permettent pas de conclure à une utilité des IgG anti-aliments pour la prise en charge des migraines. ...
... Rees et al.[79] ont effectué une étude de preuve de concept financée par le laboratoire Yorktest qui commercialise les IgG anti-aliments au Royaume-Uni. Au cours de cette étude prospective ouverte, réalisée auprès de médecins généralistes, 61 patients souffrant de migraine, âgés de 21 à 68 ans (80 % de femmes) ont complété 2 questionnaires à l'inclusion et ont eu un dosage des IgG anti-aliments. ...
... Le résultat de l'objectif principal est négatif pour l'étude en simple insu [81]. Les trois autres sont des études ouvertes entachées de biais dont deux non contrôlées [79,80,82]. Ces résultats inconsistants ne permettent pas de conclure à une utilité des IgG anti-aliments pour la prise en charge des migraines. ...
... Rees et al.[79] ont effectué une étude de preuve de concept financée par le laboratoire Yorktest qui commercialise les IgG anti-aliments au Royaume-Uni. Au cours de cette étude prospective ouverte, réalisée auprès de médecins généralistes, 61 patients souffrant de migraine, âgés de 21 à 68 ans (80 % de femmes) ont complété 2 questionnaires à l'inclusion et ont eu un dosage des IgG anti-aliments. ...
... Le résultat de l'objectif principal est négatif pour l'étude en simple insu [81]. Les trois autres sont des études ouvertes entachées de biais dont deux non contrôlées [79,80,82]. Ces résultats inconsistants ne permettent pas de conclure à une utilité des IgG anti-aliments pour la prise en charge des migraines. ...
... Rees et al.[79] ont effectué une étude de preuve de concept financée par le laboratoire Yorktest qui commercialise les IgG anti-aliments au Royaume-Uni. Au cours de cette étude prospective ouverte, réalisée auprès de médecins généralistes, 61 patients souffrant de migraine, âgés de 21 à 68 ans (80 % de femmes) ont complété 2 questionnaires à l'inclusion et ont eu un dosage des IgG anti-aliments. ...
Introduction
Les examens biologiques sont d’un apport important pour le diagnostic et le suivi des allergies ou la recherche de facteurs prédisposant à celles-ci. L’utilisation optimisée de ces outils nécessite une actualisation constante des connaissances. En France, le texte de recommandations de la Haute Autorité de santé (HAS) date de 2005. La mise à disposition des allergènes moléculaires et l’évolution des stratégies diagnostiques a rendu indispensable une actualisation de ces recommandations, qui a été initiée sous l’impulsion de la Société française d’allergologie.
Méthodes
Nous avons utilisé la méthode de Recommandation pour la pratique clinique (RPC) élaborée par la HAS pour rédiger des recommandations concises, gradées par niveaux de preuve, répondant aux questions posées. Ces recommandations ont été relues par un groupe de relecture incluant les professionnels et usagers concernés, puis validées par un groupe de validation. Les liens d’intérêt des rédacteurs ont été déclarés selon les exigences de la HAS.
Résultats
Nous avons identifié 63 questions, objet de ces recommandations de bonne pratique, dont 11 sur les allergies respiratoires, 28 sur les allergies alimentaires, 11 sur les allergies aux médicaments, 8 sur les allergies aux piqûres et morsures d’arthropodes et 5 sur d’autres pathologies allergiques. La majorité des recommandations relèvent d’un niveau de preuve de grade C. Un préambule aborde 16 questions d’ordre plus général, liées à la biologie de l’allergie.
Discussion
Ces recommandations n’ont pas vocation à décrire l’ensemble des outils pour le diagnostic ou le suivi des maladies allergiques, mais concernent des points d’amélioration de la prise en charge de l’allergie, identifiés à l’aide de recommandations consensuelles nationales et internationales ou d’études de pratiques publiées depuis 2005. En l’absence de telles données, l’avis et l’expérience du groupe de travail a été exprimé.
Conclusion
Ces recommandations de bonne pratique de prescription et d’interprétation des examens biologiques pour le diagnostic et le suivi des hypersensibilités allergiques selon la méthode RPC de la HAS, apportent en 2018 une actualisation rendue nécessaire par l’évolution des concepts et des outils.
... Le résultat de l'objectif principal est négatif pour l'étude en simple insu [81]. Les trois autres sont des études ouvertes entachées de biais dont deux non contrôlées [79,80,82]. Ces résultats inconsistants ne permettent pas de conclure à une utilité des IgG anti-aliments pour la prise en charge des migraines. ...
... Rees et al.[79] ont effectué une étude de preuve de concept financée par le laboratoire Yorktest qui commercialise les IgG anti-aliments au Royaume-Uni. Au cours de cette étude prospective ouverte, réalisée auprès de médecins généralistes, 61 patients souffrant de migraine, âgés de 21 à 68 ans (80 % de femmes) ont complété 2 questionnaires à l'inclusion et ont eu un dosage des IgG anti-aliments. ...
There is an increasing tendency in western countries to attribute to food intolerance various clinical types of gastrointestinal disorders, joint pain or rheumatoid arthritis (RA), migraine and chronic fatigue. Several authors have reported a greater frequency of positive anti-food IgG in patients presenting irritable bowel syndrome (IBS), chronic inflammatory bowel disease (IBD) and RA compared to healthy controls. Over the last decade, screening tests have become routinely available on prescription but are also freely available over the Internet. These assays are used to create diets that avoid IgG-positive foods in the hope of improving symptoms thought to be related to the consumption of these foods associated with IgG-mediated intolerance reactions. The purpose of this study is to review the mechanisms involved in food intolerance and the physiological and pathological role of IgG immune response. Commercially available assays for food IgG are reviewed. Studies based on anti-food IgG determination applied to various diseases are reviewed and discussed. Considerable controversy surrounds the clinical relevance of anti-food IgG assays because of their poor positive predictive value. The recommendations made on the basis of these assays are likely to jeopardize the health of patients by delaying correct diagnosis or encouraging them to follow a mostly useless and occasionally harmful diet. The frequently high direct and indirect costs of assays and avoidance diets may be avoided in favor of other diagnostic strategies. Finally, in the current state of medical knowledge, anti-food IgG tests should not be performed routinely to establish a food intolerance diagnosis or to devise an avoidance diet. They should be used solely for research purposes.
... 2 A london study showed that after an intervention for 1 to 2 months with foods that induce migraine, 30% to 40% of the subjects no longer had migraines triggered by these foods. 5 Another study showed that 7% to 44% of certain types of food induced migraines. However, controversy remains on whether food induces migraine. ...
... Of these, 100 suffered from migraine based on the IHS criteria. We excluded 10 participants because they refused to participate in this study (5), suffered from sinusitis (1) or had respiratory infections (4). All subjects filled questionnaires on their intake of potential migraine-inducing foods. ...
Background Migraine headaches are a common problem worldwide, especially in adolescents. They are usually chronic, with frequent relapses. Therefore, any dietary risk factor for headaches has important implications on migraineurs. However, the association between migraine and diet needs to be examined further.
Objective To investigate the association between diet and migraine in adolescents.
Methods We conducted a cross-sectional study in August to September 2009 on 13 - 18 year old adolescents in a senior high school in Medan, North Sumatera. We included subjects diagnosed with migraine, according to the International Headache Society (IHS) criteria. Ninety participants completed the questionnaire. Foods we observed for a link to migraine included milk, chocolate, ice cream, cheese, bread, instant noodles, meatballs, chili sauce, sweetener, yoghurt, pizza, and other foods and beverages.
Results Of the 90 participants with migraines, there were more females (61.1%) than males. There were statistically significant associations between migraine and triggering foods (P = 0.045, 95% CI 0.59 to 0.79) as well as between migraine and family history of migraine (P = 0.043, 95% CI 0.46 to 0.66). Stress (P = 0.164), menstruation (P = 0.369), and sound or light (P= 0.577) had no significant association with migraine. A wide variety of foods and beverages were implicated as migraine precipitants. The most common were chili sauce (75.8%), ice cream (71.0%), milk (67.7%), instant noodles (67.7%), chocolate (61.3%), peanuts (59.7%), cheese (54.8%) and meatballs (54.8%).
Conclusion Food and family history have a significant association with the occurrence of migraine in adolescents.
... There is some evidence in the literature that dietary intolerances and sensitivities based on IgG cause migraine [165][166][167]. Increased levels of cytokines and IgG antibodies are associated with inflammatory response, which is involved in migraine [168]. ...
In recent years, numerous efforts have been made to identify reliable biomarkers useful in migraine diagnosis and progression or associated with the response to a specific treatment. The purpose of this review is to summarize the alleged diagnostic and therapeutic migraine biomarkers found in biofluids and to discuss their role in the pathogenesis of the disease. We included the most informative data from clinical or preclinical studies, with a particular emphasis on calcitonin gene-related peptide (CGRP), cytokines, endocannabinoids, and other biomolecules, the majority of which are related to the inflammatory aspects and mechanisms of migraine, as well as other actors that play a role in the disease. The potential issues affecting biomarker analysis are also discussed, such as how to deal with bias and confounding data. CGRP and other biological factors associated with the trigeminovascular system may offer intriguing and novel precision medicine opportunities, although the biological stability of the samples used, as well as the effects of the confounding role of age, gender, diet, and metabolic factors should be considered.
... 66 The first evidence came from a proof-of-concept study in which migraine patients (n = 39) embarked on an IgG-based elimination diet with 30−40% reporting clinical benefit. 67 In another study, 43 out of 65 patients with migraine refractory to traditional treatment had a complete remission of their migraine after 1−6 months of an IgG-based elimination diet. 68 In the first randomised-controlled clinical trial, a 6-week IgG-based elimination diet (n = 30) found a significant reduction in the number of headache days and number of migraine attacks in the elimination diet period. ...
Chronic migraine headaches are estimated to affect between 1.4% and 2.2% of the population, and have a huge impact on wellbeing and quality of life. A diverse range of therapeutic nutritional options have been explored for migraine headaches, with varying degrees of benefit. Dietary interventions include generally healthy food plans, identification and avoidance of trigger foods, weight-loss diets, low-glycaemic-load diets, ketogenic diets, gluten-free diets, IgG-led elimination diets and a high-omega-3/low-omega-6 diet. Nutritional supplement interventions include riboflavin, niacin, homocysteine-lowering B vitamins, vitamin B12, vitamin E, vitamin D, magnesium, zinc, iron, omega-3 fatty acids, coenzyme Q10 (CoQ10), lipoic acid, soy phytoestrogens, ginger, turmeric, carnitine, 5-hydroxytryptophan (5-HTP), palmitoylethanolamide (PEA), and multi-ingredient formulas. The wide range of therapeutic options may make it challenging to approach nutritional management of migraine in a clinical setting, so a pragmatic model that helps personalise interventions from clinical signs and symptoms and reliable biomarkers would be useful, so-called 'precision nutrition'. The aim of this narrative review is to explore the clinical evidence for nutritional medicine for migraines, including diet and nutrient-based interventions, from the perspective of personalised or precision nutrition.
... 19 Five clinical studies have utilized serum immunoglobulin G (IgG) testing to guide an individualized elimination diet in migraine sufferers. [20][21][22][23][24] These studies are summarized in Table 1. ...
... A maioria dos pacientes era do sexo feminino (88,7%) e sedentária (76,3%). A idade média para ambos os sexos foi de 40±12, 32 tratamento potencialmente eficaz para a enxaqueca 22 . Sabe-se que as partículas de alimentos não digeridos e metabólitos bacterianos podem entrar na corrente sanguínea, como resultado do aumento da permeabilidade intestinal, e essas endotoxinas bacterianas podem atuar sobre o sistema trigeminovascular para desencadear, consequentemente, os ataques de enxaqueca 39 . ...
BACKGROUND AND OBJECTIVES:
Considering the bidirectional connection between intestine and brain, the present study examined the association between migraine, lactose intolerance, and intestinal constipation in patients with status migrainosus.
METHODS:
This is a cross-sectional retrospective study that included 97 patients aged 20 years or older. The impact of pain was assessed by the Migraine Disability Assessment and the Headache Impact Test-6 questionnaires. The pain intensity was measured by the visual analog scale. Chi-square and Student-t tests were used for the statistical analysis.
RESULTS:
The sample consisted of 88.7% women, 56.8% overweight, 76.3% sedentary, 32% constipated and 23.7% lactose intolerant. Higher pain intensity (8.9±1.3) and impact pain mean was assessed by the Headache Impact Test-6 (67.6±5.3) and the Migraine Disability Assessment (36.7±26.3) in constipated patients compared to those without constipation. Lactose-intolerant patients presented higher migraine mean time (19.9±14.2) compared to lactose tolerant patients. Constipated and lactose intolerant patients presented higher prevalence of overweight (58.1 and 65.2%) and abdominal obesity (70.0 and 68.2%) compared to non-constipated and lactose tolerant patients, respectively.
CONCLUSION:
Although were observed in the evaluated sample a considerable prevalence of constipation and lactose intolerance, higher mean scores in the questionnaires used for pain impact and intensity in constipated patients and longer migraine diagnosis time in those with lactose-intolerance, there was no statistical significance in the association between migraine and these two gastrointestinal disorders.
... In their prospective studies, including 61 episodic and chronic migraine patients and completed with 39 patients, Rees et al. (18) reported what the decrease in migraine attacks was, with a 6-point scale (0=no benefit, 5=high benefit), when they excluded the foods with IgG increases by monitoring serum food-specific IgG levels of the patients within a 2-month period. At the end of the second month, 38.2% of the patients indicated a serious benefit (4-5 points) in terms of migraine symptoms, 32.4% of the patients saw few to no benefit (0-1 points). ...
Introduction:
Migraine is a common type of headache, but its pathogenesis is still not fully understood. Triggering factors may vary in migraine patients with a particular importance of certain food intake. In this study, the efficacy of limiting certain migraine- triggering foods in the prevention of migraine attacks was investigated.
Methods:
Patients diagnosed with migraine without aura according to the International Classification of Headaches were enrolled. Fifty migraine patients stating that migraine attack started after the intake of certain foods were evaluated. The patients were randomly divided into 2 groups. The migraine-triggering foods identified by the patients were excluded from the diet in both groups 1 (n=25) and 2 (n=25). Monthly attack frequency, attack duration, and attack severity (using the visual analogue scale) were recorded before starting the diet restriction and 2 months after the diet restriction. Diet restriction was relaxed in group 1 after the second month and continued in group 2. In the fourth month, the monthly attack frequency, attack duration, and attack severity (using the visual analogue scale) were determined in both groups.
Results:
A total of 50 patients comprising 9 males and 41 females were evaluated in this study. In both the groups, in the second month after diet implementation, monthly attack frequency, attack duration, and attack severity were found to have decreased to a statistically significant extent compared to those in the period before diet implementation [group 1 (p=0.011, p=0.041, and p=0.003, respectively) and group 2 (p=0.015, p=0.037, and p=0.003, respectively)]. In the evaluation in the fourth month, it was observed that this significant decrease was maintained only in group 2.
Conclusion:
The results of the study reveal that if migraine-triggering foods are identified by migraine patients, restricting their intake can be an effective and reliable method to reduce migraine attacks.
... Çıkardıkları besinleri diyetlerine sadece bir kereliğine geri koyduklarında ise migrenli hastaların %60'ının belirtilerine devam ettiği gözlenmiştir. 27 Hastalara eliminasyon diyetleri verilerek besin allerjisi temeline dayandırılan çalışmalar, IgE ve IgG antikorlarının varlığına dayanan diyetleri test etmiştir. Türkiye'de yapılan bir okul çalışmasında migren tipi baş ağrısı saptanan 39 öğrenci ile baş ağrısı tariflemeyen 167 çocuk çalışmaya alınmıştır. ...
Migren, normal duyusal olayların anormal beyin işlemesi nedeni ile sinir sisteminin aşırı
duyarlı olması sonucu oluşan poligenetik bir hastalıktır. Dünya Sağlık Örgütü (DSÖ), yaşam şartlarını etkileyen en engelleyici kronik hastalıklarından biri olarak migreni görmektedir. Beslenme, hormonal ve çevresel faktörler duyarlı bireylerde migreni tetikleyebilmektedir. Stres, hormonal değişiklikler, psikolojik yönler, yorgunluk, uyku süresinde dengesizlikler, ilaçlar ve tütün kullanımı, kokulara hassasiyet, egzersiz, ışık, iklim değişikliği ve yüksek rakım migreni artıran faktörlerdir. Migren ve beslenme arasında karmaşık bir ilişki mevcuttur. Besinsel tetikleyici faktörler hâlen tartışmalı bir konudur ve değerlendirilmesi bireysel farklılıklar nedeni ile oldukça zordur. Genel olarak açlık veya öğün atlama ciddi bir tetikleyici olmakla beraber; çikolata, kırmızı şarap, peynir, kafein, monosodyum glutamat (MSG), nitrit ve aspartam önemli tetikleyiciler olarak karşımıza çıkmaktadır. Yapılan yeni çalışmalarda, migren tedavisine ek olarak; magnezyum, riboflavin, koenzim Q10 gibi bazı fonksiyonel besinlerin kullanımının migren ataklarının sıklığını, şiddetini ve süresini azaltılabileceği bulunmuştur. Migrenin allerji ile ilişkili olduğu düşünülerek, allerji oluşturan besinlerin diyetten çıkarılmasını kapsayan eliminasyon diyetleri gündeme gelmiştir. Beden kitle indeksi ve migren özellikleri arasındaki ilişki çelişkili olmasına rağmen, çok zayıf ve kilolu olmanın migren nöbetlerini tetikleyebileceğini gösteren bazı çalışmalar mevcuttur. Bu çalışmada, yapılmış güncel araştırmalar ışığında migreni tetikleyen besinler ve bu besinler ile migren nöbetlerinin şiddeti, yoğunluğu ve süresi arasındaki ilişkilerin incelenmesi amaçlanmıştır.
... A positive response to a diet based on IgG antibodies against food has been reported in several different diseases, such as migraine [49,80], obesity [81], Crohn disease [82]. A common thread of all above cases is inflammation. ...
There is an increasing amount of evidence which links the pathogenesis of irritable bowel syndrome (IBS) with food IgG hyperreactivity. Some authors have suggested that food IgG hyperreactivity could be also involved in the pathophysiology of major depressive disorder (MDD). The aim of this study was to compare levels of serum IgG against 39 selected food antigens between three groups of participants: patients with MDD (MDD group), patients with IBS (IBS group) and healthy controls (HC group). The study included 65 participants (22 in the MDD group, 22 in the IBS group and 21 in the HC group). Serum IgG levels were examined using enzyme-linked immunosorbent assay (ELISA). Medical records, clinical data and laboratory results were collected for the analysis. IgG food hyperreactivity (interpreted as an average of levels of IgG antibodies above 7.5 µg/mL) was detected in 28 (43%) participants, including 14 (64%) from the MDD group, ten (46%) from the IBS group and four (19%) from the HC group. We found differences between extreme IgG levels in MDD versus HC groups and in IBS versus HC groups. Patients with MDD had significantly higher serum levels of total IgG antibodies and IgG against celery, garlic and gluten compared with healthy controls. The MDD group also had higher serum IgG levels against gluten compared with the IBS group. Our results suggest dissimilarity in immune responses against food proteins between the examined groups, with the highest immunoreactivity in the MDD group. Further studies are needed to repeat and confirm these results in bigger cohorts and also examine clinical utility of IgG-based elimination diet in patients with MDD and IBS.
... Diyetlerine çıkardıkları besinleri sadece bir kereliğine geri koyduklarında ise migrenli hastaların %60'ının belirtilerine devam ettiği belirtilmiştir. 27 Hastalara eliminasyon diyetleri verilerek besin alerjisi temeline dayandırılan çalışmalar IgE ve IgG antikorlarının varlığına dayanan diyetleri test etmiştir. Türkiye'de yapılan bir okul çalışmasında migren tipi başağrısı tespit edilen 39 öğrenci ile başağrısı tariflemeyen 167 çocuk çalışmaya alınmıştır. ...
... It is demonstrated that migraineurs are positive for IgG food allergens more frequently than control subjects and their symptoms may improve with an elimination diet (79). In recent years, studies have focused on the IgGbased elimination diet for migraineurs and also IBS patients and successful results have been reported in the attenuation of symptoms (80)(81)(82). This supports the theory that inflammation may play a key role in the pathophysiology of migraine and may help to explain the comorbidity of primary headaches and GI complaints. ...
There are studies reporting primary headaches to be associated with gastrointestinal disorders, and some report resolution of headache following the treatment of the associated gastrointestinal disorder. Headache disorders are classified by The International Headache Society as primary or secondary; however, among the secondary headaches , those attributed to gastrointestinal disorders are not appreciated. Therefore, we aimed to review the literature to provide evidence for headaches, which originate from the gastrointestinal system. Gastrointestinal disorders that are reported to be associated with primary headaches include dyspepsia, gastro esophageal reflux disease (GERD), constipation, functional abdominal pain, inflammatory bowel syndrome (IBS), inflammatory bowel disorders (IBD), celiac disease, and helicobacter pylori (H. Pylori) infection. Some studies have demonstrated remission or improvement of headache following the treatment of the accompanying gastrointestinal disorders. Hypotheses explaining this association are considered to be central sensitization and parasympathetic referred pain, serotonin pathways, autonomic nervous system dysfunction, systemic vasculopathy, and food allergy. Traditional Persian physicians, namely Ebn-e-Sina (Avicenna) and Râzi (Rhazes) believed in a type of headache originating from disorders of the stomach and named it as an individual entity, the "Participatory Headache of Gastric Origin". We suggest providing a unique diagnostic entity for headaches coexisting with any gastrointestinal abnormality that are improved or cured along with the treatment of the gastrointestinal disorder.
... While the use of IgG-mediated testing is not universally-accepted as accurate or valid in identifying foods that are reactive or "allergenic" due to the occurrence of IgG antibodies in the blood of healthy individuals [13,22], others have suggested that non-IgE mechanisms are useful for individuals who may be symptomatic to certain foods [23]. Additionally, researchers in headaches and gastroenterological complaints and disorders have discovered improvements in symptoms by using IgG-mediated testing combined with a subsequent food elimination diet [18,[24][25][26][27][28]. Furthermore, while IgE testing is the commonly-recognized method to determine food allergies [29,30], the use of IgG testing may continue to show utility, as IgG antibodies against food antigens were shown to be linked to intima media thickness in obese adolescents juveniles [15]. ...
Background:Given the relationship between chronic disease and poor nutritional habits, using strategies to address the crisis of poor health in the U.S. is necessary. We explored if overweight people wanting to lose weight could benefit from having the Immuno Bloodprint, a proprietary IgG-mediated food sensitivity test to determine which foods to eliminate from the diet. IgG-mediated antibodies are thought to be causal in some food hypersensitivity and thus related to overweight status.
Objective:This study assessed the effect of an IgG-mediated food sensitivity test in combination with a food elimination diet on body composition and secondary outcomes in people who wanted to lose weight and/or were overweight.
Methods: A total of 120 subjects aged 18 and over took part in the study. Subjects had to eliminate all reactive foods from their diet for 90 days. Body composition, blood pressure and pulse, and quality of life were assessed at baseline and 30-, 60-, and 90-day follow-up.
Results: Subjects who eliminated IgG-mediated reactive foods from their diet had reductions in weight, body mass index, waist and hip circumferences, resting diastolic blood pressure and had improvements in all indicators of quality of life according to the SF-36 from baseline to 90-day follow-up.
Conclusions and Context:Subjects were able to improve their body composition and quality of life in response to eliminating IgG reactive foods from the diet. This test may represent a strategy to counteract the severe U.S. obesity epidemic.
Abbreviations:Body mass index (BMI), Immunoglobulin E (IgE), Immunoglobulin G (IgG), and Waist/hip ratio (WHR).
... The low prevalence of specific IgG antibodies against cola nut (4.9%) reported among patients suffering from migraine suggests that prevalence of frequently occurring food specific IgG antibodies may vary in different disorders. 17 Furthermore modified food materials tend to support production of higher amounts of food specific IgG, IgM, IgA and IgE antibodies compared to raw food materials. 18 Cola nut, extensively used as a flavoring agent in beverages after having been processed, could have possibly triggered higher amounts of cola nut specific IgG antibody production observed in the present study. ...
BACKGROUND: Food intolerance mediated by food specific IgG antibodies has been implicated in a variety of disorders. OBJECTIVES: To assess the prevalence of food specific IgG antibodies among patients clinically presenting with allergic symptoms lacking laboratory evidence of allergy. DESIGN: Descriptive retrospective cross-sectional study. SETTING: King Khalid University Hospital, Riyadh between 2010–2015. PATIENTS AND METHODS: Patients were screened for food specific IgG antibodies. All symptomatic patients lacking laboratory evidence of allergy who underwent food specific IgG testing during the study duration were included. MAIN OUTCOME MEASURE(S): Levels of IgG antibodies in patients with unidentified allergic symptoms. RESULTS: We selected 71 patients with allergic symptoms lacking laboratory evidence of allergy. There were 49 female and 22 male patients mean age 38.8 (16.0) years. The majority (85.7%) had urticaria. The most frequently occurring food specific IgG antibodies were against cola nut in 80.3% of patients followed by yeast in 78.9%, wheat in 77.5%, red kidney bean in 71.8%, pea in 63.4%, corn in 62% and egg white in 62% of the patients. Compared with male patients, females harbored significantly higher food specific IgG antibodies for frequently occurring food materials, particularly against wheat (74% vs 25.5%; P
... Bu çalışmada antikor konsantasyonları yüksek görülen en sık yiyeceklerin yumurta, peynir, inek sütü, yulaf, buğday, domates, kazein, domuz eti ve fasulye olduğu görülmüştür. Diyetten fayda gören hastaların % 60'ı gıdaları tekrar aldıklarında baş ağrılarının tekrarladığını belirtmişlerdir(20). Mitchell ve ark. ...
Öz
Özet: Gıdalara karşı gelişen immunoglobulin G (IgG) tipi antikorların kronik inflamasyona yol açarak irritabl barsak sendromu, obezite gibi bir çok hastalığın patojenezinde rol oynadığı bir süredir bilinmektedir. Migren ve gerilim tipi baş ağrısı benzer şekilde IgG tipi geç başlangıçlı kronik inflamatuar yanıtın ağrı ve diğer semptomların oluşumunda rol aldığının saptandığı, ancak bunun nedeninin tam olarak anlaşılamadığı, çok sık saptanan hastalıklardır. Yakın zamanda spesifik gıdaların uzun süre küçük miktarlarda tekrarlayan alımından sonra geç başlangıçlı IgG tipi inflamasyona yol açtığı ve bu hastalarda vazodilastayona yol açan mediatörlerin miktarlarının arttığı gösterilmiştir. Üstelik bu durum baş ağrısı atakları sırasında belirginleşmektedir. Konuyla ilgili en önemli gelişme, özellikle migrenli ve gerilim tipi baş ağrılı hastalarda IgG tipi antikor gelişmiş olan gıdaların diyetten çıkarılması sonucu atak sıklıklarında %70’e varan azalmanın saptanmış olmasıdır. Bu derlemede IgG tipi gıda alerjisi tanımlanmış ve gerilim tipi baş ağrısı ve migrendeki rolü tartışılarak konu ile ilgili güncel araştırmalar özetlenmiştir.
Anahtar kelimeler: IgG tipi gıda alerjisi, Baş ağrısı, Migren, Gerilim tipi baş ağrısı
THE ROLE OF FOOD ALLERGY IN MIGRAINE AND TENSION TYPE HEADACHE AT A GLANCE: A REVIEW OF THE LITERATURE
Abstract: The role of immunoglobulin G mediated chronic inflammation against foods (also in the pathophysiology of many diseases such as irritable bowel syndrome and obesity has been researched for a while. Similarly, in common diseases like tension type headache and migraine, immunoglobulin G mediated late onset chronic inflammation against foods is shown to be associated with pain and other symptoms, however the pathophysiology is not fully understood. Some of the studies suggest that migraine and tension type headache share a common pathophysiological process with tension type headache being a less severe form of migraine. Being exposed to little amounts of specific foods repeatedly cause immunoglobulin G mediated late onset inflammation and, also it is shown that the amount of mediators causing vasodilatation are increased in patients especially during the headache attack. A few recent studies about migraine and tension type headache has been showed that eliminating foods -against which the patient has immunoglobulin G antibodies- from the patient’s diet decreased headache attacks up to 70% percent which is considered to be the most important progress in this field. The review summarizes the definition of mediated food allergy and its role in tension type headache and migraine headaches consistent with the current literature.
Keywords: IgG mediated food allergy, Headache, Migraine, Tension type headache
... In the literature, it is shown that when the foods those increase the IgG levels are eliminated from the diet, the 30-70% of patients had positive developments in the symptoms [31,32,35,36,37,38,39,40]. Marinkovich et al. showed the relationship between food sensitivity and specific IgG levels and he reported that food elimination diet improved the clinical symptoms of the patients [35]. ...
Obesity is caused by the chronic low-level inflammation of white adipose tissue associated with the activation of the immune system. Food intolerance (FI) is one of the probable cause of this low-level inflammation. Food intolerance test had been done to the patients who were refractory to lose weight. In this study, we tried to prove that the elimination diet, based on test results, can help with weight loss in patients. 82 patients were enrolled in the study. Their ages were between 18-65 years and had BMI ≥ 25 kg / m². The FI test was done to all of them. The patients randomized to control or FI groups. The FI group was given food intolerance elimination diet (FIED) while the patients in the control group underwent a weight loss program by supervision of a dietitian. The patient's body weight, fat weight, lean body mass, body mass index, waist/hip ratio were measured before and after the diet program of the two groups. At the same time, fasting blood sugar, lipid and A1c levels were tested. In the FI group, patients significantly lost weight 86.60±20.93 kg (BMI=31.40±4.68 kg/m 2) to 77.99±14.23 kg (BMI=28.95±4.23 kg/m 2) (p<0.05). In the control group the body weight also decreased from 89.60±17.69 kg (BKI= 33.09±4.70 kg/m 2) to 88.69±18.44 kg (BKI= 32.44±5.09 kg/m 2) (p<0.05). Body fat weight decreased from 32.22±8.18 kg to 27.00±8.27 kg in the FI group while in the control group it was decreased from 36.18±10.50 kg to 36.17±12.76 kg (p<0.05). Triglyceride levels of the FI group decreased significantly than the control group (p<0.05). There was no significant change in fasting blood glucose, A1c and cholesterol levels of two groups at the end of study (p>0.05). In this study, people who cannot lose weight by low-calorie diet can lose weight and fat with elimination diet according to the results of FI test. FIED is also significantly effective in triglyceride levels.
... Previous studies revealed that the exclusion of the foods found to contain IgG antibodies from the daily diet of patients with Irritable Bowel Syndrome (IBS) alleviates their symptoms 17,18 and also the exclusion of the intolerance developing foods from the diet of migraine patients decreases the number of migraine attacks 19 . ...
... A previous study in adults showed that testing for immunoglobulin (Ig)E-specific food allergy and restricting diets based on the results of these tests may help to decrease migraine frequency (15). Observational studies and a randomized controlled trial have shown that diet restriction based on IgG antibodies may reduce the frequency of migraine attacks (16)(17)(18). However, another study found no difference in IgE and IgG4 titers in responses among adults with dietary migraine and non-dietary migraine (19). ...
Several potential dietary trigger factors for migraine have been proposed. However, few studies have examined the intake pattern of these dietary items compared to adequate control populations and whether intake levels may vary by migraine aura status or attack frequency.
We conducted a cross-sectional study among participants in the Women's Health Study. We used logistic regression to evaluate the association between migraine and headache status and low intake of foods commonly reported to affect migraine.
A total of 25,755 women reported no history of migraine or headache, 5573 reported non-migraine headache and 7042 reported any migraine. Those with non-migraine headache or any migraine were more likely to have low intake of total alcohol (OR = 1.22, 95% CI:1.14-1.29 and OR = 1.17, 95% CI:1.11-1.24, respectively). Migraineurs with aura were more likely to have low intake of chocolate, ice cream, hot dogs, and processed meats. Those who experience migraine at least once per week were more likely to have low intake of skim/low-fat milk and white and red wine.
Intake of most suggested migraine dietary triggers differs by migraine aura status and attack frequency, a pattern not found for non-migraine headache.
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... IgG antibodies to food antigens are often present in healthy individuals and are generally considered to be part of the normal immune response to food allergens ( Barnes, 1995). Food intolerance has been associated with a myriad of chronic symptoms including headaches (Rees et al., 2005), intestinal and skin symptoms (Sampson and McCaskill, 1985), behavioural changes and respiratory disorders ( Pelikan, 1988). Currently, the best accepted method for diagnosing and confirming food intolerance is empirical, by elimination diet and subsequent challenge (Radcliffe, 2002). ...
Purpose
– To provide evidence that elimination diet based on food‐specific IgG test results is an effective, reliable and valid aid to the management of chronic medical conditions.
Design/methodology/approach
– A postal survey, commissioned by Allergy UK, was carried out with 5,286 subjects reporting a wide range of chronic medical conditions, who had taken a food‐specific IgG enzyme‐linked immunosorbant assay blood test. Questionnaires, issued three months after the results, were analysed to investigate the effect of eliminating the foods identified by the test. To check for response bias, a separate group of patients who had not responded were interviewed by telephone. The analysis and reporting of the data was carried out at the University of York.Findings – Of patients who rigorously followed the diet 75.8 per cent had a noticeable improvement in their condition. Of patients who benefited from following the recommendations 68.2 per cent felt the benefit within three weeks. Those who reported more than one condition were more likely to report noticeable improvement. 81.5 per cent of those that dieted rigorously and reported three or more co‐morbidities showed noticeable improvement in their condition. For those who dieted rigorously and reported high benefit, 92.3 per cent noticed a return of symptoms on reintroduction of the offending foods.
Originality/value
– These data provide evidence for the use of elimination diet based on food‐specific IgG blood test results as an aid to management of the symptoms of a range of chronic medical conditions.
... 4,5 Immunoglobulin (IgG) antibodies against various food antigens have been reported to be associated with migraine. 6 Accordingly, consumption of IgG-reactive food elimination diets for a specific period provided decrease in headache attacks and significant improvement in symptoms. 1 Irritable bowel syndrome (IBS) is a multifactorial condition involving a number of different mechanisms. ...
To evaluate therapeutic potential of the immunoglobulin G (IgG)-based elimination diet among migraine patients with irritable bowel syndrome (IBS).
Food elimination has been suggested as an effective and inexpensive therapeutic strategy in patients with migraine and concomitant IBS in the past studies.
A total of 21 patients (mean [standard deviation] age: 38.0 [11.2] years; 85.7% females) diagnosed with migraine and IBS were included in this double-blind, randomized, controlled, cross-over clinical trial composed of baseline (usual diet), first diet (elimination or provocation diets), and second diet (interchange of elimination or provocations diets) phases and 4 visits.
IgG antibody tests against 270 food allergens revealed mean (standard deviation) reaction count to be 23.1 (14.1). Compared with baseline levels, elimination diet per se was associated with significant reductions in attack count (4.8 [2.1] vs 2.7 [2.0]; P < .001), maximum attack duration (2.6 [0.6] vs 1.4 [1.1] days; P < .001), mean attack duration (1.8 [0.5] vs 1.1 [0.8] days; P < .01), maximum attack severity (visual analog scale 8.5 [1.4] vs visual analog scale 6.6 [3.3]; P < .001), and number of attacks with acute medication (4.0 [1.5] vs 1.9 [1.8]; P < .001). There was a significant reduction in pain-bloating severity (1.8 [1.3] vs 3.2 [0.8]; P < .05), pain-bloating within the last 10 days (3.2 [2.8] vs 5.5 [3.1]; P < .05), and improvement obtained in quality of life (3.6 [1.4] vs 2.9 [1.0]; P < .05) by the elimination diet as compared with provocation diet.
Our findings indicate that food elimination based on IgG antibodies in migraine patients who suffer from concomitant IBS may effectively reduce symptoms from both disorders with possible positive impact on the quality of life of the patients as well as potential savings to the health-care system.
Die Bezeichnung Nahrungsmittelunverträglichkeit (NMU) stellt den Oberbegriff für alle reproduzierbaren Reaktionen des menschlichen Organismus dar, die regelmäßig oder chronisch im Zusammenhang mit dem Verzehr eines definierten Nahrungsmittels auftreten. In der Regel führt die Aufnahme dieser Nahrungsmittel zu einer lokalen Symptomatik im Verdauungstrakt, die Unverträglichkeit kann aber auch andere Organe wie die Haut, die Atemwege oder das Nervensystem betreffen oder sich als systemische Befindlichkeitsstörung äußern. Aus Sicht des Laien werden gemeinhin alle belastenden Reaktionen, die mit dem Verzehr von Nahrungsmitteln in Verbindung gebracht werden, als Allergien bezeichnet. Diese Einschätzung bedeutet allerdings oftmals eine Fehlinterpretation, weil auch andere nahrungsmittelassoziierte Pathomechanismen als die klassische IgE-vermittelte Nahrungsmittelallergie für das Auftreten der Symptome verantwortlich sein können. Leider verwenden auch Therapeuten häufig die Begriffe „Unverträglichkeit“, „Allergie“, oder „Intoleranz“ irrtümlicherweise synonym und verursachen dadurch Verwirrung beim Patienten.
Die Vielfältigkeit der verschiedenen Formen einer NMU lässt die exakte Diagnosefindung manches Mal der Suche nach der berühmten Nadel im Heuhaufen gleichen. Mit einiger allergologischer und ernährungstherapeutischer Erfahrung kann sich jedoch die Ursachenforschung einer NMU auch wie das gekonnte Zusammenfügen eines Mosaiks aus vielen kleinen Informationen gestalten. In diesem Sinne basiert die Diagnosefindung bestenfalls auf vier Säulen: die Krankengeschichte (inkl. Ernährungsanamnese), aussagekräftige diagnostische Testverfahren (inkl. Nachweis der klinischen Relevanz), die diagnostische Eliminationsdiät, eine nachfolgende Provokation (Reexposition).
Aus labormedizinischer Sicht ist es wichtig, dem Therapeuten ein strukturiertes und zielgerichtetes differentialdiagnostisches Regime zur Beurteilung fraglicher NMU an die Hand zu geben. Im Folgenden sollen dem geneigten Leser die verschiedenen Möglichkeiten einer NMU vorgestellt und jeweils dafür geeignete labordiagnostische Tests empfohlen werden.
A dverse food reactions are generally classified as food allergy and food intolerance. 1 Whereas food allergy is typically mediated by IgE anti-bodies, food intolerance is mediated by IgG class of antibodies. 2-4 The prevalence of food intolerance is believed to be 5-20% of the general population; however , the true prevalence of food intolerance remains unknown due to insufficient data. 5 IgG-mediated food intolerance is believed to be caused by increased gut permeability, which permits food substances to gain
Abstract There are studies reporting primary headaches to be associated with gastrointestinal disorders, and some report resolution of headache following the treatment of the associated gastrointestinal disorder. Headache disorders are classified by The International Headache Society as primary or secondary; however, among the secondary head-aches, those attributed to gastrointestinal disorders are not appreciated. Therefore, we aimed to review the litera-ture to provide evidence for headaches, which originate from the gastrointestinal system. Gastrointestinal disor-ders that are reported to be associated with primary headaches include dyspepsia, gastro esophageal reflux disease (GERD), constipation, functional abdominal pain, inflammatory bowel syndrome (IBS), inflammatory bowel disor-ders (IBD), celiac disease, and helicobacter pylori (H. Pylori) infection. Some studies have demonstrated remission or improvement of headache following the treatment of the accompanying gastrointestinal disorders. Hypotheses explaining this association are considered to be central sensitization and parasympathetic referred pain, serotonin pathways, autonomic nervous system dysfunction, systemic vasculopathy, and food allergy. Traditional Persian physicians, namely Ebn-e-Sina (Avicenna) and Râzi (Rhazes) believed in a type of headache originating from disor-ders of the stomach and named it as an individual entity, the "Participatory Headache of Gastric Origin". We suggest providing a unique diagnostic entity for headaches coexisting with any gastrointestinal abnormality that are im-proved or cured along with the treatment of the gastrointestinal disorder. Key words: Headache; migraine disorders; gastrointestinal diseases; medicine, traditional; headache disorders, primary; headache disorders, secondary
Objective:
To report a migraineur with osmophobia and trigger to garlic and onion aroma.
Background:
While odors serve as a trigger in 70% of migraineurs, alliaceous aromas have been described only rarely. Furthermore, nor has more than one type of alliaceous odor acted as a trigger in the same individual. Neither has migraine with aura been described as precipitated by such aromas. A patient experiencing migraines with aura, triggered almost exclusively by alliaceous aromas, is described.
Methods:
Case study:
32-year-old woman; 5 years previously felt nasal pruritis upon eating a red onion dip. Shortly thereafter, the mere aroma of raw onions caused a sensation of her throat closing along with an associated panic attack. Over the intervening years, upon exposure to onions and garlic aroma she experienced a fortification spectra and visual entopia, followed by a bipareital, crushing level 10/10 headache, burning eyes and nose, lacrimation, perioral paresthesias, generalized pruritis, nausea, fatigue, sore throat, dysarthria, confusion, dyspnea, palpitations, presyncopal sensations, hand spasms, tongue soreness, neck pain, phonophobia, and photophobia. These would persist for 1 hour after leaving the aroma. She was unresponsive to medication and would wear a surgical mask when out. The patient also experienced chemosensory complaints: dysosmias every few months; phantosmias of food or cleaning products every month for a minute of level 5/10 intensity; pallinosmia of onion or garlic odor for 30 minutes after exposure; and metallic pallinugeusia after eating with metal utensils.
Results:
Neurological exam normal except for bilateral positive Hoffman reflexes.
Chemosensory testing:
Quick Smell Identification Test 3/3 and Brief Smell Identification Test 12/12 were normal. Magnetic resonance imaging and computed tomography with and without contrast normal. Allergy skin test was positive for garlic and onion. Nose plug and counter stimulation with peppermint prevented the onset of headaches and associated symptoms.
Conclusion:
This is the first report of migraines with aura triggered by more than one alliaceous compound in the same individual. Possible mechanisms include odor induced, emotional change, vasomotor instability, trigeminal-induced neurogenic inflammation, and allergic response. In alliaceous and odor-induced migraines, a trial of counter stimulation and nose plugs is warranted.
Purpose
Evidence has suggested that elimination diets based on food‐specific IgG measurement can lead to improvements in chronic ill health symptoms. This paper aims to review the evidence from studies on food‐specific IgG measurement and dietary change.
Design/methodology/approach
A literature review of studies on the putative role for food‐specific IgG‐based elimination diets was undertaken.
Findings
The use of fully standardised clinically evaluated food‐specific IgG tests as a basis for elimination diet could lead to a considerable improvement in many patients' quality of life.
Originality/value
This unique review captures evidence for a viable alternative to the time consuming and expensive elimination diet/food challenge approach.
It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks in this randomised, double blind, cross-over, headache-diary based trial on 30 patients diagnosed with migraine without aura.
Following a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA. Then, the patients were randomised to a 6-week diet either excluding or including specific foods with raised IgG antibodies, individually. Following a 2-week diet-free interval after the first diet period, the same patients were given the opposite 6-week diet (provocation diet following elimination diet or vice versa). Patients and their physicians were blinded to IgG test results and the type of diet (provocation or elimination). Primary parameters were number of headache days and migraine attack count. Of 30 patients, 28 were female and 2 were male, aged 19-52 years (mean, 35 +/- 10 years).
The average count of reactions with abnormally high titre was 24 +/- 11 against 266 foods. Compared to baseline, there was a statistically significant reduction in the number of headache days (from 10.5 +/- 4.4 to 7.5 +/- 3.7; P < 0.001) and number of migraine attacks (from 9.0 +/- 4.4 to 6.2 +/- 3.8; P < 0.001) in the elimination diet period.
This is the first randomised, cross-over study in migraineurs, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.
Migraine and other severe headaches can cause suffering and reduce functioning and productivity. Patients are the best source of information about such impact.
To develop a new short form (HIT-6) for assessing the impact of headaches that has broad content coverage but is brief as well as reliable and valid enough to use in screening and monitoring patients in clinical research and practice.
HIT-6 items were selected from an existing item pool of 54 items and from 35 items suggested by clinicians. Items were selected and modified based on content validity, item response theory (IRT) information functions, item internal consistency, distributions of scores, clinical validity, and linguistic analyses. The HIT-6 was evaluated in an Internet-based survey of headache sufferers (n = 1103) who were members of America Online (AOL). After 14 days, 540 participated in a follow-up survey.
HIT-6 covers six content categories represented in widely used surveys of headache impact. Internal consistency, alternate forms, and test-retest reliability estimates of HIT-6 were 0.89, 0.90, and 0.80, respectively. Individual patient score confidence intervals (95%) of app. +/-5 were observed for 88% of all respondents. In tests of validity in discriminating across diagnostic and headache severity groups, relative validity (RV) coefficients of 0.82 and 1.00 were observed for HIT-6, in comparison with the Total Score. Patient-level classifications based in HIT-6 were accurate 88.7% of the time at the recommended cut-off score for a probability of migraine diagnosis. HIT-6 was responsive to self-reported changes in headache impact.
The IRT model estimated for a 'pool' of items from widely used measures of headache impact was useful in constructing an efficient, reliable, and valid 'static' short form (HIT-6) for use in screening and monitoring patient outcomes.
Patients with irritable bowel syndrome (IBS) often feel they have some form of dietary intolerance and frequently try exclusion diets. Tests attempting to predict food sensitivity in IBS have been disappointing but none has utilised IgG antibodies.
To assess the therapeutic potential of dietary elimination based on the presence of IgG antibodies to food.
A total of 150 outpatients with IBS were randomised to receive, for three months, either a diet excluding all foods to which they had raised IgG antibodies (enzyme linked immunosorbant assay test) or a sham diet excluding the same number of foods but not those to which they had antibodies.
Primary outcome measures were change in IBS symptom severity and global rating scores. Non-colonic symptomatology, quality of life, and anxiety/depression were secondary outcomes. Intention to treat analysis was undertaken using a generalised linear model.
After 12 weeks, the true diet resulted in a 10% greater reduction in symptom score than the sham diet (mean difference 39 (95% confidence intervals (CI) 5-72); p = 0.024) with this value increasing to 26% in fully compliant patients (difference 98 (95% CI 52-144); p<0.001). Global rating also significantly improved in the true diet group as a whole (p = 0.048, NNT = 9) and even more in compliant patients (p = 0.006, NNT = 2.5). All other outcomes showed trends favouring the true diet. Relaxing the diet led to a 24% greater deterioration in symptoms in those on the true diet (difference 52 (95% CI 18-88); p = 0.003).
Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.
Because serotonin, released from platelets, has been suggested to initiate migraine, a decreased platelet serotonin content, attained by a reduced intake of serotonin and the serotonin precursor tryptophan, might be beneficial. In the brain, however, increased serotonin levels, achieved by a high carbohydrate intake, are probably favourable. Seven migraine patients (four with classic, three with common migraine) were placed on a carbohydrate-rich diet, low in protein-tryptophan. Three of the four classic migraineurs, but none of the common migraineurs, noted improvement in their migraine. Platelet serotonin uptake was within the normal range both before and at the end of the diet period. The apparent positive effect in the classic migraineurs could be due to a reduced intake of migraine-precipitating foods and/or increased brain serotonin levels.
Five hundred seventy-seven consecutive patients attending the Princess Margaret Migraine Clinic from 1989 to 1991 have been questioned about dietary precipitants of their headaches. Four hundred twenty-nine patients had migraine, of which 16.5% reported that headaches could be precipitated by cheese or chocolate, and nearly always both. Of the migraine patients, 18.4% reported sensitivity to all alcoholic drinks, while another 11.8% were sensitive to red wine but not to white wine; 28% of the migrainous patients reported that beer would precipitate headaches. There was a definite statistical association between sensitivity to cheese/chocolate and to red wine (P < 0.001) and also to beer (P < 0.001), but none between diet sensitivity and sensitivity to alcoholic drinks in general. None of 40 patients with tension headache (diagnosed by International Headache Society criteria) reported sensitivity to foods, and only one was sensitive to alcoholic drinks. The prevalence of sensitivity among 46 patients with some migrainous features was intermediate between the migraine and tension headache categories. It is concluded that cheese/chocolate and red wine sensitivity, in particular, have closely related mechanisms, in some way related more to migraine than to more chronic tension-type headache, while quite separate mechanisms play a major role in sensitivity to alcoholic drinks in general.
The physiopathology of migraine is still largely unknown. The author reviews the changes of immunoglobulins (especially IgE), complement fractions, mediators, cytokines and inflammatory cells published in the literature. An IgE mechanism seems to be unimportant in the process of food-induced migraine. Increasing arguments for the reciprocal modulation of the brain and immune system are also reviewed as the close links between interleukins and the sensory neuromediators. However, it is presently too early to implicate a definite immunological mechanism in the physiopathogeny of migraine.
A provocative double-blind study of headache was performed using chocolate as the active agent and carob as the placebo. The chocolate and carob samples were formulated to duplicate products used in an earlier study (1) in which strong differential effects between the ability of chocolate and carob to trigger headache in migraine were shown. Sixty-three women with chronic headache (50% migraine, 37.5% tension-type, 12.5% combined migraine and tension-type) participated in the study. After 2 weeks of following a diet that restricted vasoactive amine-rich foods, each subject underwent double-blinded provocative trials with two samples of chocolate and two of carob presented in random order. Diaries were maintained by the subjects throughout the study, monitoring diet and headache. The results demonstrated that chocolate was not more likely to provoke headache than was carob in any of the headache diagnostic groups (chi2(2)=0.36, p=0.83). Interestingly, these results were independent of subjects' beliefs regarding the role of chocolate in the instigation of headache (chi2(1)=0.73, p=0.39). Headache diagnosis and the concomitant use of additional vasoactive amine-containing foods were also not associated with chocolate acting as a headache trigger. Thus, contrary to the commonly held belief of patients and physicians, chocolate does not appear to play a significant role in triggering headaches in typical migraine, tension-type, or combined headache sufferers.
Migraine headaches are a common, debilitating syndrome causing untold suffering and loss of productivity. A review of the literature indicates that high levels of blood lipids and high levels of free fatty acids are among the important factors involved in triggering migraine headaches. Under these conditions, platelet aggregability, which is associated with decreased serotonin and heightened prostaglandin levels, is increased. This leads to vasodilation, the immediate precursor of migraine headache. A high-fat diet is one factor that may directly affect this process. This study, undertaken to evaluate the impact of dietary fat intake on incidence and severity of migraine headache, was conducted over a 12-week period on 54 previously diagnosed migraine headache patients. During the first 28 days, the study subjects recorded all food consumption in a diet diary and maintained a headache diary. At the conclusion of this 28-day baseline period, subjects were individually counseled to limit fat intake to no more than 20 g/day. A 28-day run-in period was allowed for adaptation to the low-fat diet. Results are reported on the final 28-day postintervention period. Subjects significantly decreased the ingestion of dietary fat in grams between baseline (mean 65.9 g/day, p < 0.0001) and the postintervention period (mean 27.8 g/day). The decreased dietary fat intervention was associated with statistically significant decreases in headache frequency, intensity, duration, and medication intake (all p < 0.0001). There was a significant positive correlation between baseline dietary fat intake and headache frequency (r = .44, p = 0.02). This study indicates that a low-fat diet can reduce headache frequency, intensity, and duration and medication intake.
In Western countries, recent community-based studies of migraine prevalence using standardized diagnostic criteria give 1-year prevalence estimates of around 10 to 12%. The prevalence of migraine is age- and gender-dependent. Age at onset of migraine is earlier in boys than in girls. Migraine is two to three times more common in women than in men, with peak prevalence occurring during mid-life in both sexes. Current evidence also indicates that migraine prevalence is higher in Caucasians than in Africans or Asians. In some migraineurs, attacks may be frequent or prolonged, leading to considerable pain and disability. There has been much debate over predisposing factors, which are not sufficient by themselves to cause an attack, as well as precipitants, which immediately precede the attack. However, convincing data are lacking for most of these. Significant associations have been reported between migraine and certain psychiatric disorders, epilepsy, and stroke in women under the age of 45. These findings demonstrate that migraine is common, has a substantial impact on sufferers, and may be associated with other disorders.
Mechanisms underlying migraine precipitation are largely unknown. A role of the immune system in migraine precipitation is a matter of debate because of the association of atopic disorders and migraine. Recently, it was demonstrated that migraineurs benefit from eradication of a Helicobacter pylori infection, which substantiates a possible role for (sub-clinical) infections in precipitation of migraine. Since 1966, about 45 clinical investigations have reported on alterations of immune function in migraine patients, which we present in this review. Changes of serum levels of complement and immunoglobulins, histamine, cytokines and immune cells were found in some of these studies but in most cases not corroborated by others. Migraineurs suffering from comorbid atopic disorders show elevated plasma IgE levels but not patients without a type I hypersensitivity. Histamine plasma levels are chronically elevated in migraineurs, and interictally decreased lymphocyte phagocytotic function and increased plasma tumor necrosis factor alpha (TNFalpha) levels were found, and may be related to increased infection susceptibility. The cause of this increased susceptibility is unclear but most likely is a result of chronic stress, a well-known suppressor of the immune system. Stress relief enhances immune activity and triggers a burst of circulating vasoactive compounds that function as mediators of inflammation and potential precipitators of a migraine attack in vulnerable subjects. In conclusion, in the clinical literature of the past decades, there is no clear-cut evidence of an immune dysfunction in migraineurs, but we cannot totally exclude the possibility of an altered immune function in migraineurs. Discrepancies in the literature most likely are caused by the divergent patterns of sample collection relative to the time of the attack. We propose stringent definition of sample collection times for future studies of immune function in migraine patients.
Diet can play an important role in the precipitation of headaches in children and adolescents with migraine. The diet factor in pediatric migraine is frequently neglected in favor of preventive drug therapy. The list of foods, beverages, and additives that trigger migraine includes cheese, chocolate, citrus fruits, hot dogs, monosodium glutamate, aspartame, fatty foods, ice cream, caffeine withdrawal, and alcoholic drinks, especially red wine and beer. Underage drinking is a significant potential cause of recurrent headache in today's adolescent patients. Tyramine, phenylethylamine, histamine, nitrites, and sulfites are involved in the mechanism of food intolerance headache. Immunoglobulin E-mediated food allergy is an infrequent cause. Dietary triggers affect phases of the migraine process by influencing release of serotonin and norepinephrine, causing vasoconstriction or vasodilatation, or by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. Treatment begins with a headache and diet diary and the selective avoidance of foods presumed to trigger attacks. A universal migraine diet with simultaneous elimination of all potential food triggers is generally not advised in practice. A well-balanced diet is encouraged, with avoidance of fasting or skipped meals. Long-term prophylactic drug therapy is appropriate only after exclusion of headache-precipitating trigger factors, including dietary factors.
Patient-centered strategies for effective management of migraine
- Aw Bedell
- Rk Cady
- Diamond
Bedell AW, Cady RK, Diamond ML et al. Patient-centered strategies for effective management of migraine. Springfield, Missouri: Primary Care Network, 2000
Migraine: diagnosis and assessment of disability CrossRef links are available in the online published version of this paper: http://www.cmrojournal.com Paper HC-0047_2, Accepted for publication: 27 January
- Rb Lipton
- Pj Goadsby
- Sawyer
Lipton RB, Goadsby PJ, Sawyer JPC et al. Migraine: diagnosis and assessment of disability. Rev Contemp Pharmacother 2000;11:63-73 CrossRef links are available in the online published version of this paper: http://www.cmrojournal.com Paper HC-0047_2, Accepted for publication: 27 January 2005 Published Online: 18 February 2005 doi:10.1185/174234305X14962
Independent audit of IgG food intolerance tested patient survey
- Ta Sheldon
Sheldon TA. Independent audit of IgG food intolerance tested
patient survey. British Allergy Foundation, 2000