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J Lab Med 2010;34(4) 2010 by Walter de Gruyter •Berlin •New York. DOI 10.1515/JLM.2010.033et
2010/0331
Article in press - uncorrected proof
Allergy and Autoimmunity Redaktion: H. Renz
Testing of IgG and IgG
4
to foods is not recommended
Position of the German Society of Allergy and Clinical Immunology
(DGAKI)
a
, the Physician’s Society of German Allergists (A
¨DA) and the
Society of Pediatric Allergy and Environmental Medicine (GPA), the
Austrian Society of Allergy and Immunology (O
¨GAI) and the Swiss
Society of Allergy and Immunology (SGAI) after Adoption of the Task
Force Report
b
of the European Academy of Allergy and Clinical
Immunology (EAACI)
Jo¨rg Kleine-Tebbe
1,
*, Imke Reese
2
, Barbara K.
Ballmer-Weber
3
, Kirsten Beyer
4
, Stephan Erdmann
5
,
Thomas Fuchs
6
, Margot Henzgen
7
, Annice
Heratizadeh
8
, Isidor Huttegger
9
, Lothar Ja¨ger
10
, Uta
Jappe
11
, Ute Lepp
12
, Bodo Niggemann
13
, Martin
Raithel
14
, Joachim Saloga
15
, Zsolt Sze´pfalusi
16
,
Torsten Zuberbier
17
, Thomas Werfel
8
, Stefan Vieths
11
and Margitta Worm
17
1
Allergie- und Asthma-Zentrum Westend, Berlin, Germany
2
Erna¨hrungsberatung, Mu¨ nchen, Germany
3
Dermatologische Klinik, Universita¨tsSpital Zu¨ rich, Zu¨rich,
Switzerland
4
Klinik fu¨r Pa¨diatrie m. S. Pneumologie und Immunologie,
Charite´-Universita¨ tsmedizin Berlin, Germany
5
Praxis fu¨ r Dermatologie, Bergisch-Gladbach, Germany
6
Abteilung Dermatologie und Venerologie,
Universita¨tsmedizin Go¨ ttingen, Go¨ttingen, Germany
7
Pneumologie und Allergologie, Klinik fu¨ r Innere Medizin
I, Friedrich-Schiller-Universita¨t, Jena, Germany
8
Klinik und Poliklinik fu¨ r Dermatologie und Venerologie,
Medizinische Hochschule Hannover, Hannover, Germany
9
Universita¨tsklinik fu¨r Kinder- und Jugendheilkunde,
Paracelsus Medizinische Privatuniversita¨t, Salzburger
Landeskliniken, Salzburg, O
¨sterreich
10
Jena, Germany
11
Abteilung Allergologie, Paul-Ehrlich-Institut, Langen,
Langen, Germany
12
Herz-Lungen-Praxis Stade, Stade, Germany
a
Translated and commented by the authors of the DGAKI Food
Allergy Working Group. The original German online version is
available at: http://www.reference-global.com/toc/labm/34/4.
b
Coordinated by the EAACI Interest Group Allergy Diagnosis and
the EAACI Interest Group Food Allergy.
*Correspondence: Priv.-Doz. Dr. Jo¨ rg Kleine-Tebbe, Allergie-
und Asthma-Zentrum Westend, Spandauer Damm 130, Haus 9,
14050 Berlin, Germany
Tel.: q030/30202910
Fax: q030/30202920
E-Mail: kleine-tebbe@allergie-experten.de
13
Pa¨diatrische Allergologie und Pneumologie, Hedwig-von-
Rittberg-Zentrum, DRK-Kliniken Westend, Berlin,
Germany
14
Gastroenterologie, Pneumologie und Endokrinologie,
Medizinische Klinik 1, Universita¨t Erlangen, Erlangen,
Germany
15
Universita¨tshautklinik, Johannes-Gutenberg-Universita¨t,
Mainz, Mainz, Germany
16
Universita¨tsklinik fu¨r Kinder- und Jugendheilkunde,
Medizinische Universita¨t Wien, Vienna, Austria
17
Allergie-Centrum-Charite´, Klinik fu¨ r Dermatologie,
Venerologie und Allergologie, Charite´ -Universita¨tsmedizin
Berlin, Berlin, Germany
Preambel
The position of the European Academy of Allergy and Clin-
ical Immunology (EAACI) on immunoglobulin G (IgG) test-
ing to foods w1xhas been well received and its entire content
has been adopted as a translated version by the German,
Austrian and Swiss Allergy Societies.
Due to current scientific understanding IgG(4) antibodies
to foods should not be misinterpreted as an indicator for
disease causing mechanisms but rather as a sign of a normal
(physiological) human immune response after repeated expo-
sure to food components. Therefore, the allergen specific
measurement of IgG or IgG4 antibodies to foods is useless
and is definitely not recommended for the work-up and diag-
nosis of various types of food hypersensitivity w2–5x.
This is also true for chronic diseases and health com-
plaints, falsely believed to be caused by an underlying food
hypersensitivity, which has not yet been diagnosed. These
health problems include chronic inflammatory bowel dis-
eases like irritable bowel disease, Crohn’s disease, colitis
ulcerosa, inflammatory skin diseases like acne, atopic ecze-
ma, psoriasis and general symptoms like migraine, chronic
2Kleine-Tebbe et al.: Preambel IgG-testing
Article in press - uncorrected proof
fatigue, obesity and numerous others. The commonly used
argument for IgG measurements often falsely exchanges
cause and effect. More specifically, elevated physiological
IgG concentrations to foods are often blamed as a cause for
inflammatory responses, instead of being interpreted as a
consequence of such pathology.
For none of these above-mentioned diseases and health
complaints has scientific evidence based on valid, controlled
studies been established, indicating that the presence of
serum IgG or IgG4 antibodies to foods might have a diag-
nostic value or could represent a pathological finding. Meas-
urements of IgG antibodies to foods are therefore not
recommended. This conclusion is not necessarily based on
technical assay flaws, but rather on rejecting the misleading
interpretations of such test results, which are often abused as
a reasoning to recommend unjustified and frequently drastic
diets. These diets will increase the pressure of suffering,
decrease the quality of life, promote uncertainty and even
place these subjects at further health risks.
At present there is no indication for IgG or IgG4 antibody
tests to food items. This type of diagnostic procedure is
strictly not recommened due to a lack of evidence from prop-
erly controlled studies. The authors speaking for the German-
language allergy societies, therefore adopt the European
position in its present form as outlined above.
References
1. Stapel SO, Asero R, Ballmer-Weber BK, Knol EF, Strobel S,
Vieths S, et al., EAACI Task Force. Testing for IgG
4
against
foods is not recommended as a diagnostic tool: EAACI Task
Force Report. Allergy 2008;63:793–6.
2. Kleine-Tebbe J, Ballmer-Weber BK, Beyer K, Erdmann S, Fuchs
T, Henzgen M, et al. In-vitro-Diagnostik und molekulare Grund-
lagen von IgE-vermittelten Nahrungsmittelallergien. Leitlinie
von DGAKI, A
¨DA, GPA, O
¨GAI und SGAI. Allergo J 2009;
18:132–46.
3. Kleine-Tebbe J, Fuchs T, Lepp U, Niggemann B, Saloga J, Vieluf
I, et al. In-vitro-Diagnostik von Nahrungsmittel-Allergien. Aller-
go J 2001;10:333–9.
4. Renz H, Becker W-M, Bufe A, Kleine-Tebbe J, Raulf-Heimsoth
M, Saloga J, et al. In-vitro-Allergiediagnostik. Positionspapier
der Deutschen Gesellschaft fu¨r Allergologie und klinische Immu-
nologie (DGAKI). Arbeitsgruppe ,,In-vitro-Allergiediagnostik‘‘
der Sektion Immunologie. Allergo J 2002;11:492–506.
5. Renz H, Biedermann T, Bufe A, Eberlein B, Jappe U, Ollert M,
et al. In-vitro-Allergiediagnostik. Leitlinie der Deutschen
Gesellschaft fu¨ r Allergologie und klinische Immunologie (DGA-
KI) unter Beteiligung des A
¨rzteverbandes Deutscher Allergolo-
gen (A
¨DA), der Gesellschaft fu¨r Pa¨diatrische Allerlogie und
Umweltmedizin (GPA) und der Deutschen Dermatologische
Gesellschaft (DDG). Allergo J 2010;19:110–28. (www.
uniduesseldorf.de/AWMF/II/061-017.htm).
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