Intrinsic Atopic Dermatitis: Titration of Precipitins in the Screening of Food Allergens for Prescription of Elimination Diets and Desensitization Strategies

Abstract

Background: The diagnosis of non-IgE mediated food allergies may be a complex puzzle when there is no start point to establish an elimination diet to allow a clear clinical field to initiate diagnostic Oral Food Challenges tests.
 Objective: To evaluate the opportunity of the tube titration of precipitins to select food allergens to proceed with elimination diets to assist the diagnosis and management of adult patients with Food Allergy manifested as Intrinsic Atopic Dermatitis (IAD).
 Methods: The tube titration of specific precipitins against anamnesis-chosen food allergens were performed in 64 IAD patients and their titers were associated with an Improvement Verbal Scale Rate (IVSR) of the patient’s perception of the benefits of the Precipitins-based Elimination Diet (PED) performed with these specific food allergens, as well correlated with their positive or negative perception of the impairment of symptoms after the reintroduction of the Symptom-Related Food Allergen (SRFA).
 Results: In most cases, the PED contributed to a significant clinical improvement that allowed the patients to evaluate the individual effect of the reintroduction of each food allergen on their diets. There was a significant positive correlation coefficient between the titers of the food-specific titration of precipitins and the percentage of positive SRFA (Pearson r = 0.91; p-value = 0.0004). 
 Conclusion: The semiquantitative titration of specific precipitins against food allergens is a promising triage test to select food allergens to proceed with elimination diets to support the diagnosis and management of non-IgE mediated Food Allergy in patients with Intrinsic Atopic Dermatitis.

Anti-Saccharomyces cerevisiae Antibodies (ASCA) Researched by Tube Precipitins are Elevated in Patients with Dermatologic and Gastrointestinal Non-Ige-Mediated Hypersensitivity

“…This suggests that patients with exclusively respiratory symptoms diagnosed as non-IgEmediated rhinitis and/or non-IgE-mediated asthma present significantly less humoral immunoreactivity against S. cerevisiae than patients with non-IgE-mediated food allergy and patients diagnosed with as intrinsic atopic dermatitis and/or non-IgE-mediated urticaria. In this discussion, two types of interpretations cannot be neglected; to wit, the perspective that the presence of ASCA may be an unspecific marker of intestinal hyperpermeability in patients with inflammatory intestinal conditions; and the perspective that ASCA may be contributing to patient's symptoms through the participation in Gell and Coomb's types II and/or type III hypersensitivity reactions by mean of cell-bound antibodies and antigen-antibody complexes, respectively, when the S. cerevisiae allergens are been ingested in sufficient amounts [35], [62].…”

“…Group R was composed of 36 patients with respiratory symptoms diagnosed as non-IgE-mediated rhinitis and/or non-IgE-mediated asthma (17 male; 18-87 years old; mean age = 42.1 years, SD =18.4 years). The diagnosis of these conditions was done according to our previous publications [35]- [40]. All individuals had normalrange total IgE, non-detectable S. cerevisiae specific-IgE, and non-reactive skin tests against the S. cerevisiae extract.…”

“…The semi-quantitative tube titration of precipitins against the S. cerevisiae extract in a transparent solution was performed as previously reported [35]. Shortly, the patient's blood was collected in a clot-activator collecting tube.…”

Considering Intestinal Hyperpermeability and Immune-Inflammatory Metabolism in the Treatment of Food Allergy

“…Up to a certain limit, this situation does not produce any disturbance, however, in greater quantities, these circulating immune complexes can be deposited in organic tissues and produce inflammatory diseases mediated by the activation of the Complement System [30]. The search for these food-specific antibodies through precipitation tests has been one of the cornerstones of both Microbial Immunology and Allergology as medical sciences [31]- [35]. Intestinal hyperpermeability has recently been linked not only to food allergy but also to Metabolic Syndrome and Non-Alcoholic Fat Liver Disease, two interrelated inflammatory diseases that have emerged from the industrialized diet [36], [37].…”