Elimination Diet Effectively Treats Eosinophilic Esophagitis in Adults; Food Reintroduction Identifies Causative Factors.
Gastroenterology. 2012 Mar 3. Epub 2012 Mar 3. PMID: 22391333
Nirmala Gonsalves, Guang-Yu Yang, Bethany Doerfler, Sally Ritz, Anne M Ditto, Ikuo Hirano
Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
BACKGROUND & AIMS: Adults with eosinophilic esophagitis (EoE) typically present with dysphagia and food impaction. A 6-food elimination diet (SFED) is effective in children with EoE. We assessed the effects of the SFED followed by food reintroduction on the histologic response, symptoms, and quality of life in adults with EoE. METHODS: At the start of the study, 50 adults with EoE underwent esophagogastroduodenoscopies (EGDs), biopsies, and skin-prick tests for food and aeroallergens. After 6 weeks of SFED, patients underwent repeat EGD and biopsies. Histologic responders, defined by≤5 eosinophils/high-power field (eos/hpf) (n = 32), underwent systematic reintroduction of foods followed by EGD and biopsies (n = 20). Symptom and quality of life scores were determined before and after SFED. RESULTS: Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%). The mean peak eosinophil counts in the proximal esophagus were 34 eos/hpf and 8 eos/hpf, before and after the SFED, and 44 eos/hpf and 13 eos/hpf in the distal esophagus, respectively (P<.0001). After the SFED, 64% of patients had peak counts≤5 eos/hpf and 70% had peak counts of ≤10 eos/hpf. Symptom scores decreased in 94% (P<.0001). After food reintroduction, esophageal eosinophil counts returned to pretreatment values (P<.0001). Based on reintroduction, the foods most frequently associated with EoE were wheat (60% of cases) and milk (50% of cases). Skin-prick testing predicted only 13% of foods associated with EoE. CONCLUSIONS: An elimination diet significantly improves symptoms and reduces endoscopic and histopathologic features of EoE in adults. Food reintroduction re-initiated features of EoE in patients, indicating a role for food allergens in its pathogenesis. Foods that activated EoE were identified by systematic reintroduction analysis but not by skin-prick tests.
Article Published Date : Mar 02, 2012
Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimination diet protocol.
J Altern Complement Med. 2010 Jul;16(7):807-9. PMID: 20618099
BACKGROUND: Premature ovarian failure is diagnosed with a picture of amenorrhea, elevated follicle-stimulating hormone (FSH), and age under 40 years. Twenty percent (20%) of patients with premature ovarian failure have a concomitant autoimmune disease. Cases of premature ovarian failure associated with Sjögren syndrome have been reported in the literature.
PATIENT AND METHOD: We report a case of a 42-year-old white woman with Sjögren syndrome and premature ovarian failure who underwent a reversal of her premature ovarian failure and restoration of normal menses using an elimination diet protocol. The patient was diagnosed with her rheumatological condition in 2005 and started on disease-modifying antirheumatoid drugs, which were taken intermittently due to a concern over medication side-effects. Her menses became irregular at the time of initial diagnosis and finally ceased in 2006, with a dramatic elevation in her FSH, indicative of autoimmune-induced premature ovarian failure. In March 2009, she commenced an elimination diet protocol, eliminating gluten, beef, eggs, dairy products, nightshade vegetables, refined sugars, and citrus fruit for 4 months.
RESULTS: Her repeat laboratory tests after 4 months showed a drop in FSH from 88 to 6.5 and a drop in erythrocyte sedimentation rate from 40 to 16. Her menses also resumed and her rheumatological symptoms significantly improved.
CONCLUSIONS: It is hypothesized that the restoration of normal menses was caused by reduced inflammation in the ovarian tissue and supports the hypothesis that the gut immune system can influence autoimmune disease and inflammation.
Article Published Date : Jul 01, 2010
Dietary exclusions for improving established atopic eczema in adults and children: systematic review.
Allergy. 2009 Feb;64(2):258-64. PMID: 19178405
F Bath-Hextall, F M Delamere, H C Williams
Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
Atopic eczema is the most common inflammatory skin disease of childhood in developed countries. We performed a systematic review of randomized controlled trials to assess the effects of dietary exclusions for the treatment of established atopic eczema. Nine trials (421 participants) were included, most of which were poorly reported. Six were studies of egg and milk exclusion (n = 288), one was a study of few foods (n = 85) and two were studies of an elemental diet (n = 48). There appears to be no benefit of an egg- and milk-free diet in unselected participants with atopic eczema. There is also no evidence of benefit in the use of an elemental or few-foods diet in unselected cases of atopic eczema. There may be some benefit in using an egg-free diet in infants with suspected egg allergy who have positive specific IgE to eggs - one study found 51% of the children had a significant improvement in body surface area with the exclusion diet as compared with normal diet (95% CI 1.07-2.11) and change in surface area and severity score was significantly improved in the exclusion diet as compared with the normal diet at the end of 6 weeks (MD 5.50, 95% CI 0.19-10.81) and end of treatment (MD 6.10, 95% CI 0.06-12.14). Despite their frequent use, we find little good quality evidence to support the use of exclusion diets in atopic eczema.
Article Published Date : Feb 01, 2009
Wheat is a primary food trigger for migraines
Lancet. 1979 May 5 ;1(8123):966-9. PMID: 87628
60 migraine patients completed elimination diets after a 5-day period of withdrawal from their normal diet. 52 (87%) of these patients had been using oral contraceptive steroids, tobacco, and/or ergotamine for an average of 3 years, 22 years, and 7.4 years respectively. The commonest foods causing reactions were wheat (78%), orange (65%), eggs (45%), tea and coffee (40% each), chocolate and milk (37%) each), beef (35%), and corn, cane sugar, and yeast (33% each). When an average of ten common foods were avoided there was a dramatic fall in the number of headaches per month, 85% of patients becoming headache-free. The 25% of patients with hypertension became normotensive. Chemicals in the home environment can make this testing difficult for outpatients. Both immunological and non-immunological mechanisms may play a part in the pathogenesis of migraine caused by food intolerance.
Are antiepidermal transglutaminase antibodies titre correlated with dermatitis herpetiformis lesions during the disease follow-up?
G Ital Dermatol Venereol. 2018 Oct;153(5):609-612
Authors: Cozzani E, Pappalardo F, Gasparini G, Gallo F, Drago F, Parodi A
BACKGROUND: Dermatitis herpetiformis (DH) is characterized by the presence of antitissue transglutaminase (tTG) IgA antibodies in patient sera. In 2002, antiepidermal transglutaminase (eTG) antibodies have been identified in DH patients. Nowadays, their role is still controversial. The aim of this study was to evaluate any association between presence/absence of anti-eTG antibodies and cutaneous manifestations during the follow-up.
METHODS: Anti-eTG and anti-tTG antibodies from 13 patients on gluten-free diet (GFD) were studied during follow-up on ELISA. Cutaneous manifestations baseline differences among age, gender, anti-eTG IgA, anti-tTG IgA, and treatment groups were tested by the Wilcoxon Rank Sum and Fisher's Exact Test. In order to investigate the associations of cutaneous manifestations with age, gender, anti-eTG IgA, anti-tTG IgA, and treatment groups the mixed-effects (ME) model was performed. To test whether the cutaneous manifestations in treatment groups were different according to the anti-eTG levels, an exploratory interaction analysis was carried out using the ME Model.
RESULTS: Seven patients (53.85%) had an anti-eTG value greater than 22 AU/mL, while six (46.15%) were classified as anti-eTG value <22 AU/mL. A significant correlation between anti-eTG antibodies and cutaneous manifestations was observed. No significant cutaneous manifestations differences existed in treatment groups according to the anti-eTG antibodies levels. Anti-tTG antibodies resulted negative in every patient serum.
CONCLUSIONS: Anti-eTG antibodies persist much longer after the elimination of gluten from the patients diet compared to anti-tTG antibodies and seem to be a valid marker for monitoring the disease during the follow-up.
PMID: 27845514 [PubMed - indexed for MEDLINE]