Foods causing highest IgG Immune Response in Saudi Arabia

Abdulhameed F. Alkhateeb
Biomedical Engineering, Electrical & Computer Engineering Department,
Faculty of Engineering, King Abdulaziz University, Jeddah, Saudi Arabia.
Email: afalkhateeb@kau.edu.sa
Abstract

Background: Type III hypersensitivity caused by immunoglobulin G (IgG) to food has

been gaining a lot ofelicited plenty of scholarly attention in recent years. Opinions

remain divided regarding the linkage between IgG reactivity to food and chronic

inflammatory diseases.

Objective: To identify which foods caused thefoods that cause the most maximum

amount of IgG immune reaction in patients and to identify any difference due to age

and or gender.

Method: A pre-existing database for patients participated in the standardized panel of

268 foods ELISA-based IgG to conduct a food allergy test called ImuPro™ Complete.

Using established procedures from R-Biopharm AG using standard ELISA plates, the

samples were processed in ELISA Washer and Readermachines. R-Biopharm’s

analyzed readings using the standard ImuPro™ software.

Results: 1644 different patients (913 males and 731 females =55.5% male, 44.5%

female) were tested. IgG reactivity was predominant to in 8 foods (3%) in at least three-

quarters of the studied population. These included: Oats (82.5%), Barley (79.1%), Rye

(76.1%) Cow’s Milk (75%), Wheat (74.9%), Kamut (74.6%), Spelt (74.6%) and Gluten

(73.9%). Males and females had almost the same The IgG immune response of males

and females to each food type was almost the same. Children have a significantly

different IgG food profile than as compared to adults (p-value =0.024). Cow's milk

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caused the mostinduced the highest IgG immune response among children below five

years of age in (95.74%),, followed by oats in (92.2%).

Conclusion: To the best of our knowledge, globally, this is one of the largest studies

worldwide that involvesinvolving patients with IgG response to food. The top-most

foods were ‘mainstream’ foods consumed almost daily, which include gluten and dairy

products. There is a clear difference inA clear difference can be seen in the IgG immune

reaction to different food items between children and adults. Further investigations are

recommended into what determining the food characteristics and eating habits that

cause such anthese IgG immune responses.

Introduction

Allergy affects is known to affect millions of people worldwide. In this context,

Immunoglobulin E (IgE) allergy, also known as type I allergy, has been extensively

studied ([1], [2]). Allergies can be classified into two major groups:; inhalant and food Field Code Changed
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allergies. About 4-8% of the population suffers from food allergy [2], [3]. There is a
Field Code Changed

smaller subclass, which is the allergy toallergic to different drugs and medications, Field Code Changed

including some antibiotics.

Some Meanwhile, some foods cause an immune response in patients. This type of

response is categorized as Type III IgG food sensitivity, which is a new type of allergy

that has recently been gaining rapid recognition in thegained recognition among the

medical community. It affects about 50% of the population who are suffering from

chronic inflammatory diseases. The IgG-mediated allergy is a delayed-type of allergy,

with symptoms only appearing hours or up to 3 three days after the consumption of

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thefollowing the consumption of allergic food. This makes it practically impossible to

identify such food without a test. The objective of this study is to show which foods

caused the most IgG immune response in patients that did theunderwent the ImuPro

Complete test against all the 268 foods. The study also shows if there is aIn addition, it

aims to examine whether there is any difference between males and females and

between children and adults. It was observed thatAccording to the findings, most of the

foods that had this effect werecausing this response were mainstream foods. For this

reason, it is interesting to study the causes of this type immune response.

Motivation

When someone hasIt is notable that IgG I, IgG II, or IgG III reaction to certain kinds of

food, this reaction takesis found to occur every time the patient consumes the affecting

food place every time they eat the food. If they eat this food every day, then theAs a

matter of fact, everyday consumption of these foods will cause thisinduces this

inflammatory process every single day. This is where thewhen a positive IgG reaction

becomes something turns negative.

Moreover, it is not logical to think that it is normal for all of us toimpractical for any

individual to have antibodiespossess antibodies to all foods, including beef, chicken,

rice, potatoes, and vegetable. This is not the case at all. For instance,The fact remains

that less than 5% of people are allergic to beef, although most of us eat beef more

thanmillions of people all over the world consume beef once per week. We only have

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antibodies to a type of food when our immune systems react to it and tag it as something

dangerous. Every time we eat food that is positive forsomeone consumes food rich

in IgG, it induces anis known to induce an inflammatory reaction.

We can conclude from this that it isBased on this observation, it can be concluded that

important to determine determining which the foods that cause IgG allergies assumes

great importance in order to avoid such allergies.

Benefits

There are thousands of patients who have done theundergone and benefitted from the

IgG test and benefited from it. In general, they arethese patients are suffering from

chronic medical conditions like IBS [4], [5], migraine [5], [6], psoriasis, joint pains, Field Code Changed
Field Code Changed
Crohn's disease [7], [8], hypertension [9] asthma [10] to name a few. Many of them
Field Code Changed

have even taken medical treatments without positive outcomes. Many of these Field Code Changed
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patientsIn addition, a number of these patients carry on their lives by taking medications Field Code Changed
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that treat the symptoms but not the cause of thedo not address the root cause of the
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problem. Food might not be the primary cause for their ailments, but IgG marked food

antigens may indeed be fixed by a sensitized organ, attract phagocytes, and be destroyed

locally. This action will maintain the tissue inflamed and enhance the progression

ofbefore increasing the progression of the disease. To stop this process, one needs to

identify and remove this individual trigger.

However, it is observed that patients who take the IgG test, either because their doctor

advised them to do so or because they stumbled upon it while searching the internet for

a cure to their pain and suffering, get cured of their problems by extricating these foods

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from their diet. Why this occurs isHowever, the reason why this occurs is outside the

scope of this research.

Literature Review

Food allergy is known to be a prevalent type of sensitivity reaction that can occur

anytime or anywhere. These allergies are quite harder to avoid and aredifficult to avoid

and are usually prevented by some medicines, such as antihistamines [11]. However, Formatted: Not Highlight
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preventing these allergies may become difficult since they can occur due to everyday

food items such as, milk, chicken, eggs, and peanuts [12]. These foods , along with and Formatted: Not Highlight
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many other common food items, can cause life-threatening anaphylaxis [13], [14].
Formatted: Not Highlight
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These allergies are occasionally assumed as to be synonymous with the term Field Code Changed

intolerance. These food items are regarded as foreign or invader particles. As a

resultresult, of this, the immune system produces IgG antibodies that attack the foreign

food items, thus causing an inflammatory reaction to occur. This inflammatory or

hypersensitivity reaction, in turn, may produce various other symptoms like such as

constipation, tiredness, bloating, irritable bowel syndrome (IBS), diarrhea, migraines,

eczema, and headaches [15], [16]. Formatted: Not Highlight

Field Code Changed

There are several types of food testing, but the most common method is to test or screen Field Code Changed

the patient against an innumerable number of food additives and items. The consumer

is then provided with aConsumers are then provided with a list of those food items to

which they are intolerant. One ofIn this regard, the most useful methods for food

intolerance testing is the IgG (immunoglobulin G) testing is one of the most useful

methods for food intolerance testing [9], [17], [18]. The test is used in various kinds of Field Code Changed
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conditions where diet elimination and preventing allergies is deemed mandatory. Such
Field Code Changed

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conditions can include movement disorders, gastrointestinal, and neurological

conditions [19]. Formatted: Not Highlight

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In such conditions, the human body produces specialized proteins called referred to as

antibodies or immunoglobulins. The body produces three basic types of

immunoglobulins, i.e., immunoglobulin A, immunoglobulin G, and immunoglobulin

M. The main types of immunoglobulins are the IgG which make up around 80 percent

of the overall antibodies within the human body. IgG has somecan be divided further

into four subgroups, namely from IgG1 - IgG4 [20], [21], [22],[23]. IgG antibodies Formatted: Not Highlight
Field Code Changed
have several characteristics such as protective immunity and support for tolerance.
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Protective immunity allows the body to identify foreign body objects and kill them Field Code Changed
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before they cause an infection in the body. Blood is routinely screened for the presence

of IgG antibodies so that the presence of any infection can be markedin order to mark

the trace of any infection. On the other hand, tolerance occurs when the immune system

does not produce any reaction to the foreign body items, such as the human body intake

of foods [24], [25], [26]. Formatted: Not Highlight

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Nevertheless, in the case of allergic reactions, another antibody type (i.e., IgG) starts Field Code Changed
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producing a chemical called histamine, which then leads to a hypersensitivity reaction

in which symptoms can appear within minutes or sometimes up to a few hours/ or up

to three days later. With the help ofIn order to solve this problem, IgG food allergy

testing helps identify, the food items that cause IgG hypersensitivity reactions can be

identified, and they can then be eliminatedbefore eliminating them from the individuals'

dietary intake [27]. After removing the IgG-positive foods from the diet,By doing so, Formatted: Not Highlight
Field Code Changed
various a variety of medical conditions such as epilepsy, rheumatoid arthritis, cystic

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fibrosis, autism, AD(H)D, and irritable bowel syndrome disappear, or symptoms can

be dealt with adequately [4], [28]. Field Code Changed

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Methods

A For this study, a preexisting database for patients in Saudi Arabia who did

theunderwent the ImuPro™ food allergy between 2011 and 2016 was used. The test is

a made bywas devised by R-Biopharm AG from Germany. The testand is an enzyme-

linked immunosorbent assay (ELISA). It is and used a standardized panel of 268 foods

ELISA-based IgG food allergy test. All samples were processed by CTL laboratory,

Germany and. 5 ml of blood was taken fromextracted from each patient, then before

being centrifuged and serum was collectedand collecting the serum. Standard

procedures from R-Biopharm AG using standard ELISA plates (Plate 1, Please 2, Plate

3) were then applied. In addition, all the samples were sent across to CTL laboratories

in Germany in order to process the samples in an ELISA Washer and Reader machines.

The measurements were analyzed by R-Biopharm’s standard ImuPro™ software.

Only numerical test results, as well as patient age and gender data, were used in this

study. No patient identifying information was used. Inclusion criteria included all

patients who took the test inpatients who were part of a pre-existing database and took

the aforementioned test in Saudi Arabia in the period frombetween 2011 and 2016. A

total of 1644 Patientspatients (913 males and 731 females of different ages) were

analysedanalyzed. The large size of this sample allowed it to represents all patients

since it is a large sample and no exclusions were made. Some patients were referred by

physicians, while others opted to perform thedo the test on their own accord. ThusPut

succinctly, the sample is a representative sample of all patients.

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Patients signed a consent form allowing theirwhich allowed their data to be used for

research purposes.

Results and Discussion

In this section, the results areThis section explains the findings explained based on

actual measured resultsmeasurements involving 1644 patients (913 males and 731

females) in Saudi Arabia who were tested for the same 268 food types.

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Figure 1Food groups causing IgG immune reaction. The size of the circle indicates the percentage of the population Field Code Changed
affected by this food group

Figure 1Figure 1 Shows shows the topmost food groups inducing an IgG immune Field Code Changed
Formatted: Font:
response. The size of the circle indicates the percentage of the population that is affected

by this food group. We see thatEvidently, milk products, eggs, yeast, cereals, and seeds

are the found to be the biggest contributors to the topmost IgG immune responsefood

groups.

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Figure 2(a) Box and Whisker plot of the entire data with outliers. (b) Outlier foods with the percentage of the Field Code Changed
population they affected.

Figure 2Figure 2 (a) uses a Box and Whisker plot to display the distribution of the Field Code Changed

foods, thus inducing an IgG immune response in the population tested. We see that the

majority ofIt can be seen that the majority of the foods (243 foods = 91%) tested

affected less than 30% of the population. There were as many as 25 outliers that affected

more than 70% of the population. The outliers and the percentage of the population they

affected are shown in Figure 3Figure 3(b) shows the outliers and the percentage of the Field Code Changed

population they affected.

Figure 3Figure 3 (a) presents theillustrates the same data shown in Figure 2Figure 2(a), Field Code Changed
Field Code Changed
albeit but in a histogram plot. It plots the percentage of patients affected by each food

type. For the purpose of analogy, the curve shown in Figure 3Figure 3(a) is an Field Code Changed

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exponential probability density random function. By means of probability rules, we We

can determine the probability characteristics for any region by means of probability

rules.

Figure 3% of patients with IgG levels above the cut-off threshold for each food tested in descending order Field Code Changed

Figure 3Figure 3(b) shows the foods affecting morethat affects over than 50% of the Field Code Changed

population. The size of the circle reflects the percentage of the population affected. One

can easily compare between theA comparison between the data in Figure 2Figure 2(b) Field Code Changed

and Figure 3Figure 3(b). This clearly shows the presence of a well-defined prevalence Field Code Changed

of IgG allergic response to foods. From Meanwhile Table 1, we can see thatdepicts that

26 foods (9.7% of the foods tested) caused an IgG reaction in 26% of the population,

and whereas 14 foods (5.2% of the foods tested) caused an IgG reaction in 51% of the

population. However, only 8 foods (3% of the foods tested) triggered an IgG immune

response in more than 73% of the tested patients.

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Table 1: Number of Foods causing the most IgG immune response Field Code Changed

# of Foods % Compared to total foods tested % of Population affected

26 26 / 268 = 9.7 % > 26.5 %
14 14 / 268 = 5.2 % > 51.2 %
8 8 / 268 = 3.0 % > 73.8 %

What the outlier foods in Figure 2Figure 2(b) have in common is that shows that the Field Code Changed

outlier foods they areexhibit an overlapping trait in that they are ‘mainstream’ foods

that are consumed by the majority of people almost daily and are part of most of our

dietsform part of most of our diets. These are mainly wheat, gluten, cow’s milk, and

eggs. This is further clarified if we study Figure 3Figure 3(b) where we see that the 14 Field Code Changed

foods affecting more than 50% of the population are actually mainstream foods

consumed on a regular basis. It is also interesting to look at the other end of the spectrum

and analyze the ten foods that cause the least IgG allergic response in the population

tested.

Table 2Table 2 lists the ten foods causing the least IgG response in descending order. Field Code Changed

It is interesting to note thatNotably, although cow’s milk affects 75% of the population

and cow’s milk is consumed almost daily either directly or indirectly as an ingredient

in other food recipes, there are other foods that are consumed almost equally as much,

but continue to induce almost negligible IgG immune response. For exampleexample,,

from our results show that, black tea and green tea have a very low effect on IgG

immune response, affecting only 1.58% and 0.72% of the participants, respectively.

Although people drink tea and cow’s milk regularly and almost on a daily basis, yet

one affects three-quarters of the population tested, while the other affects lessimpacts

less than 2% of the population tested. Some of the other foods, that are consumed

almost daily, are chicken, beef, and rice;, yet they affect onlyhowever, they impact only

11.98%, 5.42%, and 4.89% of the population, respectively. We conclude that merely

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eating a particular food regularly and in large quantities alone is not reason enough

tonot a strong enough reason to cause a large percentage of the population to develop an

IgG immune response to it. The foods must have someIt is important for the foods to

have some intrinsic properties that cause many people to develop an IgG immune

response to it when consumed often and inas well as in large quantities. This point

makes for an interesting topic for further research.

Table 2: Ten foods causing the least response in the population Field Code Changed

Food % of Population
1 Tannin 1.07
2 Lemon balm 1.07
3 Teff 1.07
4 Fonio 0.77
5 Carrageenan (E407) 0.77
6 Goat meat 0.72
7 Tea, green 0.72
8 Nettle 0.42
9 Moluchia 0.36
10 Saffron 0.30

Since all the patients were tested for the same 268 food items, the median is 134 foods.

The five foods that fall above and below the median are listed inshown in Table 3Table Field Code Changed

3. We see that most foods around theIt is evident that most foods around the medial

induced an IgG response in only about 7% of the population tested.

Table 3: Ten foods around the median Field Code Changed

% of
Food Population
129 Rosemary 7.33
130 Bamboo shoots 7.15
131 Sunflower seed 7.39
132 Sea bass 7.09
133 Thyme 7.21
134 Amaranth 7.15

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 % of
Food Population
135 Cauliflower 6.97
136 Lupine 6.97
137 Pectin (E440) 6.85
138 Oysters 6.73
139 Nutmeg 6.79

It is also interesting to compare the results of males and female participantss. Figure Field Code Changed

4Figure 4 shows the percentage of males and females who had anreported an IgG

immune response to each food tested. It is clear thatEvidently, most of these foods had

almost the same effect on both males and females.

Figure 4: Comparing male and female Immune response to all foods tested Field Code Changed

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Meanwhile Figure 5Figure 5 plots the percentage of population affected by each food Field Code Changed
Formatted: Font: (Default) +Headings CS (Times New
for children below 5 years of agethe age of five against the percentage of the population Roman)

above 15 years of age that were affected by the same food. We see that there is aAn

analysis of these foods reveals a clear difference. Some foods affected awere found to

impact the majority of children below 5 five years much more than the rest of the

population above the age of 15. While other foods had a small effect on children below

5 five years of age, but had a bigger effect on thethey had a stronger effect on the rest

ofremainder of the population above 15 years. In generalgeneral, Figure 5Figure 5 Field Code Changed

shows thatillustrates that children are affected by more foods than adults. This is

becomes evident from the prevalence of more data points to the right of the 45

degree45-degree line.

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Figure 5: Comparing IgG induced immune response for each food in children below 5 five years old and the rest Field Code Changed
ofremainder of the population above 15 years of age

Figure 6Figure 6(a) uses aillustrates a Box and Whisker plot to display for each food Field Code Changed

tested the subtraction of theand subtracted the percentage of the children population

under 5 five years from the percentage of the rest ofremainder of the population above

15 years of age who had an IgG immune response to that same food. There areAs many

as 22 foods in the upper outlier (foods that affected children much more than adults)

and three foods in the lower outlier, they areoutlier are listed in Figure 6Figure 6(b). Field Code Changed

What this shows clearly is that there is a bigThis clearly shows that there is a major

change in the immune profile between children and adults. For example, 60% more

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children below the age of 5 five years have anshowed an IgG immune reaction to

coconut than adults older than 15 years. In contrastContrastingly, more than 30% of

adults reported an IgG immune response to black pepper as compared to children below

five years of age.

Figure 6: (a) Box and Whiskers plot showing for each food tested the % affected children below 5 five years - % Field Code Changed
affected for those above 15 years, (b) outliers

Table 4Table 4 compares the foods that caused an IgG immune response in 50% or Field Code Changed
more in the children population of children under fivebelow the age of five years (141
children), and theas well as the corresponding percentage of affected population above
15 years (1164 persons) to the same food., the The data is sorted in descending order
for % of children affected.

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Table 4: In this table we provide the list List of foods where the difference between the % affected Adults and Field Code Changed
children was the greatest

Food % Affected % Affected Difference

Below 5 five Above 15 years
years
Coconut 73.76 9.45 64.31
Hazelnut 59.57 9.11 50.46
Soybean 60.99 12.11 48.88
Brazil nut 51.06 5.93 45.13
Halloumi 84.4 40.38 44.02
Pistachio 60.28 18.99 41.29
Quinoa 54.61 13.49 41.12
Milk, cooked 86.52 45.62 40.9
Orange 62.41 21.56 40.85
Aubergine 52.48 11.68 40.8
Cashew kernels 59.57 19.59 39.98
Sheep: milk and cheese 61.7 23.54 38.16
Ricotta 87.23 49.57 37.66
Kefir 69.5 31.96 37.54
Goat: milk and cheese 59.57 22.68 36.89
Rennet cheese (cow) 90.07 53.44 36.63
Apple 49.65 14.18 35.47
Lentil 51.06 15.81 35.25
Sour-milk products (cow) 90.78 56.7 34.08
Pepper, black 0.71 31.96 -31.25
Yeast 13.48 40.21 -26.73
Pineapple 2.84 24.31 -21.47

In this analysis, we determined the allergic level of the food versus the individual's age,

starting from a very early age. Our results were compared based on the foods that

caused an IgG immune response in children aged under 5 five years (141 children to

the rest of the population tested aged above 15 years (1164 persons). The reason behind

choosing theseThe selection of these age groups is attributed to the fact that it is

important to emphasize the role of age with regards to the IgG immune response. This

approach, in turn, helps in understanding the nature of the IgG food Immune response

in human beings. As evidenced in Table 4Table 4, different results can be seen for both Field Code Changed

children and adults. The most interesting result seen in the table is that cow's milk has

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the highest indication of IgG response for children below 5 yearsfive years of age. The

second It is oats, and the third is cowfollowed by oats, cow sour-milk,.

This is followed by rennet cheese, ricotta cheese, and cooked milk, respectively.

However, the order and prevalence of these same foods on persons aboveindividuals

above 15 years for the same foods changedwas observed to change. This result leads to

the conclusion that, for children below 5 five years of age, foods derived from cow's

milk cause aninduce the strongest IgG allergic response. Therefore, with With age, this

effect continues to reduce.

Conclusion

In this study, theThis study obtained and compared the data results from 1644 patients

in Saudi Arabia who did theunderwent the ELISA-based ImuPro IgG test (from R-

Biopharm AG – Germany) on 268 food items from R-Biopharm AG – Germany.. The

test is an ELISA-based test, using three standard ELISA plates per patient made by R-

Biopharm AG. The first concluded result is thatAccording to the findings, eight foods

which representing 3% of the tested foods affected 73.4% of the population. What

theNotably, all the topmost type III IgG allergy-causing foods all have in common is

that they arefoods are the essentially ‘mainstream’ foods that are consumed by the

majority of people almost on a daily basis and are partform part of most of their

everyday diets. These are mainly wheatThey primarily comprise of wheat, gluten, cow's

milk, and eggs. In contrastContrastingly, some other common foods such as beef, and

rice and drinks like tea, had very little IgG response in the population. Foods were also

found to affected both genders almost equally.

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The most interesting result is that theMost crucially, the most significant foods for

children younger than five are cow's milk, oats, sour cow's milk, rennet cheese, ricotta

cheese, and cooked milk. For those older than 15 years, the same foods' order sequence

of the same foods is 8, 1, 9, 10, 12, and 13, respectively. This result leads to the

conclusion that forThus, it can be inferred that for children younger than five years of

age, cow's milk is the most effective food that causes an the strongest IgG allergic

response because. children have a significantly different IgG food profile than adults

(p<.05 i.e. p-value =.024). There is also a gradual change in the foods that cause IgG

allergic responses as age increases.

We can conclude that theIn summation, it can be concluded that IgG induced immune

response for some foods can disappear be eradicated or be drastically reduced with

time. Similarly,At the same time, the IgG induced immune response for some foods can

appear or even drastically radically increase with time. These findings also

reinforcefindings reinforce the belief that the adverse of type III IgG food immune

response is acquired and can be reduced or even completely cured, and that the method

used for. Finally, we can state that this method used for testing IgG immune response

is very effective in comparison to other traditional methods.

Acknowledgment

This project was funded by the Deanship of Scientific Research (DSR), King Abdulaziz

University, Jeddah, under grant No. (DF- Year - College #- Project #). The author,

therefore, gratefully acknowledges the DSR technical and financial support rendered

by the DSR.

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The author would also like to thank express his gratitude to Dr. Khaled Daqrouq

(Biomedical Engineering Specialty, Electrical and Computer Engineering Department,

Faculty of Engineering), Prof. Emad Koshak (Allergy and Immunology Division,

Internal Medicine Department, Faculty of Medicine) and Dr. Mazin Alahmadi

(Industrial Engineering Department, Faculty of Engineering), all of whom are from

King Abdulaziz University, Jeddah, Saudi Arabia, for their valuable time, comments,

encouragement and support.

References

[1] A. M. Branum and S. L. Lukacs, "Food allergy among US children: trends in Field Code Changed
prevalence and hospitalizations," 2008.
[2] R. S. Gupta et al., "The prevalence, severity, and distribution of childhood food
allergy in the United States," Pediatrics, vol. 128, no. 1, pp. e9-e17, 2011.
[3] B. B, J. L, and F. G, "Summary Health Statistics for U.S. Children: National
Health Interview Survey, 2012," Vital Health Stat, vol. 10, Table 2, pp. 1-81,
2013.
[4] W. Atkinson, T. A. Sheldon, N. Shaath, and P. J. Whorwell, "Food elimination
based on IgG antibodies in irritable bowel syndrome: a randomised controlled
trial," Gut, vol. 53, no. 10, pp. 1459-1464, 2004.
[5] E. I. Aydinlar et al., "IgG‐based elimination diet in migraine plus irritable bowel
syndrome," Headache: The Journal of Head and Face Pain, vol. 53, no. 3, pp.
514-525, 2013.
[6] K. Alpay, M. Ertaş, E. K. Orhan, D. K. Üstay, C. Lieners, and B. Baykan, "Diet
restriction in migraine, based on IgG against foods: a clinical double-blind,
randomised, cross-over trial," Cephalalgia, vol. 30, no. 7, pp. 829-837, 2010.
[7] S. Bentz et al., "Clinical relevance of IgG antibodies against food antigens in
Crohn’s disease: a double-blind cross-over diet intervention study," Digestion,
vol. 81, no. 4, pp. 252-264, 2010.
[8] H. Uzunısmaıl et al., "The effects of provocation by foods with raised IgG
antibodies and additives on the course of Crohn's disease: a pilot study," The
Turkish journal of gastroenterology: the official journal of Turkish Society of
Gastroenterology, vol. 23, no. 1, pp. 19-27, 2012.
[9] M. Wilders-Truschnig, H. Mangge, C. Lieners, H. J. Gruber, C. Mayer, and W.
März, "IgG antibodies against food antigens are correlated with inflammation
and intima media thickness in obese juveniles," Experimental and clinical
endocrinology & diabetes, vol. 116, no. 04, pp. 241-245, 2008.
[10] G. H. S. Vance, C. A. Thornton, T. N. Bryant, J. A. Warner, and J. O. Warner,
"Ovalbumin‐specific immunoglobulin G and subclass responses through the
first 5 years of life in relation to duration of egg sensitization and the
development of asthma," Clinical & Experimental Allergy, vol. 34, no. 10, pp.
1542-1549, 2004.

21
[11] A. Dannaeus and M. Inganäs, "A follow‐up study of children with food allergy.
Clinical course in relation to serum IgE‐and IgG‐antibody levels to milk, egg
and fish," Clinical & Experimental Allergy, vol. 11, no. 6, pp. 533-539, 1981.
[12] S. Rowntree, J. J. Cogswell, T. A. Platts-Mills, and E. B. Mitchell,
"Development of IgE and IgG antibodies to food and inhalant allergens in
children at risk of allergic disease," Archives of disease in childhood, vol. 60,
no. 8, pp. 727-735, 1985.
[13] J. O. Hunter, "Food elimination in IBS: the case for IgG testing remains
doubtful," Gut, vol. 54, no. 8, pp. 1203-1203, 2005.
[14] S. H. Sicherer, Food allergy: practical diagnosis and management. CRC Press,
2013.
[15] K. Beyer and S. S. Teuber, "Food allergy diagnostics: scientific and unproven
procedures," Current opinion in allergy and clinical immunology, vol. 5, no. 3,
pp. 261-266, 2005.
[16] I. Skypala and C. Venter, Food hypersensitivity: diagnosing and managing food
allergies and intolerance. John Wiley & Sons, 2009.
[17] C. M. Arroyave Hernández, M. E. Pinto, and H. L. Hernández Montiel, "Food
allergy mediated by IgG antibodies associated with migraine in adults," Revista
Alergia de Mexico, vol. 54, no. 5, 2007.
[18] M. i. Park and M. Camilleri, "Is there a role of food allergy in irritable bowel
syndrome and functional dyspepsia? A systematic review,"
Neurogastroenterology & Motility, vol. 18, no. 8, pp. 595-607, 2006.
[19] A. Dannaeus, S. G. O. Johansson, and T. Foucard, "Clinical and immunological
aspects of food allergy in childhood," Acta Pædiatrica, vol. 67, no. 4, pp. 497-
504, 1978.
[20] S. B. Miller, "IgG food allergy testing by ELISA/EIA: what do they really tell
us?," Townsend Letter for Doctors and Patients, pp. 62-65, 1998.
[21] A. Dannaeus, S. G. O. Johansson, T. Foucard, and S. Öhman, "Clinical and
immunological aspects of food allergy in childhood I. Estimation of IgG, IgA
and IgE antibodies to food antigens in children with food allergy and atopic
dermatitis," Acta Pædiatrica, vol. 66, no. 1, pp. 31-37, 1977.
[22] H. A. Sampson, "Food allergy. Part 2: diagnosis and management," Journal of
Allergy and Clinical Immunology, vol. 103, no. 6, pp. 981-989, 1999.
[23] M. Ebisawa, B. K. Ballmer-Weber, S. Vieths, and R. A. Wood, Food allergy:
Molecular basis and clinical practice. Karger Medical and Scientific
Publishers, 2015.
[24] H. S. Dixon, "Treatment of delayed food allergy based on specific
immunoglobulin G RAST testing," Otolaryngology-Head and Neck Surgery,
vol. 123, no. 1, pp. 48-54, 2000.
[25] A. Muraro et al., "EAACI food allergy and anaphylaxis guidelines: diagnosis
and management of food allergy," Allergy, vol. 69, no. 8, pp. 1008-1025, 2014.
[26] J. Drisko, B. Bischoff, M. Hall, and R. McCallum, "Treating irritable bowel
syndrome with a food elimination diet followed by food challenge and
probiotics," Journal of the American College of Nutrition, vol. 25, no. 6, pp.
514-522, 2006.
[27] G. E. Mullin, K. M. Swift, L. Lipski, L. K. Turnbull, and S. D. Rampertab,
"Testing for food reactions: the good, the bad, and the ugly," Nutrition in
clinical practice, vol. 25, no. 2, pp. 192-198, 2010.
[28] S. H. Sicherer and H. A. Sampson, "Food allergy," Journal of allergy and
clinical immunology, vol. 125, no. 2, pp. S116-S125, 2010.

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