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Prevalence of food intolerance in bronchial asthma in india

Published on: Mar 4, 2016
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Transcripts - Prevalence of food intolerance in bronchial asthma in india

  • 1. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal original article Prevalence of food intolerance in bronchial asthma in India Raj Kumar, Mandeep Singh, Nitesh Gupta, Manoj Kumar, Indu Bisht, Shailendra Nath Gaur Access this article online ABSTRACT Website: www.ijaai.in DOI: 10.4103/0972-6691.124394 Quick Response Code: Background and Objective: Food intolerance is an adverse reaction to food in which there is no involvement of defense (immune) system. There is some evidence for the use of food-specific immunoglobulin G (IgG) levels as a guide to identify food intolerance. The current study was thus planned to study the prevalence of IgG-based food intolerance in bronchial asthma (BA) patients and healthy controls in Indian population. Materials and Methods: A total of 65 subjects were recruited for the study comprising 50 cases of BA and 15 healthy controls. These were assessed for food intolerance using specific IgG against selected food items. The results were graded as specific IgG against the selected food item: >30 U/mL – elevated and <30 –normal as per manufacturer`s recommendation. Results: The BA group had highest food intolerance against the vegetables, whereas in control subjects the food intolerance was highest for nuts. The prevalence of food intolerance was higher in male asthmatic patients, but in the control group females showed higher intolerance. The common food items to which food intolerance test was positive in descending order were cow milk (56%), casein (48%), tiger nut (48%), almond (46%), amaranth (46%), peanut (46%), soybean (44%), alga wakame (44%), scallop (44%), mulberry (42%) in asthmatic patients and almond (80%), cowmilk (73%), casein (66.6%), peanut (60%), cashew nut (60%), tiger nut (53.3%), carrot (53.3%), flax seed (53.3%), quino (53.3%), clan (53.3%), sunflower seed (53.3%) in control subjects. Conclusion: The specific IgG is a test to evaluate food intolerance. The common food items to which food intolerance test was positive in descending order were cow milk (56%), casein (48%), tiger nut (48%), almond (46%), amaranth (46%), peanut (46%), soybean (44%), alga wakame (44%), scallop (44%), mulberry (42%) in asthmatic patients. Key words: BA, food intolerance, specific IgG INTRODUCTION Non allergic food hypersensitivity also referred to as food intolerance is an adverse reaction to food in which there is no involvement of defense (immune) system. The gold standard method for diagnosing food intolerance is double-blind placebo-controlled food control tests.[1, 2] The test is laborious and difficult to test all combinations of food types that may be causing symptoms. On the contrary, studies have shown evidence for the use of food specific IgG National Centre of Respiratory Allergy, Asthma and Immunology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India Address for correspondence: Dr. Raj Kumar, National Centre of Respiratory Allergy, Asthma and Immunology Vallabhbhai Patel Chest Institute, University of Delhi, Delhi - 110 007, India. E-mail: rajkumarvpci@gmail.com Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2 121
  • 2. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal Kumar, et al.: Food intolerance and bronchial asthma 80 60 50 40 30 20 10 0 Male 100 90 80 70 60 50 40 30 20 10 0 Male Female Overall Figure 2: Prevalence of food intolerance in control subjects Male Female er th O bl e s ta d ut Ve ge N s oo ce pi /s ea tf M bs er H fo ts n a Se ai ry fo od Overall ra i Food intolerance % 100 90 80 70 60 50 40 30 20 10 0 od 122 Overall Figure 1: Prevalence of food intolerance in bronchial asthma D A total of 221 food items were tested for food intolerance in each of the 65 subjects. The prevalence of food intolerance was higher in male (66.7%) as compared with female (56.2%) asthma subjects [Figure 1]. However, in the control group more females (75%) showed intolerance to food items as Female Food item elevated (>30) RESULTS Subject characteristics The study included 65 subjects; 21 females and 44 males. The subjects belonged to age group of 6-40 years. The study included 50 BA patients and 15 control subjects. The average age in BA group was 28.8 years, the control group had average age of 31.07 years. 70 G Statistical analysis All data analysis was performed using SPSS statistical package version 16.0 for windows (SPSS, Chicago, IL, USA). The number of subjects positive for the food item in both the BA and control groups was compared using Chi-square test. A P < 0.05 was considered statistically significant. 90 od Specific IgG test Specific IgG was estimated in all the subjects using Genesis Diagnostic kit, UK. This test was performed by Genarrayt microarray System, UK, is produced by printing hundreds of protein spots onto a specially prepared glass slide, each spot measuring only 130 μm across. The Genarrayt system includes a recommended wash station, microcentrifuge, and scanner to ensure optimum assay performance. On completion of the assay, the microarray slide was scanned using a high-resolution optical scanner. The data were processed by the Genarrayt Report Writer software, which presents final results in a simple, straightforward manner. The specific IgG measurement was done by Genarrayt microarray System using Genesis Diagnostic Kit, (UK) and results were graded as: >30 U/mL – elevated; 24-30 U/mL- Borderline; and <24- Normal. 100 Fr ui Study population and design The diagnosed patients of BA and healthy volunteers as controls were enrolled for the study from the outpatient clinics. A total of 65 subjects (21 females and 44 males) aged between 6 and 40 years were evaluated. The diagnosis of asthma was based on Global Initiative for Asthma guidelines.[5] On subgroup analysis, in dairy products food intolerance was found to range from 60% to cow’s milk to minimum of 3% to alpha-lactalbumin in the studied subjects [Table 1]. Alga Wakame (44.6%) showed the highest intolerance in the sea food category, while no food intolerance was found to cod, monkfish, and mussels [Table 2]. Among the fruits, fo MATERIALS AND METHODS compared with males (69.7%) [Figure 2]. The prevalence of food intolerance in male and female bronchial asthma and control subjects in different food groups is summarized in Figure 3. Food intolerance % levels as a guide for identification of food intolerance. It was proposed that presence of food specific IgGmay indicate a potential sensitivity and eliminating the corresponding food item from diet may be beneficial to the patient`s clinical status.[3,4] Thus, the current study was planned to study the prevalence of IgG-based food intolerance in bronchial asthma (BA) patients and healthy controls. Food group elevated > 30 Figure 3: Prevalence of food intolerance in bronchial asthma and control subjects in different food groups Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2
  • 3. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal Kumar, et al.: Food intolerance and bronchial asthma mulberry showed the highest intolerance among 41.5% subjects studied, while no intolerance was found to apple or olive [Table 3]. Coscous intolerance was found in 31%, while no intolerance was found to millets among the grains in the study subjects [Table 4]. Among the spices, currey showed intolerance among 18.5% of subjects, while no intolerance was found to bassil, dill, nettle, saffron, and tarragon [Table 5]. Rabbit showed the highest intolerance among the meat foods among 12% of studied subjects, while lowest intolerance among meat food was found for beef, chicken, partridge, and veal (among 3% of studied subjects in each) [Table 6]. Intolerance to almonds was found in 53% Table 1: Food intolerance to dairy food item in bronchial asthma and control subjects Name of food Cow’s milk Casein Goat milk Sheep milk Egg white Beta-lactoglobulin Buffalo milk Egg yolk Alpha-lactalbumin Elevated n (%) 39 (60.0) 34 (55.3) 24 (36.92) 21 (32.3) 18 (27.69) 5 (7.6) 3 (4.6) 3 (4.6) 2 (3.0) Total (%) 28 (56.00) 24 (48.00) 18 (36.00) 19 (38.00) 11 (22.00) 3 (6.00) 2 (4.00) 2 (4.00) 1 (2.00) Asthma (n = 50) Males (%) 18 (64.28) 14 (58.33) 11 (61.11) 13 (68.42) 9 (81.81) 2 (66.67) 1 (50.00) 1 (50.00) 1 (100.00) Females (%) 10 (31.72) 10 (41.67) 7 (38.89) 6 (31.58) 2 (18.19) 1 (33.33) 1 (50.00) 1 (50.00) 0 Total (%) 11 (73.00) 10 (66.6) 6 (40.00) 2 (13.3) 7 (46.6) 2 (13.3) 1 (6.6) 1 (6.6) 1 (6.6) Control (n = 15) Males (%) 8 (72.72) 8 (80.00) 6 (100.00) 2 (100.00) 7 (100.00) 2 (100.00) 1 (100.00) 1 (100.00) 0 Females (%) 3 (27.28) 2 (20.00) 0 0 0 0 0 0 1 (100.00) P value Total (%) 7 (46.6) 5 (33.3) 8 (53.3) 6 (40) 4 (26.6) 6 (40) 5 (33.3) 1 (6.6) 4 (26.6) 4 (26.6) 3 (20.0) 0 3 (20.0) 2 (13.3) 3 (20.0) 3 (20.0) 2 (13.3) 2 (13.3) 0 2 (13.3) 0 0 1 (6.6) 3 (20.0) 2 (13.3) 0 0 0 0 0 2 (13.3) 0 0 0 0 0 0 0 0 Control (n = 15) Males (%) 5 (71.42) 3 (60.00) 5 (62.5) 3 (50.00) 3 (75.00) 4 (66.66) 3 (60.00) 1 (100.00) 2 (50.00) 2 (50.00) 2 (66.66) 0 2 (66.66) 2 (100.00) 2 (66.66) 2 (66.66) 1 (50.00) 2 (100.00) 0 2 (100.00) 0 0 1 (100.00) 1 (33.34) 1 (50.00) 0 0 0 0 0 2 (100.00) 0 0 0 0 0 0 0 0 Females (%) 2 (28.58) 2 (40.00) 3 (37.5) 3 (50.00) 1 (25.00) 2 (33.34) 2 (40.00) 0 2 (50.00) 2 (50.00) 1 (33.34) 0 1 (33.34) 0 1 (33.34) 1 (33.34) 1 (50.00) 0 0 0 0 0 0 2 (66.66) 1 (50.00) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.229 0.204 0.059 0.051 0.061 Table 2: Food intolerance to sea food in bronchial asthma and control subjects Name of food Alga Wakame Scallop Clam Crab Alga Espaguette Caviar Salmon Tuna Alga Spirulina Winkle Carp Oyster Turbot Anchovy Barnacle Pike Plaice Cockle Shrimp/Prawn Bass Eel Mackerel Perch Razor clam Sardine Sole Haddock Hake Herring Octopus Swordfish Cuttle fish Dorado Lobster Squid Trout Cod Monkfish Mussel Elevated n (%) 29 (44.6) 27 (41.5) 25 (38.4) 15 (23.0) 12 (18.4) 12 (18.4) 9 (13.84) 9 (13.84) 8 (12.30) 7 (10.7) 6 (9.2) 6 (9.2) 6 (9.2) 5 (7.6) 5 (7.6) 5 (7.6) 5 (7.6) 4 (6.1) 4 (6.1) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 1 (1.5) 1 (1.5) 1 (1.5) 1 (1.5) 1 (1.5) 0 0 0 Total (%) 22 (44.00) 22 (44.00) 17 (34.00) 9 (18.00) 8 (16.00) 6 (12.00) 4 (8.00) 8 (16.00) 4 (8.00) 3 (6.00) 3 (6.00) 6 (12.00) 3 (6.00) 3 (6.00) 2 (4.00) 2 (4.00) 3 (6.00) 2 (4.00) 4 (8.00) 1 (2.00) 3 (6.00) 3 (6.00) 2 (4.00) 1 (2.00) 1 (2.00) 3 (6.00) 2 (4.00) 2 (4.00) 2 (4.00) 2 (4.00) 0 1 (2.00) 1 (2.00) 1 (2.00) 1 (2.00) 1 (2.00) 0 0 0 Asthma (n = 50) Males (%) 14 (63.63) 17 (77.27) 12 (70.58) 4 (44.44) 6 (75.00) 3 (50.00) 1 (25.00) 4 (50.00) 3 (75.00) 1 (33.33) 2 (66.67) 3 (50.00) 1 (33.33) 2 (66.67) 1 (50.00) 0 1 (33.33) 0 3 (75.00) 0 1 (33.33) 2 (66.67) 1 (50.00) 0 0 2 (66.67) 1 (50.00) 1 (50.00) 1 (50.00) 0 0 1 (100.00) 0 1 (100.00) 1 (100.00) 0 0 0 0 Females (%) 8 (36.37) 5 (22.73) 5 (29.42) 5 (55.56) 2 (25.00) 3 (50.00) 3 (75.00) 4 (50.00) 1 (25.00) 2 (66.67) 1 (33.33) 3 (50.00) 2 (66.67) 1 (33.33) 1 (50.00) 2 (100.00) 2 (66.67) 2 (100.00) 1 (25.00) 1 (100.00) 2 (66.67) 1 (33.33) 1 (50.00) 1 (100.00) 1 (100.00) 1 (33.33) 1 (50.00) 1 (50.00) 1 (50.00) 2 (100.00) 0 0 1 (100.00) 0 0 1 (100.00) 0 0 0 Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2 P value 0.855 0.462 0.177 0.076 123
  • 4. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal Kumar, et al.: Food intolerance and bronchial asthma Table 3: Food intolerance to fruits in bronchial asthma and control subjects Name of food Mulberry Nectarine Pineapple Pomegranate Plum Lemon Raisin Cranberry Mango Lime Raspberry Tomato Cherry Grapefruit Blackberry Strawberry Watermelon Apricot Avocado Fig Grape Guava Pear Date Blackcurrant Kiwi Melon (honeydew) Papaya Redcurrant Banana Peach Tangerine Blueberry Lychee Rhubarb Olive Apple Olive Elevated n (%) 27 (41.5) 21 (32.30) 21 (32.30) 21 (32.30) 17 (26.1) 13 (20.0) 13 (20.0) 12 (18.4) 11 (16.9) 10 (15.3) 10 (15.3) 10 (15.3) 8 (12.30) 8 (12.30) 6 (9.2) 6 (9.2) 6 (9.2) 5 (7.6) 5 (7.6) 5 (7.6) 5 (7.6) 5 (7.6) 5 (7.6) 4 (6.1) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 2 (3.0) 2 (3.0) 2 (3.0) 1 (1.5) 1 (1.5) 1 (1.5) 0 0 0 Total (%) 21 (42.00) 17 (34.00) 15 (30.00) 16 (32.00) 12 (24.00) 11 (22.00) 9 (18.00) 10 (20.00) 8 (16.00) 10 (20.00) 7 (14.00) 9 (18.00) 5 (10.00) 5 (10.00) 3 (6.00) 3 (6.00) 3 (6.00) 2 (4.00) 2 (4.00) 4 (8.00) 3 (6.00) 3 (6.00) 3 (6.00) 2 (4.00) 2 (4.00) 1 (2.00) 2 (4.00) 1 (2.00) 3 (6.00) 0 1 (2.00) 0 1 (2.00) 1 (2.00) 1 (2.00) 0 0 0 Asthma (n = 50) Males (%) 16 (76.19) 11 (64.70) 10 (66.66) 9 (56.25) 8 (75.00) 8 (72.72) 5 (55.55) 7 (70.00) 7 (87.5) 7 (70.00) 4 (57.14) 6 (66.66) 3 (60.00) 4 (80.00) 1 (33.33) 1 (33.33) 2 (66.67) 0 1 (50.00) 2 (50.00) 1 (33.33) 2 (66.67) 1 (33.33) 0 0 1 (100.00) 2 (100.00) 0 1 (33.33) 0 0 0 0 1 (100.00) 0 0 0 0 Females (%) 5 (23.81) 6 (33.30) 5 (33.34) 7 (43.75) 4 (25.00) 3 (27.28) 4 (44.45) 3 (30.00) 1 (12.5) 3 (30.00) 3 (42.86) 3 (33.34) 2 (40.00) 1 (20.00) 2 (66.67) 2 (66.67) 1 (33.33) 2 (100.00) 1 (50.00) 2 (50.00) 2 (66.67) 1 (33.33) 2 (66.67) 2 (100.00) 2 (100.00) 0 0 1 (100.00) 2 (66.67) 0 1 (100.00) 0 1 (100.00) 0 1 (100.00) 0 0 0 Total (%) 6 (40.00) 4 (26.6) 6 (40) 5 (33.3) 5 (33.3) 2 (13.3) 4 (26.6) 2 (13.3) 3 (20.0) 0 3 (20.0) 1 (6.6) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 1 (6.6) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 1 (6.6) 2 (13.3) 1 (6.6) 2 (13.3) 0 2 (13.3) 1 (6.6) 2 (13.3) 0 0 0 0 0 0 Control (n = 15) Males (%) 5 (83.3) 4 (100.00) 3 (50.00) 3 (60.00) 3 (60.00) 2 (100.00) 2 (50.00) 2 (100.00) 2 (66.66) 0 2 (66.66) 1 (100.00) 3 (100.00) 3 (100.00) 2 (66.66) 2 (66.66) 1 (33.34) 2 (66.66) 2 (66.66) 1 (100.00) 2 (100.00) 2 (100.00) 2 (100.00) 2 (100.00) 1 (100.00) 1 (50.00) 1 (100.00) 2 (100.00) 0 0 1 (100.00) 0 0 0 0 0 0 0 Females (%) 1 (16.7) 0 3 (50.00) 2 (40.00) 2 (40.00) 0 2 (50.00) 0 1 (33.34) 0 1 (33.34) 0 0 0 1 (33.34) 1 (33.34) 2 (66.66) 1 (33.34) 1 (33.34) 0 0 0 0 0 0 1 (50.00) 0 0 0 2 0 2 (100.00) 0 0 0 0 0 0 0.89 0.594 0.806 0.917 0.593 Table 4: Food intolerance against grains in bronchial asthma and control subjects Name of food Coscous Flax seed Quino Corn (maize) Spelt Barley Durum wheat Wheat Rye flour Buckwheat Oat Rice Malt Gliadin Wheat bran Transglutaminase Polenta Millet 124 Elevated n (%) 20 (30.7) 17 (26.1) 16 (24.6) 14 (21.5) 13 (20.0) 12 (18.4) 11 (16.9) 11 (16.9) 9 (13.84) 8 (12.30) 8 (12.30) 7 (10.7) 5 (7.6) 4 (6.1) 3 (4.6) 2 (3.0) 1 (1.5) 0 Total (%) 13 (26.00) 9 (18.00) 8 (16.00) 11 (22.00) 6 (12.00) 8 (16.00) 8 (16.00) 5 (10.00) 4 (8.00) 5 (10.00) 4 (8.00) 3 (6.00) 2 (4.00) 1 (2.00) 0 0 0 0 Asthma (n = 50) Males (%) 9 (69.20) 6 (66.66) 6 (75.00) 8 (72.72) 4 (66.66) 7 (87.5) 7 (87.5) 3 (60.00) 3 (75.00) 2 (40.00) 3 (75.00) 2 (66.67) 2 (100.00) 1 (100.00) 0 0 0 0 Females (%) 4 (30.80) 3 (33.34) 2 (25.00) 3 (27.28) 2 (33.34) 1 (12.5) 1 (12.5) 2 (40.00) 1 (25.00) 3 (60.00) 1 (25.00) 1 (33.33) 0 0 0 0 0 0 Total (%) 7 (46.6) 8 (53.3) 8 (53.3) 3 (20.0) 7 (46.6) 4 (26.6) 3 (20.0) 6 (40) 5 (33.3) 3 (20.0) 4 (26.6) 4 (26.6) 3 (20.0) 3 (20.0) 3 (20.0) 2 (13.3) 1 (6.6) 0 Control (n = 15) Males (%) 6 (85.71) 5 (62.5) 5 (62.5) 3 (100.00) 5 (71.42) 3 (75.00) 3 (100.00) 4 (66.66) 3 (60.00) 2 (66.66) 4 (100.00) 2 (50.00) 2 (66.66) 3 (100.00) 2 (66.66) 2 (100.00) 1 (100.00) 0 P value Females (%) 1 (14.29) 3 (37.5) 3 (37.5) 0 2 (28.58) 1 (25.00) 0 2 (33.34) 2 (40.00) 1 (33.34) 0 2 (50.00) 1 (33.34) 0 1 (33.34) 0 0 0 0.279 0.006 0.003 Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2
  • 5. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal Kumar, et al.: Food intolerance and bronchial asthma of subjects, while walnuts were least intolerant (6%) among the nuts [Table 7]. Similarly, among vegetables amaranth was found to be most intolerant (46%), while no intolerance was detected for cauliflower, cucumber, chard, chicory, rocket, and shallot [Table 8]. Highest intolerance was found to green tea in 21.5%, while no intolerance was found to black tea, cocoa, honey, tapioca, and rapeseed among the studied subjects in the miscellaneous group [Table 9]. The BA group had highest food intolerance against the vegetables and lowest was recorded against the meat food. However, in control subjects the food intolerance was highest for nuts and lowest for meat food. BA patients were found to have higher statically significant food intolerance to almonds (P = 0.003), flax seeds (P = 0.006) and quino (P = 0.003) as compared with control Table 5: Food intolerance against herbs/spices in bronchial asthma and control subjects Name of food Elevated n (%) Currey (Mixed spices) Ginkgo Mustard seed Aloe vera Vanilla Cayenne Cinnamon Clove Ginger Mint Camomile Cumin Marjoran peppercorn Thyme Aniseed Coriandar (leaf) Garlic Ginseng Hops Nutmeg Peppermint Sage Bayel Liquorice Parsley Basil Dill Nettle Saffron Tarragon 12 (18.4) 8 (12.30) 7 (10.7) 6 (9.2) 6 (9.2) 5 (7.6) 5 (7.6) 4 (6.1) 4 (6.1) 4 (6.1) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 1 (1.5) 1 (1.5) 1 (1.5) 0 0 0 0 0 Total (%) 7 (14.00) 4 (8.00) 2 (4.00) 4 (8.00) 1 (2.00) 2 (4.00) 4 (8.00) 0 1 (2.00) 1 (2.00) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Asthma (n = 50) Males (%) Females (%) 5 (71.42) 2 (28.58) 2 (50.00) 2 (50.00) 1 (50.00) 1 (50.00) 2 (50.00) 2 (50.00) 0 1 (100.00) 2 (100.00) 0 2 (50.00) 2 (50.00) 0 0 0 1 (100.00) 1 (100.00) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total (%) 5 (33.3) 4 (26.6) 5 (33.3) 2 (13.3) 5 (33.3) 3 (20.0) 1 (6.6) 4 (26.6) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 1 (6.6) 1 (6.6) 1 (6.6) 0 0 0 0 0 Control (n = 15) Males (%) 2 (40.00) 2 (50.00) 4 (80.00) 2 (100.00) 2 (40.00) 1 (33.34) 1 (100.00) 2 (50.00) 2 (66.66) 2 (66.66) 1 (33.34) 2 (66.66) 2 (66.66) 2 (66.66) 2 (66.66) 2 (100.00) 1 (50.00) 2 (100.00) 2 (100.00) 2 (100.00) 2 (100.00) 2 (100.00) 0 1 (100.00) 1 (100.00) 1 (100.00) 0 0 0 0 0 Females (%) 3 (60.00) 2 (50.00) 1 (20.00) 0 3 (60.00) 2 (66.66) 0 2 (50.00) 1 (33.34) 1 (33.34) 2 (66.66) 1 (33.34) 1 (33.34) 1 (33.34) 1 (33.34) 0 1 (50.00) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.091 0.075 Table 6: Food intolerance against meat food in bronchial asthma and control subjects Name of food Rabbit Horse Ox Quail Lamb Pork Wild boar Billy goat Duck Ostrich Turkey Venison Beef Chicken Partridge Veal Elevated n(%) 8 (12.30) 6 (9.2) 6 (9.2) 6 (9.2) 5 (7.6) 4 (6.1) 4 (6.1) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 3 (4.6) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) Total (%) 5 (10.00) 3 (6.00) 3 (6.00) 3 (6.00) 2 (4.00) 2 (4.00) 1 (2.00) 1 (2.00) 1 (2.00) 1 (2.00) 1 (2.00) 1 (2.00) 0 0 1 (2.00) 0 Asthma (n = 50) Males (%) 4 (80.00) 1 (33.33) 1 (33.33) 1 (33.33) 1 (50.00) 0 0 1 (100.00) 0 0 0 1 (100.00) 0 0 0 0 Females (%) 1 (20.00) 2 (66.67) 2 (66.67) 2 (66.67) 1 (50.00) 2 (100.00) 1 (100.00) 0 1 (100.00) 1 (100.00) 1 (100.00) 0 0 0 1 (100.00) 0 Total (%) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 2 (13.3) 3 (20.0) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 1 (6.6) 2 (13.3) Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2 Control (n = 15) Males (%) 2 (66.66) 2 (66.66) 2 (66.66) 2 (66.66) 2 (66.66) 2 (100.00) 2 (66.66) 2 (100.00) 2 (100.00) 2 (100.00) 2 (100.00) 1 (50.00) 2 (100.00) 2 (100.00) 0 0 P value Females (%) 1 (33.34) 1 (33.34) 1 (33.34) 1 (33.34) 1 (33.34) 0 1 (33.34) 0 0 0 0 1 (50.00) 0 0 1 (100.00) 2 (100.00) 0.366 0.13 0.13 125
  • 6. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal Kumar, et al.: Food intolerance and bronchial asthma group. Further food intolerance levels to goat milk, sheep milk, and cashew nuts were higher in BA patients but could not reach statistically significant levels. The common food items to which food intolerance test was positive in descending order were cow milk (56%), casein (48%), tiger nut (48%), almond (46%), amaranth (46%), peanut (46%), soybean (44%), alga wakame (44%), scallop (44%), mulberry (42%) in asthmatic patients [Figure 4] and almond (80%), cow milk (73%), Table 7: Food intolerance against nut food in bronchial asthma and control subjects Name of food Almond Peanut Tiger nut Cashew nut Pistachio Hazelnut Pine nut Macadamia nut Brazil nut Coconut Walnut Elevated n (%) 35 (53.8) 32 (49.2) 32 (49.2) 25 (38.46) 18 (27.69) 11 (16.9) 11 (16.9) 8 (12.30) 7 (10.7) 7 (10.7) 4 (6.1) Total (%) 23 (46.00) 23 (46.00) 24 (48.00) 16 (32.00) 12 (24.00) 6 (12.00) 8 (16.00) 4 (8.00) 2 (4.00) 4 (8.00) 2 (4.00) Asthma (n = 50) Males (%) 17 (73.91) 14 (60.86) 17 (70.83) 12 (75.00) 7 (58.33) 3 (50.00) 5 (62.5) 2 (50.00) 1 (50.00) 3 (75.00) 2 (100.00) Females (%) 6 (22.09) 9 (29.14) 7 (29.17) 4 (25.00) 5 (41.67) 3 (50.00) 3 (37.5) 2 (50.00) 1 (50.00) 1 (25.00) 0 Total (%) 12 (80.0) 9 (60.00) 8 (53.3) 9 (60.00) 6 (40.00) 5 (33.3) 3 (20.0) 4 (26.6) 5 (33.3) 3 (20.0) 2 (13.3) Control (n = 15) Males (%) 10 (83.3) 6 (66.67) 5 (62.5) 5 (55.5) 4 (66.66) 3 (60.00) 2 (66.66) 3 (75.00) 3 (60.00) 3 (100.00) 2 (100.00) Females (%) 2 (16.7) 3 (33.33) 3 (37.5) 4 (44.5) 2 (33.34) 2 (40.00) 1 (33.34) 1 (25.00) 2 (40.00) 0 0 P value 0.003 0.341 0.717 0.051 0.056 Table 8: Food intolerance against vegetables in bronchial asthma and control subjects Name of food Amarnath Pea Soybean Bean (red kidney) Lentil Bean (white haricot) Bean (broad) Potato Caper Carrot Turnip Leek Radish Marrow Yucca Artichoke Brussel sprout Aubergine Gourd (squash) Onion Sweet potato Broccoli Cabbage (red) Watercress Bean (green) Beetroot Cabbage Fennel (leaf) Lettuce Spinach Asparagus Celery Chickpea Peppers (mixed) Cauliflower Chard Chicory Cucumber Rocket Shallot 126 Elevated n (%) 30 (46.15) 28 (43.07) 27 (41.5) 16 (24.6) 16 (24.6) 15 (23.07) 11 (16.9) 10 (15.3) 9 (13.84) 9 (13.84) 9 (13.84) 8 (12.30) 8 (12.30) 6 (9.2) 6 (9.2) 5 (7.6) 5 (7.6) 4 (6.1) 4 (6.1) 4 (6.1) 4 (6.1) 3 (4.6) 3 (4.6) 3 (4.6) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 2 (3.0) 1 (1.5) 1 (1.5) 1 (1.5) 1 (1.5) 0 0 0 0 0 0 Total (%) 23 (46.00) 21 (42.00) 22 (44.00) 14 (28.00) 14 (28.00) 11 (22.00) 7 (14.00) 8 (16.00) 3 (6.00) 1 (2.00) 5 (10.00) 7 (14.00) 4 (8.00) 3 (6.00) 3 (6.00) 2 (4.00) 2 (4.00) 2 (4.00) 1 (2.00) 1 (2.00) 3 (6.00) 1 (2.00) 1 (2.00) 1 (2.00) 0 1 (2.00) 2 (4.00) 0 1 (2.00) 1 (2.00) 0 1 (2) 1 (2.00) 1 (2.00) 0 0 0 0 0 0 Asthma (n = 50) Males (%) Females (%) 15 (65.21) 8 (34.79) 14 (66.66) 7 (33.34) 15 (68.18) 7 (31.72) 12 (85.71) 2 (14.29) 10 (71.42) 4 (28.58) 9 (81.81) 2 (19.19) 6 (85.71) 1 (14.29) 6 (75.00) 2 (25.00) 1 (33.33) 2 (66.67) 1 (100.00) 0 3 (60.00) 2 (40.00) 4 (57.14) 3 (42.86) 3 (75.00) 1 (25.00) 1 (33.33) 2 (66.67) 1 (33.33) 2 (66.67) 1 (50.00) 1 (50.00) 2 (100.00) 0 1 (50.00) 1 (50.00) 1 (100.00) 0 0 1 (100.00) 2 (66.67) 1 (33.33) 0 1 (100.00) 1 (100.00) 0 0 1 (100.00) 0 0 1 (100.00) 0 1 (50.00) 1 (50.00) 0 0 0 1 (100.00) 1 (100.00) 0 0 0 0 0 1 (100.00) 0 0 1 (100.00) 0 0 0 0 0 0 0 0 0 0 0 0 Total (%) 7 (46.6) 7 (46.6) 5 (33.3) 2 (13.3) 2 (13.3) 4 (26.6) 4 (26.6) 2 (13.3) 6 (40) 8 (53.3) 4 (26.6) 1 (6.6) 4 (26.6) 3 (20.0) 3 (20.0) 3 (20.0) 3 (20.0) 2 (13.3) 3 (20.0) 3 (20.0) 1 (6.6) 2 (13.3) 2 (13.3) 2 (13.3) 2 (13.3) 1 (6.6) 0 2 (13.3) 1 (6.6) 1 (6.6) 1 (6.6) 0 0 0 0 0 0 0 0 0 Control (n = 15) Males (%) Females (%) 4 (57.14) 3 (42.86) 7 (100.00) 0 2 (40.00) 3 (60.00) 1 (50.00) 1 (50.00) 2 (100.00) 0 3 (75.00) 1 (25.00) 3 (75.00) 1 (25.00) 2 (100.00) 0 3 (50.00) 3 (50.00) 6 (75.00) 2 (25.00) 3 (75.00) 1 (25.00) 1 (100.00) 0 2 (50.00) 2 (50.00) 2 (66.66) 1 (33.34) 2 (66.66) 1 (33.34) 3 (100.00) 0 2 (66.66) 1 (33.34) 2 (100.00) 0 2 (66.66) 1 (33.34) 3 (100.00) 0 1 (100.00) 0 1 (50.00) 1 (50.00) 2 (100.00) 0 2 (100.00) 0 1 (50.00) 1 (50.00) 0 1 (100.00) 0 0 2 (100.00) 0 1 (100.00) 0 1 (100.00) 0 1 (100.00) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 P value 0.964 0.749 0.784 0.195 0.195 0.959 Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2
  • 7. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal Kumar, et al.: Food intolerance and bronchial asthma casein (66.6%), peanut (60%), cashew nut (60%), tiger nut (53.3%), carrot (53.3%), flax seed (53.3%), quino (53.3%), clan (53.3%), sunflower seed (53.3%) in control subjects [Figure 5]. DISCUSSION In our day to day practice, a number of asthma subjects report that they have eliminated a large number of products from their diet based on suspicion that these are worsening their asthma symptoms. In a study from New Zealand, it was found that 64% of parents had altered their asthmatic child’s diet in the belief that dietary modifications would help control their child’s underlying asthma. But, it has also been demonstrated that unnecessarily restrictive diets can result in nutritional deficiencies and in extreme cases may be fatal.[5-7] Hence, there is a need for an objective test for guidance of dietary elimination of food items and IgG against specific food item may suggest a potential sensitivity to that food. The current study showed food specific IgG is raised in both asthmatics as well as in control subjects; there being no significant difference between the two groups. The findings of our study are consistent with questionnaire based assessment of food intolerance by Woods et al.,[8] which concluded that participants with current asthma did not had a higher prevalence of food-related illness in general than those without asthma. A number of studies have shown that diet elimination based on raised IgG has led to symptom improvement in respiratory symptoms,[8] irritable bowel syndrome,[8,9] celiac disease,[10,11] and rheumatoid arthritis.[12] Intolerance to vegetables (P = 0.717) and fruits (P = 0.377) was found more commonly in asthmatics as compared to controls, although intolerance to none of the food items could reach statically significance. On an individual level, intolerance to almonds, flax seeds, quino, goat milk, sheep milk, and cashew nuts was more common in asthma patients in comparison to controls. This is consistent with study by Woods et al.,[7] who found that fresh fruit, dried fruit, dairy, chocolate, sauces, alcohol, and high fat foods are the products most likely to induce respiratory symptoms. 80 48 Percentage of positive food item Percentage of positive food item 49 47 46 45 44 43 42 41 40 39 Caesin Tiger nut Almond Amar -anth Pea nut Soyab Algae Scallop Mulberry -ean wakame 70 60 50 40 30 20 10 0 Cow milk Caesin Pea nut Cashew Tiger nut Carrot Flax seed Quino Sunflowe nut seedr Food item Food items Figure 4: Prevalence of common food item intolerance in bronchial asthma Figure 5: Prevalence of common food item intolerance in control subjects Table 9: Food intolerance against other food items in bronchial asthma and control subjects Name of food Tea (green) Sunflower seed Cola nut Agar agar Yeast (baker’s) Cane sugar Chestnut Yeast (brewer’s) Coffee Mushroom Sesame seed Carob Cocoa Bean Tea (black) Honey Rapeseed Tapioca Elevated (%) 14 (21.5) 13 (20.0) 12 (18.4) 10 (15.3) 10 (15.3) 9 (13.84) 8 (12.30) 8 (12.30) 6 (9.2) 5 (7.6) 5 (7.6) 3 (4.6) 3 (4.6) 3 (4.6) 2 (3.0) 1 (1.5) 1 (1.5) Total (%) 7 (14.00) 5 (10.00) 6 (12.00) 5 (10.00) 5 (10.00) 4 (8.00) 3 (6.00) 4 (8.00) 3 (6.00) 1 (2.00) 1 (2.00) 1 (2.00) 0 0 0 0 0 Asthma (n = 50) Males (%) 5 (71.42) 4 (75.00) 4 (66.66) 3 (60.00) 3 (60.00) 2 (50.00) 3 (100.00) 2 (50.00) 2 (66.67) 1 (100.00) 1 (100.00) 1 (100.00) 0 0 0 0 0 Females (%) 2 (28.58) 1 (25.00) 2 (33.34) 2 (40.00) 2 (40.00) 2 (50.00) 0 2 (50.00) 1 (33.33) 0 0 0 0 0 0 0 0 Total (%) 7 (46.6) 8 (53.3) 6 (40) 5 (33.3) 5 (33.3) 5 (33.3) 5 (33.3) 4 (26.6) 3 (20.0) 4 (26.6) 4 (26.6) 2 (13.3) 3 (20.0) 3 (20.0) 2 (13.3) 1 (6.6) 1 (6.6) Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2 Control (n = 15) Males (%) 4 (57.14) 5 (62.5) 4 (66.66) 3 (60.00) 3 (60.00) 3 (60.00) 2 (40.00) 3 (75.00) 1 (33.34) 1 (25.00) 2 (50.00) 2 (100.00) 2 (66.66) 2 (66.66) 2 (100.00) 1 (100.00) 1 (100.00) P value Females (%) 3 (42.86) 3 (37.5) 2 (33.34) 2 (40.00) 2 (40.00) 2 (40.00) 3 (60.00) 1 (25.00) 2 (66.66) 3 (75.00) 2 (50.00) 0 1 (33.34) 1 (33.34) 0 0 0 0.235 0.22 0.043 127
  • 8. [Downloaded free from http://www.ijaai.in on Saturday, January 04, 2014, IP: 115.184.84.75]  ||  Click here to download free Android application for this journal Kumar, et al.: Food intolerance and bronchial asthma One of the limitations of our study was that we were not able to follow-up the raised food specific IgG levels with elimination of those foods from diet and evaluating the response to avoidance of food. A further study is required to evaluate if avoidance of these particular food items leads to improvement in asthma control. CONCLUSION The specific IgG is a test to evaluate food intolerance. The common food items to which food intolerance test was positive in descending order were cow milk (56%), casein (48%), tiger nut (48%), almond (46%), amaranth (46%), peanut (46%), soybean (44%), alga wakame (44%), scallop (44%), and mulberry (42%) in asthmatic patients. REFERENCES 1. 2. 3. 4. 128 Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, DreborgS, Haahtela T, et al. EAACI (the European Academy of Allergology and Cinical Immunology) nomenclature task force. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56:813-24. Metcalfe D, Sampson H. Workshop on experimental methodology for clinical studies of adverse reactions to foods and food additives. J Allergy Clin Immunol 1990;86:421-42. Marinkovich V Specific IgG antibodies as markers of adverse . reactions to foods. Monogr Allergy 1996;32:221-5. Hardman G, Hart G. Dietary advice based on food-specific IgG results. Nutr Food Sci 2007;37:16-23. GINA Report, Global Strategy for Asthma Management and Prevention [Internet]. [place unknown] The Global Initiative for Asthma (GINA); 2009 May. pdf 1.0Mb. Available from: http://www.ginasthma.com/Guidelineitem.asp??l1=2 and l2=1 and intId=1561 [Last updated 2010 Jan 12, Last cited 2010 Aug 23]. 6. Dawson KP Ford RP Mogridge N. Childhood asthma: What , , do parents add or avoid in their children’s diets? N Z Med J 1990;103:239-40. 7. Spergel JM, Fiedler J. Food allergy and additives: Triggers in asthma. Immunol Allergy Clin North Am 2005;25:149-67. 8. Woods RK, Abramson M, Raven JM, Bailey M, Weiner J, Walters EH. Reported food Intolerance and respiratory symptoms. Eur Respir J 1998;11:151-5. 9. Nanda R, James R, Smith H, Dudley CRK, Jewell DP . Food intolerance and the irritable bowel syndrome. Gut 1989;30:1099-104. 10. Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: A randomised controlled trial. Gut 2004;53:1459-64. 11. Green PH, Collier C. Celiac disease. N Engl J Med 2007;357:1731-43. 12. Hafstom I, Ringertz B, Spangberg A, von Zweigbergk L, Brannemark S, Nylander I, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: The effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford) 2001;40:1175-9. 5. How to cite this article: Kumar R, Singh M, Gupta N, Kumar M, Bisht I, Gaur SN. Prevalence of food intolerance in bronchial asthma in India. Indian J Allergy Asthma Immunol 2013;27:121-8. Source of Support: Nil, Conflict of Interest: None declared. Indian Journal of Allergy, Asthma and Immunology | Jul-Dec 2013 • Volume 27 • Issue 2

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