Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report
Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report
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DOI：
10.1111/j.1398-9995.2008.01705.x
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发表时间：
2008-07-01
期刊：
影响因子：
12.4
通讯作者：
Kleine-Tebbe, J.
中科院分区：
文献类型：
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作者：
Stapel, Steven O.;Asero, R.;Kleine-Tebbe, J.
免疫球蛋白G4 （IgG4）对食物的血清学检测一直被提倡用于食物致过敏的诊断。由于许多患者认为他们的症状与食物摄入有关，而没有诊断证实两者之间存在因果关系，因此针对食物特异性IgG4的检测代表着一个不断增长的市场。在儿童、青少年和成人中，通过酶联免疫吸附试验和放射过敏症吸附试验，对数百种食物进行大规模筛选，对不同食物进行血液IgG4检测。然而，许多血清样本显示IgG4阳性，但没有相应的临床症状。这些发现，再加上缺乏令人信服的证据证明IgG4在人体内的组胺释放特性，以及缺乏任何关于IgG4检测在食物过敏中的诊断价值的对照研究，都不能为食物特异性IgG4在食物过敏中发挥效应作用的假设提供任何基础。与有争议的观点相反，对抗食物的IgG4表明生物体已经反复暴露于食物成分，被免疫系统识别为外来蛋白质。它的存在不应被视为诱发超敏反应的因素，而应被视为与调节性T细胞活性相关的免疫耐受指标。总之，食物特异性IgG4并不表明（迫在眉睫的）食物过敏或不耐受，而是暴露于食物成分后免疫系统的生理反应。因此，对食物的IgG4检测被认为与食物过敏或不耐受的实验室检查无关，不应在与食物有关的投诉中进行。
Serological tests for immunoglobulin G4 (IgG4) against foods are persistently promoted for the diagnosis of food-induced hypersensitivity. Since many patients believe that their symptoms are related to food ingestion without diagnostic confirmation of a causal relationship, tests for food-specific IgG4 represent a growing market. Testing for blood IgG4 against different foods is performed with large-scale screening for hundreds of food items by enzyme-linked immunosorbent assay-type and radioallergosorbent-type assays in young children, adolescents and adults. However, many serum samples show positive IgG4 results without corresponding clinical symptoms. These findings, combined with the lack of convincing evidence for histamine-releasing properties of IgG4 in humans, and lack of any controlled studies on the diagnostic value of IgG4 testing in food allergy, do not provide any basis for the hypothesis that food-specific IgG4 should be attributed with an effector role in food hypersensitivity. In contrast to the disputed beliefs, IgG4 against foods indicates that the organism has been repeatedly exposed to food components, recognized as foreign proteins by the immune system. Its presence should not be considered as a factor which induces hypersensitivity, but rather as an indicator for immunological tolerance, linked to the activity of regulatory T cells. In conclusion, food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in case of food-related complaints.