Total, Group-Specific and IgE-Specific to Food in Patients' Sera Referred for Allergy Testing in the Republic of Macedonia
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Abstract
INTRODUCTION: The term "food allergy" refers to a patient's immune response directed towards food. Food allergy is a ''negative health effect arising from a specific immune response that occurs during repeated exposure to certain foods". This definition includes immune responses that are IgE-mediated, non-IgE-mediated or combinations of both. IgE-mediated reactions are characterized by the acute onset of symptoms, usually within two hours after intake or exposure to food and symptoms frequently involve abnormalities of the skin, gastrointestinal tract and/or the respiratory tract. Even though any food may bear the potential for mediating an allergic reaction and more than 170 foods have been reported to cause IgE-mediated immune responses, it is a rather small number of foods that have been found to cause the majority of allergic reactions. They are described in the literature as "major food allergens'', and include: peanuts, nuts, eggs, milk, fish, crabs, shellfish, wheat and soy. Globally, the prevalence of food allergies seems to be on the rise and increases in incidence are observed in almost all countries. Food allergy prevalence varies in a manner that is dependent on the respective culture and population.
OBJECTIVES: The objectives of this study include: the quantitative examination of total and specific IgE levels from blood serum in response to allergens from animal and plant-derived foods in patients suspected of food allergy; the determination of the degree of an allergic reaction; the qualitative examination of group-specific IgE; the correlation between the total and specific IgE antibodies to food allergens of plant and animal origin, and the calculation of the percentage of food allergies in the Macedonian population.
MATERIALS AND METHODS: Eight thousand eight hundred ninety eight (8898) consecutive patients tested for allergies over a ten year period (from 01.01.2001 to 01.01.2011) at the Institute of Immunobiology and Human Genetics were analyzed retrospectively. All patients were grouped according to gender, age, and place of residence and according to the analysis of total and specific IgE to allergens originating from plant and animal food. The quantitative and qualitative determination of total IgE, specific IgE and specific IgE to groups of food allergens was performed with the UniCAP100 System (Pharmacia, Uppsala, Sweden).
RESULTS: The results were statistically processed and organized in tables and graphs. The number of patients being tested for allergies grew continually over the ten year period. Most patients originated from Skopje (1.2% of the city population), whereas the rest were from other Macedonian cities, whose number remained below 1% with respect to the total population of their respective city of origin
The results for the distribution of the patient number in relation to the total IgE concentration group revealed that most of the patients had normal total IgE levels.
Furthermore, total IgE levels varied in a statistically significant manner between the respective age groups (p <0.01, <0.05). Gender-specific analyses revealed that the geometric mean for the total serum IgE levels was higher in men compared to those in women, or p <0.01, t (3271) = 3732; p = 0.00, <0.01, <0.05, which means that there is a statistically significant difference between total IgE in men and women.
Moreover, the various food-specific IgE antibody concentration levels were found to be dependent on the respective patient age group.
There was a significant correlation between total IgE and egg white, milk, alpha-lactalbumin and casein. A further significant correlation was found between total IgE and group-specific IgE: mixture of food, meat mixture, a mixture of fruit and a cereal mixture. 28.5% of all analyzed patients had a positive finding for IgE antibodies in their blood, while 71.5% were negative.
CONCLUSION: The increase in the number of patients with food allergy may be due to an ever increasing trend in the use of ethnic or exotic food ingredients. Another cause may be the greater exposure to artificial, factory-processed food products. Differences in admitted patient number originating from various cities in the Republic of Macedonia can be explained by the different awareness levels of family doctors for the available analyses performed at Institute of Immunobiology and Human Genetics, the geographical distance of the cities to Skopje. Our findings highlight the need for opening additional allergologic laboratories in several cities in the country. The large number of patients that tested negative for food allergies illustrate the need for further education of the primary care physicians by means of seminars, conferences and lectures.
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