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Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial
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  • Published on:
    This trial did not actually test IgG testing

    Dear Editor

    I agree that designing an RCT for a dietary treatment is difficult, but some of the factors that have led to this trial being criticised could have been avoided, even within the existing design of the trial.[1] For example, if all those on the 'sham diet' who did not have high levels of IgG to wheat had been asked to avoid wheat, that would have given roughly equal numbers avoiding wheat in both groups...

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    Conflict of Interest:
    None declared.
  • Published on:
    IgG anti-betalactoglobulin in children with IBS symptoms: a valid aid to decide for the elimination
    • Antonio Carroccio, MD
    • Other Contributors:
      • Calogero Scalici, Lidia Di Prima, Giuseppe Iacono

    Dear Editor

    We applaud the very elegant study by Atkinson and colleagues, who demonstrated that the assay of IgG antibodies to food may have an important role in helping patients and clinicians identify candidate foods for elimination, with consequent significant improvement of irritable bowel syndrome (IBS) symptoms.[1] For more than 10 years we have assayed IgG anti- betalactoglobulin in children to help us in the...

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    Conflict of Interest:
    None declared.
  • Published on:
    Author's reply
    • Peter J. Whorwell, Senior Lecturer in Medicine & Consultant Physician
    • Other Contributors:
      • Wendy Atkinson and Trevor A. Sheldon

    Dear Editor

    John Hunter states that the generally held view is that IgG testing for food intolerance is not of value and gives references in support of this contention.[1] However, the consensus of these papers and others is that the research is of poor quality and better designed studies are needed to resolve this question. Designing trials in this field, which meet all the criticisms that can be levelled at t...

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    Conflict of Interest:
    None declared.
  • Published on:
    Food elimination in IBS: the case for IgG testing remains doubtful

    Dear Editor

    I have read with interest the study of a diet for IBS based on serum IgG levels to foods.[1]

    In rigorous elimination diet studies, about one third of IBS patients turn out not to have food intolerance.[2-4] Yet everyone tested for food-specific IgG in this study had some positive reactions and was therefore subject to dietary recommendations. This does not suggest that serum IgG is a particul...

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    Conflict of Interest:
    None declared.
  • Published on:
    Author's reply
    • Peter J. Whorwell, Senior Lecturer in Medicine and Consultant Physician
    • Other Contributors:
      • Kathryn J. Bentley, Wendy Atkinson and Trevor A. Sheldon

    Dear Editor

    Mawdsley et al raises the important question as to whether patients with irritable bowel syndrome (IBS) would gain as much symptomatic improvement if recommended to exclude the top four foods (yeast, milk, whole egg and wheat) compared to an IgG antibody test-based diet.[1] In other words, does the test add specificity? This requires a trial which compares patients receiving an IgG antibody tes...

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    Conflict of Interest:
    None declared.
  • Published on:
    IgG food antibodies should be studied in similarly treated groups

    Dear Editor

    The recent paper by Atkinson et al[1] regarding IgG food antibodies and irritable bowel syndrome (IBS) fails to compare like with like. Regardless of the IgG results, the treatment group excluded significantly different food to the control group, particularly those foods which appear to exacerbate symptoms of IBS. Of particular concern is the 'yeast exclusion' diet. A low yeast diet is not a r...

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    Conflict of Interest:
    None declared.
  • Published on:
    IgG antibodies to foods in IBS
    • Joel E Mawdsley, Clinical Research Registrar
    • Other Contributors:
      • Peter M. Irving and Richard J. Makins

    Dear Editor

    We read with interest the article by Atkinson et al[1]. The authors describe an important advance in our understanding of the putative role of inflammation in irritable bowel syndrome (IBS). However we wonder whether their conclusion that assay of IgG antibodies may have a role in identifying candidate foods for elimination to treat patients with IBS may be a step too far. The four foods to...

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    Conflict of Interest:
    None declared.