Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report *

  title={Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report *},
  author={Steven O. Stapel and Riccardo Asero and Barbara K. Ballmer-Weber and Edward F. Knol and Stephan Strobel and Stephan Vieths and J{\"o}rg Kleine‐Tebbe},
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… 
Food-Specific IgG4 Lack Diagnostic Value in Adult Patients with Chronic Urticaria and Other Suspected Allergy Skin Symptoms
In adult patients, testing for specific IgG4 lacks clinical utility for the diagnosis of food allergy or intolerance and should not be part of the diagnosis and therapy of adult patients with allergy-like skin diseases.
Non-IgE Mediated Hypersensitivity to Food Products or Food Intolerance—Problems of Appropriate Diagnostics
It was found that higher IgG4 levels against foods and higher cytotoxic test values are not clinically relevant in each of the studied individuals and should not be decisive for the elimination of food products.
CSACI Position statement on the testing of food-specific IgG
The Canadian Society of Allergy and Clinical Immunology (CSACI) is very concerned about the increased marketing of food-specific immunoglobulin G (IgG) testing towards the general public over the
Variable Food-Specific IgG Antibody Levels in Healthy and Symptomatic Chinese Adults
The levels of food-specific IgGs were variable both in healthy and in symptomatic Chinese adults, and demographic factors, the type of food and specific chronic symptoms should be considered before food elimination treatment based on IgG testing in patients with chronic symptoms is used in clinical practice.
Unproven Diagnostic Tests for Adverse Reactions to Foods.
  • J. Kelso
  • Medicine, Biology
    The journal of allergy and clinical immunology. In practice
  • 2018
Foods Causing Highest IgG Immune Response in Saudi Arabia
This is one of the largest studies to have been conducted worldwide that involves the IgG immune response of patients to food and a clear difference can be seen between children and adults when it comes to the Igg immune reaction to different food items.
Evidence for IgG Testing: Challenging the Status Quo Regarding Food Intolerance Tests
It is concluded that food intolerance tests are reliable and useful tools to guide dietary choices and can potentially improve patient symptoms, however, interventional studies are needed to demonstrate a cause an effect relationship between test use and symptom reduction in a more controlled manner.
Adverse food reactions--an emerging issue for adults.
  • I. Skypala
  • Medicine, Biology
    Journal of the American Dietetic Association
  • 2011
Specific Immunoglobulin (Ig) G Reference Intervals for Common Food, Insect, and Mold Allergens.
BACKGROUND The clinical utility of serum IgG measurement in the diagnosis of allergy and food-induced hypersensitivity has been largely discredited. Recent studies, however, have shown that specific


The clinical significance of food specific IgE/IgG4 in food specific atopic dermatitis
Protein microarray can be one of the useful methods to assess ongoing status of allergic diseases, and allergen‐specific IgE/IgG4 may provideone of the clues to understand the mechanism of food allergy in atopic dermatitis, the present study suggests.
Relationship between IgG1 and IgG4 antibodies to foods and the development of IgE antibodies to inhalant allergens. II. Increased levels of IgG antibodies to foods in children who subsequently develop IgE antibodies to inhalant allergens
  • P. Calkhoven, M. Aalbers, R. Aalberse
  • Biology, Medicine
    Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
  • 1991
It is found that children with a high IgG antibody response to foods have an increased risk of developing IgE antibodies to inhalant allergens and the prediction of the development of IgE anti‐mite (house dust mite) appeared less useful than the IgG1 anti‐food scores.
Food elimination in IBS: the case for IgG testing remains doubtful.
The numbers of patients with positive responses to eggs, cow’s milk, and cashew nuts, as judged by IgG levels, are much higher than one would expect from empirical dietary studies, and the same, in my view, would follow for several other foods.
Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial
Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research.
Serologic aspects of IgG4 antibodies. I. Prolonged immunization results in an IgG4-restricted response.
Evidence is provided that antigen-binding assays may even underestimate the contribution of IgG4 antibodies, because in contrast to IgG1 antibodies, IgG 4 antibodies act as monovalent antibodies in being unable to cross-link immunosorbent-bound antigen and radiolabeled antigen.
Changes in humoral responses to β‐lactoglobulin in tolerant patients suggest a particular role for IgG4 in delayed, non‐IgE‐mediated cow's milk allergy
A marked difference in β‐LG‐specific Ig ratios suggested a tolerance‐induced inhibition of a Th2‐type of immune response with significantly increased IgA dominance in both CMA patient groups.
Relation between IgG antibodies to foods and IgE antibodies to milk, egg, cat, dog and/or mite in a cross‐sectional study
  • Eysink, De Jong, Aalberse
  • Biology, Medicine
    Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
  • 1999
Increased levels of IgG antibodies to foods might be used as a predictor of IgE‐mediated allergy in initially nonatopic children.
Serologic aspects of IgG4 antibodies. II. IgG4 antibodies form small, nonprecipitating immune complexes due to functional monovalency.
Human IgG4 antibodies directed against phospholipase A, the P1 antigen from Dermatophagoïdes pteronyssinus extracts, and cat albumin were found unable to cross-link antigen, stressing the point that IgG 4 antibodies take a special place in the immune response upon chronic exposure to antigen.
Monoclonal antibodies to immunoglobulin G4 induce histamine release from human basophils in vitro.
Grass Pollen Immunotherapy Induces Mucosal and Peripheral IL-10 Responses and Blocking IgG Activity1
Grass pollen immunotherapy may induce allergen-specific, IL-10-dependent “protective” IgG4 responses and both the increases in IgG and the IgG “blocking” activity correlated with the patients’ overall assessment of improvement.