Antacid medication inhibits digestion of dietary proteins and causes food allergy Eva Untersmayr, MD, Isabella Schöll, MSc, Ines Swoboda, PhD, Waltraud.

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Antacid medication inhibits digestion of dietary proteins and causes food allergy Eva Untersmayr, MD, Isabella Schöll, MSc, Ines Swoboda, PhD, Waltraud J Beil, MD, Elisabeth Förster-Waldl, MD, Franziska Walter, MSc, Angelika Riemer, MD, Georg Kraml, MSc, Tamar Kinaciyan, MD, Susanne Spitzauer, MD, George Boltz-Nitulescu, PhD, Otto Scheiner, PhD, Erika Jensen-Jarolim, MD Journal of Allergy and Clinical Immunology Volume 112, Issue 3, Pages 616-623 (September 2003) DOI: 10.1016/S0091-6749(03)01719-6

FIG 1 Time kinetics of in vitro digestion of caviar proteins by pepsin at pH 2.0. A, The effects of protein digestion were analyzed by Coomassie-stained SDS-PAGE. B, Protein extracts of untreated or pepsin-digested caviar extracts were blotted onto nitrocellulose and tested for IgE reactivity using serum of an allergic patient. Bound IgE was detected by I125-labeled anti-human IgE-antibody. Journal of Allergy and Clinical Immunology 2003 112, 616-623DOI: (10.1016/S0091-6749(03)01719-6)

FIG 2 Induction of IgE, IgG1, and IgG2a antibodies to caviar in antacid-treated mice. Balb/c mice were divided in 4 groups (n = 5): group A (ranitidine hydrochloride im and caviar ig), group B (caviar and sucralfate ig), positive control group C (caviar and Al[OH]3 ip), and in group D (caviar extract ig). Blood was taken from the tail vein on day 0 (preimmune serum), 28 (white boxes), 49 (light gray boxes), and 84 (dark gray boxes). Caviar-specific IgE (A), IgG1 (B), or IgG2a (C) antibodies were measured by ELISA. The background values of preimmune sera were subtracted. The boxes represent the range of the inner quartiles of the samples divided by the median. Sera with signals showing more than 1.5-fold deviation from the end of the box were defined as outlines and marked as circles. Sera with titers lying more than 3-fold away were defined as extremes and marked with asterisks. Brackets indicate the groups being statistically compared (°P < .01, ∗P < .05). Journal of Allergy and Clinical Immunology 2003 112, 616-623DOI: (10.1016/S0091-6749(03)01719-6)

FIG 3 Skin reactivity and mucosa hypersensitivity to Beluga caviar. Four groups of Balb/c mice were treated and immunized as shown in Fig 2. Five weeks after the last immunization, type I skin testing was performed. Evans blue was injected intravenously, then caviar extract was applied intradermally in the upper right quadrant, positive control degranulation compound 48/80 in the lower right, mouse food extract in the upper left, and rBet v 1 in the lower left quadrant. Animals were put to death 20 minutes after injection. Representative tests from groups A, B, C, and D are shown in panel 1. In the same mice a food challenge with caviar extracts was performed just before skin tests and 25 minutes before they were put to death. Representative preparations of mice palates are shown in panel 2. Circles highlight the color reaction in the palate. Journal of Allergy and Clinical Immunology 2003 112, 616-623DOI: (10.1016/S0091-6749(03)01719-6)

FIG 4 Transmission electron micrograph of a basal portion of the antrum mucosa from a mouse treated with sucralfate and immunized with caviar (group B). Two eosinophils (Eo) are located in the lamina propria close to a capillary, composed of endothelial cells (En) and erythrocytes (E) and cross-sections through gastric glands (G). One of the eosinophils is almost completely embraced by a macrophage (M); the other is closely attached to that cell. Other stromal cells, a lymphocyte (Ly), and a peripheral nerve (N) are grouped around the eosinophils in the lamina propria. The cell borders are indicated with lines. Stain, uranyl acetate and lead citrate; original magnification, ×4000. Journal of Allergy and Clinical Immunology 2003 112, 616-623DOI: (10.1016/S0091-6749(03)01719-6)

FIG 5 Induction of parvalbumin-specific IgE antibody in antacid-treated mice. Groups of mice (n = 8) were immunized intragastrically with recombinant parvalbumin. Group 1 was premedicated with ranitidine hydrochloride, and group 2 was injected with omeprazole intramuscularly 2 hours before immunization. Control group 3 was fed with parvalbumin alone. Mice were immunized at day 0 and 56. Blood was taken from the tail vein on day 0 (preimmune serum), 28 (white boxes), 49 (light gray boxes), and 84 (dark gray boxes), and parvalbumin-specific IgE antibodies were measured by ELISA. Brackets indicate the groups being statistically compared (∗P < .05). Journal of Allergy and Clinical Immunology 2003 112, 616-623DOI: (10.1016/S0091-6749(03)01719-6)