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Role of Food Antigen in IgA Nephropathy Remission

The articles tries to understand the role of food antigens in causing protenuria and how food antigens cause immune responses and affect chronic kidney disease. We will explain what are Food antigens, how they reach into the stomach, how food antigens cause protenuria and how can we prevent this and preserve kidney function.

Normally plasma cells in the stomach mucosal lining produce iga antibodies. After an infection, disease, a type of gene gets expressed and B2 cells get the capacity to produce iga antibodies to ward of this infection. These are a different phenotype which cannot be recognised by the stomach barrier and allow it to pass to the blood stream. This causes kidney damage. Any food that resembles a bacteria will immediately cause production of iga antibodies and cause kidney damage. The best way is to avoid such foods and go for plant based diet.

What are Food Antigens

We consume tons of processes foods each day without thinking what type of chemicals or components are used in these foods to make it tastier, spicier, sweet, and keep them fresh for longer time.

Foods are made of many types nutrients such as  carbohydrates, proteins, nutrients and vitamins. These nutrients will be digested and the molecules in these foods will be absorbed by the body. In some individuals, some type of molecules in foods create immune responses by triggering IgA, IgE, IgG and IgM antibodies. These foods are called food antigens.

Food antigens are specific to the individual and cause prolonged immune responses and create immune reactions in kidney and cause chronic kidney disease. Restricted diets according to clinical and biological data were followed by complete remissions in idiopathic nephrotic syndrome.

Food Antigens Characteristics

1. They are low-grade immune responses. This means they responses are mild but can cause prolonged organ damage.

2. The immune responses may last for several days. The food antigens will enter blood stream and can cause immune responses till the food antigens are completely removed from the blood stream.

3. The more food antigens are there, the more immune responses will be.

4. The immune responses can be delayed up to 24 -48 hours which is why it is difficult to diagnose some food antigens.

5. Some food antigens can be destroyed by heat. Cooking the foods are helpful in decreasing food antigens in some foods. 

6. Eating heavy food at night cause cause immune responses. Food generally takes 5 hours to move through the small intestine. Hence it would be advisable to have food at least 5 hours before you sleep. If you are sleeping at 11 pm, have food by  6 pm in the evening. 

Major Studies on Food Antigens and immune responses

There are many studies that were conducted to identify certain food antigens and how they trigger immune responses. I have compiled some of them here for your information.

Role of Food Antigen in IgA Nephropathy Remission

1. Detection of IgE, IgG, IgA and IgM antibodies against raw and processed food antigens - In this 2009 study, they developed an enzyme-linked immunosorbent assay for the measurement of IgE, IgG, IgA and IgM antibodies against raw and processed food antigens. They selected a bunch of food items are used them on 40 individuals to see the level of immune responses in their body.

They study points out that immune responses had 3–8-fold increase against processed foods compared with raw foods. This means individuals who take more processed food will have higher immune responses and likely to have diseases. They identified wheat, fried meat causes high immune responses and rice, Cucumber, Carrot, Celery, Beet, Parsley, Lettuce and Spinach causes lesser or no immune responses.

2. Immune Reactivity Against a Variety of Mammalian Milks and Plant-Based Milk Substitutes -  A 2018 study studied the allergenicity and antigenicity of different mammalian and plant-based milks/milk substitutes such as cow, goat, sheep, camel, human milks, and soy, almond, and coconut plant-based milk substitutes in healthy subjects. 

The study found that human milk was the least antigenic and allergenic, followed by camel milk. Cow's milk had the highest immune responses. In plant based substitute, almond milk substitute showed highest immune responses and coconut milk substitute showed the least. 

3. Digestive Permeability to Different-Sized Molecules and to Sodium Cromoglycate in Food Allergy - 15 healthy subjects and in 20 patients with food allergy were selected as participants. Ingestion of an allergen by these patients led to a significant increase in the absorption of lactulose (intestinal passage increased by a factor of two). Administration of 300 mg cromoglycate 1/4 hour before the provocation test completely averted abnormal intestinal permeability.  Cromoglycate mast cell stabilizer that prevents the release of inflammatory chemicals such as histamine from mast cells.

Sodium Cromoglycate Therapy has been tried and succeeded in reducing protenuria in iga nephropathy patients. Experiments in mice also substantiated it.

4. Food Sensitivities - An articles written on food sensitivity explains in details how these affect the body. Individuals can consume all types of hypo allergic foods such as onion, carrot, cucumber, apple, spinach, coriander leaves, curry leaves, broccoli, garlic, ginger and water melon. Organically grown foods are way better to reduce immune responses.

The most common food intolerance are Lactose, Tyramine, Preservatives and Additives and Gluten. Traditionally wheat, oats, barley and rye have been referred to as the "gluten grains" and that's why many companies provide gluten free grains. However many of these are processed in factories where normal grains are processed and there is a chance of cross contamination. Hence it would be best to avoid all these products.  The study titled as The Effect of a Gluten-Free Diet in Children With Difficult-to-Manage Nephrotic Syndrome shows that children had clinical improvement after gluten free diet.

Upper end of the gastrointestinal (GI) tract has a protective mucosal layer called the stomach lining. The the parietal cells in the mucosal layer produce stomach acid which helps in the break down of food items. Damage to stomach lining destroy these cells and undigested particles reach small intestine and cause immune responses. 'Exercise-induced' food allergy which occurs after an individual has eaten shortly after exercising can also cause the immune responses. 

Role of Food Antigen in IgA Nephropathy Remission

There has been multiple studies about iga nephropathy and role of food antigens. An article on IgA-containing immune complexes after challenge with food antigens in patients with IgA nephropathy. mention that milk proteins are commonly associated with IgA.

Another article titled Complete Remission of IgA Nephropathy Following Gluten Free Diet in the Setting of Cryptogenic Cirrhosis: A Case Report states that IgAN for the said patient was relate o gA antibodies produced against gliaden and antiendomysial antibodies. Having a gluten free diet provided remission for the patient.

Another article on A case report: a patient with IgA nephropathy and coeliac disease. Complete clinical remission following gluten-free diet suggest that after 4 months of gluten-free diet, protenuria fell to 0.2g per day. Another study titled "Gluten, Transglutaminase, Celiac Disease and IgA Nephropathy" says Food plays a potential role in IgAN initiation and progression.

Many research shows that increased intestinal permeability is a characteristic of IgA nephropathy. Another article "Dietary Antigens and Primary Immunoglobulin A Nephropathy" states that hyper-reactive mucosal immune system playes a big role in the disease progression. Lectins and Gliadins in foods can damage cell wall in stomach and create systemic inflammation. Lectins are found in nightshade vegetables and grains and gliadins are especially found in wheat, soya products.

Major 3 points from the consensus statements from "Nutritional treatment of advanced CKD: twenty consensus statements" were ;

In patients with CKD 4–5,

1. a diet with non-monitored intake of calories, protein, sodium, and phosphates hastens and exacerbates clinical and metabolic alterations related to advanced CKD,

2. reduction of protein intake, reduction of phosphorus intake, reduction/monitoring of sodium intake, monitoring of potassium intake, and limitation of the fixed acid load

3. satisfaction of the caloric needs, adequate intake of essential amino acids, correction of metabolic acidosis, good glyco-metabolic control

Many studies also states stopping the consumption of food antigens like gluten helps to prevent the kidneys from worsening, after a point of time it can be progressed due to other channels like having a cold, infection, stress, stomach related problems, flue etc. Since many of them are unpredictable in nature, it is always better to be careful with things that we can control like food, hygiene, proper exercise and sleep.