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  • Hi Andrea. Your presentation was great and very informative. I was just wondering if this is a tool you would utilize or recommend for someone with a delayed food hypersensitivty as opposed to the others you listed, such as the IgG ELISA test or the mediator release test (MRT)? Is it more cost effective and more reliable then the others? Thanks, Stacy
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    Alcat powerpoint Alcat powerpoint Presentation Transcript

    • The ALCAT food allergy test:
      An evaluation of efficacy
      and clinical applicability
      Andrea Martinson
      NTR5502
      March 2011
    • Allergy in America
      Allergies are the 6th leading cause of chronic disease in the US
      25% of these cases may be related to foods
      Prevalence is rising in children
      http://allergyasthma.wordpress.com/
    • What is food allergy?
      Allergy: an exaggerated immune response to a specific protein allergen in the environment
      Anaphylactic reaction with IgE response
      Atopy: familial predisposition to the production of IgE antibodies to environmental allergens
      Can manifest as childhood asthma, allergic rhinitis, eczema
      http://offthemark.com/search-results/key/food+allergy/
    • What is food hypersensitivity?
      Delayed food allergies:
      Repeated exposure to a food antigen can produce delayed allergic-like responses or hypersensitivities
      IgG antibodies have been shown to increase small intestine permeability
      Diverse symptoms, may not be evident for hours to days after initial exposure
      Eg. Celiac disease
      Up to 60% of the population may suffer from undetected food allergies
      Patients often experience short-term relief after ingesting foods which are later demonstrated to be the cause of their chronic symptoms
      http://www.dropyourallergies.com
    • Food Allergy Testing
      Immediate Food Hypersensitivity
      Delayed Food Hypersensitivity
      Many tests can be used to determine IgE allergies to pollens, mites, insect venom, latex, drugs, and foods
      RAST test: blood testing for specific IgE antibodies
      Skin prick testing (SPT)
      Standardized allergen extracts
      There are a number of tests for delayed food allergies, which remain controversial
      IgG ELISA test
      Mediator Release Test (MRT)
      ALCAT
      http://www.nosneezes.com
    • ALCAT: Activated Leukocyte Cellular Antigen Test
      Developed by Cell Science Systems Corp., an FDA-inspected and registered medical device manufacturer that operates a CLIA-certified laboratory in Deerfield, FLA
      Developed to identify the body’s response to possible allergy-producing food antigens
      ALCAT is an in-vitro food allergy test that identifies changes in blood cell sizes
      The ALCAT identifies reactions to over 350 foods, chemicals and other substances associated with inflammation
    • How does it work?
      Blood cells are lysed and incubated with purified food extracts
      Contact between allergens and cells can cause autolysis, called allergic autocytotoxicity
      Change in cell size is measured automatically using ROBOCat II
      automated liquid handling
      system designed to measure
      blood cells by number and size
      measures changes in a blood
      cell’s electrical resistance
      Percent shift in cell volume:
      >13% is positive
      <9% is negative
      Mechanism of change in cell
      size is unknown
      http://www.alcat.com/thetechnology.html
    • Marketing and Testimonials
      The ALCAT website targets people who have symptoms like migraine headaches, chronic fatigue, skin disorders, asthma, IBS symptoms, weight gain, and many others
      Testimonials are used to illustrate the claimed effects of using the results of this test as part of an elimination diet method of treatment
      Research supporting the ALCAT system is displayed on the website. They claim that:
      “It is the only test shown to correlate
      with clinical symptoms by double blind
      oral challenges, the gold standard”
      Supported by The International & American Associations of Clinical Nutritionists and American Academy of Anti-Aging Medicine
      Supporting and participating health care professionals are listed on the website
    • Available Panels
      50, 100, 150, and 200-food panels
      50 functional and medicinal herbs
      Female herbs
      Male herbs
      Food additives/Food colorings
      Molds
      Environmental Chemicals
      A number of comprehensive wellness panels
      http://ibstreatmentcenter.blogspot.com/2011/02/understanding-food-allergies.html
    • Supporting Evidence for the ALCAT
      A number of studies have reported >90% reproducibility of the ALCAT
      Comparing healthy football players to patients with suspected food sensitivities using ALCAT test:
      5 positive test results in the football players
      47 positive results in the patient group (Sandberg & Pasula, 1988)
    • Supporting Evidence: ALCAT and GI Disorders
      Berardiet al., 2009
      Tested15 patients affected by GI symptoms who were negative for IgE allergies (prick and/or RAST)
      Elimination diet for 2 months according to ALCAT results
      54% showed improvements
      Fell et al., 1991
      Patients with IBS symptoms
      1. Two-week elimination diet based on ALCAT results
      2. Six 1-week food challenges using 3 positive foods and 3 negative foods
      3. Six-week exclusion diet removing foods identified by ALCAT
      43 of 60 positive foods produced symptoms, while only 11 of 60 negative foods produced symptoms
      Symptom scores were higher in positive food group
      2/3 of the patients improved when eliminating positive foods
    • Supporting Evidence: ALCAT and Weight Loss
      Gaby, 1998:
      27 obese patients who had difficulty losing weight on a reduced-calorie diet were evaluated for white blood cell food-induced reactions using ALCAT.
      Patients were exhibiting multiple symptoms, including gastrointestinal reflux, chronic fatigue, headache and other chronic disorders associated with food sensitivities.
      Iso-caloric elimination diets based on ALCAT test results promoted weight loss, favoring fat loss over muscle
      98% of the subjects following the ALCAT plan either lost scale weight or improved their body composition
      Other benefits reports included an increased sense of well being, improved physical performance, and decreased bloating and digestive problems.
      This study suggests that delayed food hypersensitivities may interfere with weight loss, regardless of caloric restriction!
    • Supporting Evidence: Cutaneous Disorders
      Berardiet al., 2009
      45 of 52 patients with angioedema
      and chronic urticaria showed full
      remission upon elimination of the
      foods identified by ALCAT
      Mullin et al., 2010
      Patients with cutaneous disorders, who were negative with skin prick and RAST, followed a 2-month elimination diet of foods identified using the ALCAT
      86% exhibited a dramatic improvement in symptoms
      14% showed no change or did not follow the diet
      http://www.timtim.com/drawing/view/drawing_id/718
    • Evidence Refuting the ALCAT
      Most people develop IgG antibodies to foods that they eat, and some researchers believe this is a normal immune response indicating exposure, not an allergy
      Recent studies have shown that the IgG response may even be protective against the development of IgE food allergy
      Hence, there is no convincing evidence to suggest that this test has any diagnostic value for allergy
      Morris, 2009:
      “Testing for IgG4 antibodies to diagnose food intolerances is best avoided. According to UK and European allergy opinion leaders, IgG responses to food are a normal physiologic phenomenon and raised food-specific IgG has no predictive role for food allergies or intolerances…Another pseudo pseudoscientific testing modality called blood leucocytotoxic testing (ALCAT test) has been available since 1956 but has no proven diagnostic value in allergy”
    • Evidence Refuting the ALCAT
      Several investigators have reported that the ALCAT is an inappropriate modality for testing food allergy in clinical practice due to poor reproducibility and lack of scientific and clinical proof of efficacy
      A study of antibody responses to milk proteins in patients with milk-protein intolerance proved by oral challenge found no increase in IgG antibodies (Gerezet al., 2010)
    • Effectiveness, Safety, and Practicality of ALCAT in a Clinical Setting
      Pros
      Cons
      Test is easy and safe, requiring only a simple blood draw
      No safety concerns or adverse effects have been reported
      All components are modular, allowing easy troubleshooting and replacement
      The software is compatible with all versions of Microsoft Windows
      The instrument is manufactured using Good Manufacturing Practices in a FDA Registered Medical Device Establishment
      Test comes with complementary test results guide for interpretive ease
      Cost of separate panels ranges from $99-$1099
      Samples must be sent to participating labs and it may take time to receive results
      Possibility of poor reliability and lack of scientific proof of efficacy
      Possible difficulty in acquiring blood sample – requires external referral to a lab
    • Patient Selection Criteria
      Patients who may benefit from IgG food antigen testing with the ALCAT include, but are not limited to, those with the following symptoms:
      Headaches
      Weight gain
      Fatigue
      Generalized achiness or arthritis
      Gastrointestinal dysfunction
      Skin disorders
      Attention deficit hyperactivity disorder
      Unresponsive to other methods of treatment
      The test can be used on patients of any age
    • Conclusion
      The ALCAT is a simple blood test that examines the response of white blood cells to various foods
      While some researchers refute the claims that the IgG response is an accurate indication of a delayed food allergy, the ALCAT has plenty of evidence from randomized clinical trials, case studies, and testimonials, to validate its claims
      Although the cost of the panels can be quite high, this test seems to be a safe and reliable means of identifying potential food allergens, and is quite easily accessible to health practitioners
    • References
      Akmal, M., Khan, S.A., Khan, A.Q. (2009). The effect of the ALCAT test diet therapy for food sensitivity in patients with obesity. Middle East Journal of Family Medicine 7(3): 133-137.
      Berardi, L., De Amici, M., Vignini, A., Mantegna, G., Mosca, M. (2009). ALCAT test identifies food intolerance in patients with gastrointestinal symptoms. Eur J Allergy and ClinImmun 90(64): 1280-1285.
      Berardi, L., De Amici, M., Vignini, A., Torre, C., Mosca, M. (2009). Food intolerance in patients with cutaneous diseases: diagnostic value of the ALCAT test. Eur J Allergy and ClinImmun 90(64): 644-650.
      Cell Science Systems. (2011). ALCAT Worldwide. Retrieved from http://www.alcat.com/aboutus.php [February 23, 2011]
      Fell, P.J., Brostoff, J., O’Donnell, H., O’Connor, A., Charig, E. (1988). ALCAT – “A new test for food-induced problems in medicine?”. Presented at the Annual Meeting of the American Academy of Otolaryngic Allergy, Washington, D.C. Retrieved from http://www.alcat.com/studies_links [February 23, 2011]
      Fell, P.J., Soulsby, S., Brostoff, J. (1991). Cellular responses to food in irritable bowel syndrome – an investigation of the ALCAT test. J Nut Med 2:143-149.
      Gaby, A.R. (1998). The role of hidden food allergy/intolerance in chronic disease. Alternative Medicine Review 3(2): 90-100.
      Gerez, I.F.A., Shek, L.P.C., Chng, H.H., Lee, B.W. (2010). Diagnostic tests for food allergy. Singapore Med J 51(1): 4-8. Hoj, L. (1995). Food intolerance in patients with angioedema and chronic urticaria: an investigation by RAST and ALCAT test. Eur J Allergy and ClinImmun26(50): 316-322.
      Morris, A. (2009). Atopy, anamnesis and allergy testing. InnovAiT2(3): 158-165.
      Mullin, G.E., Swift, K.M., Lipski, L., Turnbull, L.K., Rampertab, S.D. (2010). Testing for food reactions: the good, the bad, and the ugly. Nutrition in Clinical Practice 25(2): 192-198.
      Sandberg, D.H., Pasula, M.J. (1988). A comparison of the ALCAT test for food reactions amongst 2 population sub-groups. Annals of Allergy, presented at the 5th Annual Congress of the American College of Allergy and Immunology, Los Angeles, CA.