Autism and Food Allergy

Link: Autism Speaks, Expert Interview
from the Centers for Disease Control: Mercury, Thimerosal, Vaccines and Autism

Excerpt from “Psychological Considerations in Food Allergy” Chapter in Food Allergy (4th ed), Blackwell Science, in press:
Childhood autism is characterized by significant abnormal or impaired development in social interaction and communication, and restricted repertoire of activity and interests [1]. Immunologic abnormalities, gluten sensitivity, and food allergy have been proposed to play a role in the pathogenesis and management of autism [2-4]. However, evidence supporting the beneficial effects of dietary manipulation on behavior and cognition in children with autism spectrum disorder have consisted mainly of anecdotal reports and small trials.

Bidet and colleagues [5] reported increased basophil degranulation to food allergens in 10 autistic children and Lucarelli [6] reported improvement in behavioral disturbance in 36 autistic children placed on a cow’s milk elimination diet More recently, two small trials examined the benefit of gluten and casein free diets in autistic children. One trial [7] reported reduction in autistic traits but equivocal results on cognitive skills, and on linguistic and motor ability. The trial by Knivsberg [8] studied 10 autistic children over one year and reported improvement in the children on the gluten and casein free diets.

Other studies by Sponheim [9], Renzoni, [10] and Pavone [11] were unable to demonstrate improvement in behavior with a gluten free diet, or any association between autism and food allergy or celiac disease. Studies by Walker-Smith [12] and McCarthy [13] failed to demonstrate an increased prevalence of celiac disease in autistic patients using antigliadin assays and jejunal biopsies.

Lymphocytic infiltration in the upper and lower GI tract [14], immune activation [15], and abnormal lymphocytic responses to dietary antigens [16] have also been recently reported in children with autism, but the relevance of these findings to cognitive function or to development of autism is still unclear.

These studies demonstrate the need for large scale quality controlled trials in this area. Given the lack of hard evidence supporting the benefits of dietary manipulation in preventing or treating autistic patients, implementation of rigorous elimination diets should be undertaken with great caution. Such unproven measures may divert the autistic patient’s family from more useful treatments and contribute to poor nutrition and further social isolation in families already facing great difficulties.

References:
1. DSM-IV Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association; 1994.
2. Coleman M. Autism: Non-drug biologic treatments. In: Gilbert C, ed. Diagnosis and Treatment of Autism. New York:Plenum Press; 1989:219-35.
3. Goodwin MS, Cowen MA, Goodwin TC. Malabsorption and cerebral dysfunction: A multicariate and comparative study of autistic children. J Autism Child Schiz 1971;1:48-62.
4. Tsaltas MO, Jefferson T. A pilot study on allergic responses. J Autism Dev Disorders 1986;16:91-2.
5. Bidet B, Leboyer M, Descours B, Bouvard MP, Benveniste J. Allergic sensitization in infantile autism. J Autism Dev Disorders 1993;23:419-20.
6. Lucarelli S, Frediani t, Zingoni AM, et al. Food allergy and infantile autism. Panminerva Med 1995;37:137-41.
7. Millward C, Ferriter M, Calver S, Connel-Jones G. Gluten-and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2004; (2): CD003498.
8. Knivsberg AM, Reichelt KL, Hoien T, Nodland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002 Sep;5(4):251-61.
9. Sponheim E. (Gluten-free diet in infantile autism. A therapeutic trial). Tidsskr Nor Laegeforen 1991;111(6):704-7.
10. Renzoni E, Beltrami V, Sestani P, Pompella A, Menchetti G, Zappella M. Brief report: Allergological evaluation of children with autism. J Autism Dev Disorders 1995;25(3):327-33.
11. Pavone L, Fiumara A, Bottaro G, Mazzone D, Coleman M. Autism and coeliac disease: failure to validate the hypothesis that a link might exist. Biol Psyhciatry 1997;42:72
12. Walker-Smith J. Gastrointestinal disease and autism-the result of a survey. Symposium on Autism. Sidney, Australia: Abbott Laboratories; 1973.
13. McCarthy DM, Coleman M. Response of intestinal mucosa to gluten challenge in autistic subjects. Lancet. 1979;2:877-8.
14. Ashwood P, Anthony A, Pellicer AA, Torrente F, Walker-Smith JA, Wakefield AJ. Intestinal lymphocyte populations in children with regressive autism: evidence for extensive mucosal immunopathology. J Clin Immunol 2003 Nov, 23(6): 504-17.
15. Ashwood P, Anthony A, Torrente F, Wakefield AJ. Spontaneous mucosal lymphocyte cytokine profiles in children with autism and gastrointestinal symptoms: mucosal immune activation and reduced counter regulatory interleukin-10. J Clin Immunol, 2004 Nov;24(6):664-73.
16. Jyonouchi H, Geng L, Ruby A, Zimmerman-Bier B. Dysregulated innate immune responses in young children with autism spectrum disorders: their relationship to gastrointestinal symptoms and dietary intervention. Neuropsychobiology. 2005;51(2):77-85.

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2 thoughts on “Autism and Food Allergy

  1. This is very interesting to me, and I’ll be fascinated to see what further research comes up with.

    I look at my daughter’s symptoms, which were primarily the result of extreme discomfort, and wonder. If we hadn’t figured out her food allergies, is it possible that she might have been errenously diagnosed with autism? I don’t know, but doctors were already suggesting things like sensory processing disorder. If someone is suffering from extreme pain or the effects of allergic reactions, it does make being social and developing skills normally more difficult.

    My child lost skills, nearly stopped eating, was afraid of new things, stopped using words, and became unresponsive and anti-social when at her worst. She fluctuated between screaming uncontrollably and staring into space for days at a time.

    Now she is a happy, communicative and extremely social child–as long as we keep her away from the foods she is allergic to and make sure she gets her reflux medicine.

    I shudder to think what life might have been like in the long-term if we hadn’t been able to figure out what was causing her symptoms. I’m just so glad she’s better now.

    Like

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