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Allergies and Autoimmune Disease

At first glance, allergies and diseases, such as rheumatoid arthritis, lupus and Hashimoto’s thyroiditis, may not seem like they have much in common. On one hand, our body is flagging harmless environmental allergens as dangerous and then going on the offense mode. While on the other hand, our immune system is “attacking” our own tissues. However, both are responses generated by the immune system, and that is where their similarities begin.

Allergies

Allergies involve an abnormal or hypersensitive reaction of the immune system when it encounters certain substances (e.g., pollens, certain foods, dust mites, etc.). The variety of symptoms produced can have an impact on quality of life and can even be life threatening in the case of anaphylaxis.1 Most allergies require long term management and are closely linked to asthma.

In 2017, 27.3% of Canadians aged 12 and older (roughly 8.4 million people) reported having allergies that had been diagnosed by allergy tests. Overall, females (28.9%) were slightly more likely to report having allergies than males (25.6%). The respondents most commonly reported being allergic to pollens or grasses (40.7%), followed by certain animals (28.5%), dust mites (27.3%) and medications (28.0%). Among allergy sufferers, roughly 43% reported being allergic to multiple allergens.2

Autoimmune Diseases

According to the classic definitions, autoimmune disease happens when the body’s natural defense system cannot tell the difference between our own cells and foreign cells, causing the body to mistakenly treats certain healthy tissues as if they were a threat and to attack normal cells.3 Our immune systems are designed to recognize substances according to the antigens they present. Antigens are molecules specific to those substances that our body can “read.” Most of our bodies know the difference between its own antigens and those that come from elsewhere, such as bacteria and viruses, but some do not resulting in autoimmune disease. There are more than 80 types of autoimmune diseases that affect a wide range of body parts including the endocrine system, connective tissue, gastrointestinal tract, heart, skin, and kidneys.4

Although it is difficult to find the exact prevalence of the combined autoimmune diseases in the country, Dr. Edward Keystone, director of The Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases at Mt. Sinai Hospital in Toronto estimates that they affect two million Canadians.5 Autoimmunity disproportionately affects women; ratios vary by disease, but overall, almost 80% of people with autoimmune disorders are female.6 The specific reasons for the high prevalence in women are unknown, but circumstantial evidence links autoimmune diseases with preceding infections. Animal models of autoimmune diseases have shown that infections can induce autoimmune disease.7 Sex hormones may further amplify this hyperimmune response to infection in susceptible persons, which leads to an increased prevalence of autoimmune diseases in women.8

From the Microbiota to Superorganisms

This classical definition of autoimmunity, or the distinction by the immune system of the “self and non-self”, is somewhat challenged by our current understanding of the human microbiota consisting of 10-100 trillion symbiotic microbial cells harbored by each person, primarily bacteria in the gut.9 These foreign bacteria are not only tolerated by our immune system, but they are also crucial to our overall wellbeing! For example, intestinal bacteria play a crucial role in maintaining immune and metabolic homeostasis and protecting against pathogens. Altered gut bacterial composition (dysbiosis) has been associated with the pathogenesis of many inflammatory diseases and infections.10

As a result of this vast number of bacterial cells in the body, the host and the microorganisms inhabiting it are often referred to as a ‘superorganism’.11 Thus, humans are superorganisms whose metabolism represents an amalgamation of microbial and human attributes.

Allergies and Autoimmune Diseases: Differences and Similarities

The most obvious similarity between allergies and autoimmune diseases is the exaggerated reaction of the immune system in the presence of a perceived threat and consequently the unnecessary attack. The main difference between the two is the trigger—allergies happen as our bodies respond to an external trigger such as pollen or certain foods, and autoimmune diseases are the result of an internal trigger, our own body’s cells. The mechanism by which our bodies achieve an excessive immune response also differs. While certain lymphocytes are responsible for the reaction toward allergens, specific T or B cells and their malfunction are involved in reactions associated with autoimmune conditions.

Allergies and autoimmune diseases often present very similar symptoms. Both typically cause some sort of redness or swelling, due to the increased immune response. Itchiness is another common symptom of both problems. In both cases, a general feeling of fatigue and sickness, in which the sufferer simply does not feel like their usual self can be present. Additionally, people who suffer from both report a synchronization of the two conditions; flare-ups of allergies tend to come on at similar times when autoimmune diseases are at their worse.

The Genetic Contribution

Genetic factors play an important role in the development and process of immunopathological diseases. Several studies suggest a close relation between gene polymorphism of HLA and cytokines and development of autoimmunity and allergy. Certain gene polymorphisms act as a risk factor or a protective factor.12 Scientists at the National Institutes of Health, and their colleagues, have discovered that a gene called BACH2 may play a central role in the development of diverse allergic and autoimmune diseases.13

The GI Connection

Recent Australian research published in Alimentary Pharmacology & Therapeutics has confirmed that patients with allergic or autoimmune diseases are at higher risk for functional gastrointestinal disorders, independent of psychological distress.14 Talley and colleagues randomly selected and surveyed 3,542 people from the Australian population. The questionnaire included questions about diagnosed autoimmune or allergic conditions and assessed psychological distress and Rome III diagnostic criteria for Functional Dyspepsia (FD) or Irritable Bowel Syndrome (IBS). After controlling for age, sex and psychological distress, researchers found that asthma, food, pollen, and animal allergies, as well as psoriasis and rheumatoid arthritis were independently associated with IBS and FD.

The Leaky Gut Factor

According to the theories proposed to explain the pathophysiology of allergies and autoimmune diseases in integrative medicine, “leaky gut” syndrome is a phenomenon of increased intestinal permeability due to the disruption of tight junctions. The intestinal epithelial lining and its secretions forms a barrier that separates the host from the environment. In pathologic conditions, the permeability of the epithelial lining may be compromised allowing the passage of bacteria, antigens, and toxins in the lumen to enter the blood stream creating a “leaky gut.” In individuals who are genetically predisposed, a leaky gut may allow environmental factors to enter the body and trigger the initiation and development of autoimmune disease.15 Leaky gut syndrome has been connected to many chronic diseases, such as food intolerance, inflammatory bowel disease, rheumatoid arthritis, asthma, and other autoimmune disease.16

Powerful Bacteria

Research shows that pathogenic bacteria that can facilitate a leaky gut and induce autoimmune symptoms can be amended with the use of antibiotic treatment.17 Therefore, modulating the gut microbiota can serve as a potential method for regulating intestinal permeability and may help to alter the course of autoimmune diseases in susceptible individuals.18

Growing evidence shows that the gut microbiota is important in supporting the epithelial barrier and therefore plays a key role in the regulation of environmental factors that enter the body. Several recent reports have shown that probiotics can reverse the leaky gut by enhancing the production of tight junction proteins.19

The 5-R Program

One of the classical approaches used to treat leaky gut syndrome and prevent allergic cascade and/or autoimmune diseases is the 5R program for digestive health. It consists in the following:

  1. Remove: elements that negatively affect the environment of the GI tract including allergic foods, parasites, bacteria, or yeast. This might involve using an allergy “elimination diet”, taking drugs or herbs to eradicate a particular bug.
  2. Replace: digestive secretions. Add back items such as hydrochloric acid, bile acids and digestive enzymes required for proper digestion and that may have been compromised.
  3. Reinoculate: support beneficial bacteria by adding in probiotic foods or supplements containing lactobacillus, bifidobacteria and other useful species. Highly soluble fibers act as “prebiotics” that feeds good bacteria. Try consuming 30 g of fibers per day through diet or by adding a guar gum based supplements.
  4. Repair: support the repair of the GI tract by supplying key nutrients that are often in short supply in a disease state such as the amino acids, glutamine, antioxidants (e.g., vitamins A, C, and E), zinc and omega-3 fatty acids
  5. Rebalance: lifestyle choices such as stress management, sleep habits, and exercise can all affect the GI tract

Conclusion

One of the most important contributions to this field of medicine is the understanding of the importance of the GI health to our overall state of wellbeing. In particular, for the prevention and management of allergies and autoimmune diseases. Improving our gut health has wide ranging effects, including on our immune system. It goes without saying that each person faces their own, unique challenges and that recommendations have to be tailored to meet these specific needs but we like to say that everything starts and ends in the gut.

 References:

  1. Pawankar R., GW. Canonica, ST. Holgate, RF. Lockey, and M. Blaiss. 2013. The WAO White Book on Allergy (Update). World Allergy Organization. (accessed July 12, 2018). https://www.worldallergy.org/UserFiles/file/WhiteBook2-2013-v8.pdf
  2. Health Canada, Health Fact Sheets. Chronic Conditions, https://www150.statcan.gc.ca/n1/en/pub/82-625-x/2018001/article/54983-eng.pdf?st=UaDug8yS
  3. https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-are-common-symptoms-of-autoimmune-disease
  4. https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-are-common-symptoms-of-autoimmune-disease
  5. https://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2019/0821#:~:text=Two%20million%20Canadians%20live%20with,common%20and%20debilitating%20chronic%20diseases.
  6. Fairweather D, Rose NR. Women and autoimmune diseases. Emerg Infect Dis. 2004;10(11):2005-2011. doi:10.3201/eid1011.040367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/
  7. Fairweather D, Rose NR. Women and autoimmune diseases. Emerg Infect Dis. 2004;10(11):2005-2011. doi:10.3201/eid1011.040367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/
  8. Fairweather D, Rose NR. Women and autoimmune diseases. Emerg Infect Dis. 2004;10(11):2005-2011. doi:10.3201/eid1011.040367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/
  9. Ursell LK, Metcalf JL, Parfrey LW, Knight R. Defining the human microbiome. Nutr Rev. 2012;70 Suppl 1(Suppl 1):S38-S44. doi:10.1111/j.1753-4887.2012.00493.x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426293/
  10. Thursby E, Juge N. Introduction to the human gut microbiota. Biochem J. 2017;474(11):1823-1836. Published 2017 May 16. doi:10.1042/BCJ20160510. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433529/
  11. Gill S.R., Pop M., DeBoy R.T., Eckburg P.B., Turnbaugh P.J., Samuel B.S. et al. (2006) Metagenomic analysis of the human distal gut microbiome. Science 312, 1355–1359 doi:10.1126/science.1124234 https://pubmed.ncbi.nlm.nih.gov/16741115/
  12. Bartůnková J, Kayserová J, Shoenfeld Y. Allergy and autoimmunity: parallels and dissimilarity: the yin and yang of immunopathology. Autoimmun Rev. 2009 Feb;8(4):302-8. doi: 10.1016/j.autrev.2008.09.004. Epub 2008 Oct 9. PMID: 18848649.
  13. News Release, Sunday, June 2, 2013. NIH scientists find link between allergic and autoimmune diseases in mouse study. https://www.nih.gov/news-events/news-releases/nih-scientists-find-link-between-allergic-autoimmune-diseases-mouse-study
  14. Koloski, N, Jones, M, Walker, MM, et al. Population based study: atopy and autoimmune diseases are associated with functional dyspepsia and irritable bowel syndrome, independent of psychological distress. Aliment Pharmacol Ther. 2019; 49: 546– 555.
  15. Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017;8:598. Published 2017 May 23. doi:10.3389/fimmu.2017.00598
  16. Farshchi MK, Azad FJ, Salari R, Mirsadraee M, Anushiravani M. A Viewpoint on the Leaky Gut Syndrome to Treat Allergic Asthma: A Novel Opinion. J Evid Based Complementary Altern Med. 2017;22(3):378-380. doi:10.1177/2156587216682169 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871166/
  17. Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017;8:598. Published 2017 May 23. doi:10.3389/fimmu.2017.00598
  18. Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017;8:598. Published 2017 May 23. doi:10.3389/fimmu.2017.00598
  19. Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017;8:598. Published 2017 May 23. doi:10.3389/fimmu.2017.00598
Chantal Ann Dumas, ND

About The Author

Chantal Ann Dumas, ND promotes an evidence-based approach while remaining faithful to the traditional principles of the different medical modalities she proposes to her patients. She undertook additional training including Licensed Birth Assistant, Healthy Breast Teacher, Licensed Homeopath and Mind-Body Therapist. She is currently completing her degree in Medical Anthropology at McGill University. Inspired by the Functional medicine paradigm, she has an inclination for functional laboratory testing and her recommendations encompass nutritional supplements, botanical and homeopathic remedies, aromatherapy, gemmotherapy as well as diet and lifestyle advice.

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