generally, allerc reactons are assocated wth elevated plasma iE antbodes. in theabsence o elevated serum iE, “allerc-lke” reactons are not always consdered “true”alleres. Many ASD chldren sufer rom just such “allerc-lke” symptoms.
observed in unaected siblings, suggesting a particular geneticbackground inuenced by environmental triggers.
A number opapers have reviewed amily or personal history o children with ASDand reported an association with immune disorders, especially duringthe third trimester o pregnancy or in the child with ASD.
Usinghealth records, a nested case-control study o inants with ASD bornin Caliornia between 1995-1999 reported that the prevalence omaternal psoriasis, asthma, hay ever, and atopic dermatitis during thesecond trimester o pregnancy correlated with a greater than 2-oldelevated risk o ASD in the children.
In a National Survey o Children’sHealth, similarly, parents o autistic children (n=483) reported moresymptoms o allergies, especially ood allergies or intolerance, thanthose o healthy control children (n=84,789).
These results, andthe presence o autoantibodies against brain proteins in the serum omany autistic children and their mothers, prompt the suggestion thatthere may be a neuroimmune component
in at least some ASDendophenotypes within the autism spectrum.
“AlleRGIC” sympTOms IN AUTIsm:A lITeRATURe sURvey
Generally, allergic reactions are associated with elevated plasmaIgE antibodies. In the absence o elevated serum IgE, “allergic-like”reactions are not always considered “true” allergies. Many ASDchildren suer rom just such “allergic-like” symptoms.
As shownin Table 1, a number o conditions can present with allergic-likesymptoms such as chronic idiopathic or chronic autoimmune urticaria,without any o the typical test results or allergies (e.g., elevated serumIgE or positive skin tests).
A recent preliminary study o children with ASD (n=245) indicatedthat the strongest association o autism was with a history o allergies.
Another paper reported that increased atopic dermatitis, asthma,rhinitis, high serum IgE, and positive skin tests were present in 70%o Asperger’s syndrome patients (n=15) compared to 7% o age-matched healthy controls (n=15).
As mentioned earlier, however,not all reports o allergic symptoms in children with ASD implicateallergic IgE antibodies. In a hospital-based case-control study usingquestionnaires completed by the parents and scored blindly by anallergist, 30% o autistic children (n=30) had a amily history oallergic eatures compared to 2.5% o age-matched “neurologiccontrols” (n=39) (p<0.005); there was no dierence, however, inserum IgE or skin prick tests to 12 common antigens between autisticsubjects and controls, suggesting non-immune triggers.
Another studyreported that the prevalence o atopic disorders in subjects with ASD(n=133) was similar to that o the controls, but non-IgE-mediatedood intolerance was observed at a signifcantly higher rate in ASDcompared to controls (n=13), again highlighting the likely role o othernon-allergic actors.
Some colleagues speculate that elevated IgG1antibodies may be indicative o non-allergic reactions, but even thisis controversial. For instance, the signifcance o increased plasmaIgG4 levels in children with autism (n=114) compared to normally-developing children (n=96) in one study is unclear,
because highlevels o IgG4 antibodies to oods during inancy are associated withtolerance later in lie
while many ASD children are intolerant to oods.Unortunately, one can only test or ood allergies against suspectedavailable ood “allergens.” When anecdotal reports suraced thatsome children with ASD present with hives ater eating meat, theywere greeted with skepticism by some investigators. Nevertheless, asrecently reported, this phenomenon turns out to be true due to IgEantibodies specifc or the meat carbohydrate epitope galactose-
-1,3-galactose, which result in delayed angioedema and urticaria atereating bee, lamb, or pork.
Mast cells are immune cells oten attributed with causing allergicreactions. In addition to being necessary or the development oallergic reactions,
mast cells are also critical or both innate andacquired immunity
as well as inammation.
Functional mast cell-neuron interactions occur in the GI tract
and the brain.
Given thatGI-related symptoms are quite common in ASD patients,
especiallyabnormal intestinal permeability,
it is important to note that mast cellsare involved in GI inammation and increased gut permeability.
gven that gi-elated smptoms ae qute common n ASD patents,especall abnomal ntestnal pemeablt, t s mpotant to note that mast cells aenvolved n gi nammaton and nceased ut pemeablt.
a. mastoytosisb. mooloal ast ell ativatio isorer (mmAd)
a. Allergiesb. mast ell ativatio i ifaatio or aer. Physial urtiarias. chroi autoiue urtiaria
a. Aaphylaxisb. Agioeea. Urtiaria. mast ell ativatio syroe (mcAS)*Aapte ro
diseases ivolvig ast ell ativatio*