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. 2024 Feb;153(2):471-478.e3.
doi: 10.1016/j.jaci.2023.09.038. Epub 2023 Nov 9.

IgE to common food allergens is associated with cardiovascular mortality in the National Health and Examination Survey and the Multi-Ethnic Study of Atherosclerosis

Corinne Keet  1 , Emily C McGowan  2 , David Jacobs  3 , Wendy S Post  4 , Nathan E Richards  2 , Lisa J Workman  2 , Thomas A E Platts-Mills  2 , Ani Manichaikul  5 , Jeffrey M Wilson  2
Affiliations

IgE to common food allergens is associated with cardiovascular mortality in the National Health and Examination Survey and the Multi-Ethnic Study of Atherosclerosis

Corinne Keet et al. J Allergy Clin Immunol. 2024 Feb.

Abstract

Background: In individuals without symptomatic food allergy, food-specific IgE is considered clinically irrelevant. However, recent studies have suggested that galactose-α-1,3-galactose (alpha-gal) IgE is associated with cardiovascular (CV) disease.

Objective: We sought to determine whether sensitization to common food allergens is associated with CV mortality.

Methods: The association between IgE sensitization to foods and CV mortality ascertained to 2019 was examined in the National Health and Examination Survey (NHANES) 2005-2006 and the Wake Forest site of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort; MESA enrolled adults without baseline clinical CV diseases between 2000 and 2002. Total and specific IgE was measured to cow's milk, egg, peanut, shrimp, and a panel of aeroallergens (NHANES), and to cow's milk, alpha-gal, peanut, dust mite, and timothy grass (MESA). Cox proportional hazard models were constructed, adjusting for sex, age, race/ethnicity, smoking, education, and asthma.

Results: A total of 4414 adults from NHANES (229 CV deaths) and 960 from MESA (56 CV deaths) were included. In NHANES, sensitization to at least 1 food was associated with higher CV mortality (hazard ratio [HR], 1.7 [95% confidence interval (CI), 1.2-2.4], P = .005). Milk sensitization was particularly associated (HR, 2.0 [95% CI, 1.1-3.8], P = .026), a finding replicated in MESA (HR, 3.8 [95% CI, 1.6-9.1], P = .003). Restricting analyses in NHANES to consumers of the relevant allergen strengthened food sensitization relationships, unmasking shrimp and peanut sensitization as additional risk factors for CV mortality.

Conclusions: The finding that food sensitization is associated with increased risk of CV mortality challenges the current paradigm that sensitization without overt allergy is benign. Further research is needed to clarify mechanisms of this association.

Keywords: Food sensitization; IgE; cardiovascular disease; mortality.

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Conflict of interest statement

Conflict of interest: Dr. Keet receives royalties from UpToDate, funding from the NIH, is an Associate Editor at the Journal of Allergy and Clinical Immunology and serves on the American Board of Allergy and Immunology. Dr. Wilson and Platts-Mills have received assay support from Thermo-Fisher/Phadia, including for this study. Dr. McGowan receives funding from the NIH and has received research support from Regeneron (all funds to the University of Virginia).

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves of cumulative cardiovascular death in NHANES (left) and MESA (right), stratified by the presence of IgE to cow’s milk (milk sensitization). Curves are unadjusted and unweighted.
See this image and copyright information in PMC

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