Biotin Supplementation-The Cause of Hypersensitivity and Significant Interference in Allergy Diagnostics

Abstract

Biotin (vitamin B7) is a common, naturally occurring water-soluble vitamin. It belongs to the broad group of B vitamins. It is a common ingredient in dietary supplements, cosmetics, medicines, and parapharmaceutical preparations administered orally or applied topically (to the skin, hair, nails). The problem of the relationship between vitamin B supplementation and sensitivity seems to be multi-threaded. There is little literature data that would confirm that oral vitamin B supplementation or local exposure to biotin is a significant sensitizing factor. Moreover, it seems that allergy to vitamin B7 is very rare. It is possible, however, that the relationship between biotin and hypersensitivity is not limited to its direct action, but results from its essential metabolic function. Vitamin B7, as a cofactor of five carboxylases, affects the main pathways of cellular metabolism. Both deficiency and excess of biotin can result in metabolic disorders, which can have a significant impact on the homeostasis of the entire organism, including the efficient functioning of the immune system. Dysregulation of immune systems leads to its dysfunctional functioning, which can also lead to sensitization to various environmental antigens (allergens). Biotin is also used as an element of some methodological models in immunochemical tests (in vitro diagnostics), including methods used to measure the concentration of immunoglobulin E (IgE), both total (tIgE) and allergen-specific (sIgE). For this reason, vitamin B7 supplementation can be a significant interfering factor in some immunochemical tests, which can lead to false laboratory test results, both false positive and false negative, depending on the test format. This situation can have a direct impact on the quality and effectiveness of diagnostics in various clinical situations, including allergy diagnostics. This review focuses on the role of biotin in allergic reactions, both as a causative factor (allergen/hapten), a factor predisposing to the development of sensitization to various allergens, and an interfering factor in immunochemical methods used in laboratory diagnosis of hypersensitivity reactions and how it can be prevented.

Keywords: allergy; biotin; hypersensitivity; immunochemical methods; interferences.

Figure 1

Chemical structure of D-(+)-biotin. Author’s own drawing based on [22,23,24].

Figure 2

Case 2—substances used in epidermal patch tests [44].

Figure 3

Substance C [44] and biotin. The red frame indicates the group probably responsible for inducing the hypersensitivity reaction. Author’s own figure based on [24,44].

Figure 4

Biotin molecule with the fragment responsible for binding to avidin and streptavidin marked in the green frame. Author’s own drawing based on [22].

Figure 5

A biotin-streptavidin ELISA format—basic scheme. Author’s own drawing based on [102,103].