Oat sensitivity
Encyclopedia
Oat sensitivity represents a sensitivity to the proteins found in oats
, Avena sativa. Sensitivity to oats
as a result of allergy or to the seed storage proteins either inhaled or ingested. A more complex condition results to individuals who have gluten-sensitive enteropathy in which there is also a response to avenin, the glutinous protein in oats similar to the gluten within wheat.
dermatitis
reveal that oat proteins can act as both respiratory and skin allergens. Oat-dust sensitivity in farms found 53% showed reactivity to dust second only to barley (70%) and almost double that of wheat dust. The 66 kDa protein in oats was visualized by 28 out of 33 sera (84%), however, there was evident non-specific binding to this region and thus it may also represent lectin-like binding. However, IgA and IgG responses, like those seen to anti-gliadin antibodies
in celiac disase or dermatitis herpetiformis, are not seen to avenins in atopic dermatitis patients. Food allergies to oats can accompany atopy dermatitis. Oat avenins share similarities with γ and ω-gliadins of wheat, based on these similarities they could potentiate both enteropathic response and anaphylactic responses. Oat allergy in gluten-sensitive enteropathy can explain an avenin sensitive individual who no histological abnormality, no T-cell reaction to avenin, bore the rarer DQ2.5trans phenotype and had anaphylactic reaction to avenin.
and Wheat dependent exercise-induced anaphylaxis
, results in the increased inflammation of the tissues of the small bowel eventually leading to villus atrophy. The disease progresses from increase lymphocyte counts to eventual flattening of the villi and crypt hyperplasia. Originally, oats were believed to cause coeliac disease. However this confusion was largely due to significant contamination of oats with wheat, barley or rye. A recent review of controlled oat tolerance studies indicated only one documented avenin-sensitive enteropathy (ASE) in 165, placing the risk of ASE at 0.6% of coeliac disease population. However, during the controlled studies, 17 candidates dropped out due to symptoms after ingestion of GF oats and were not tested at the completion of their respective studies. As a result, the actual risk of ASE in the coelic disease population may be slightly higher.
s, were called CIP 1 (gamma avenin), CIP 2, and CIP3. They had the following amino-acid sequences:
Antibody recognition sites on three avenins
CIP1 (γ-avenin) P S E Q Y Q P Y P E Q Q Q P F
CIP2 (γ-avenin) T T T V Q Y D P S E Q Y Q P Y P E Q Q Q P F V Q Q Q P P F
CIP3 (α-avenin) T T T V Q Y N P S E Q Y Q P Y
within the same paper 3 other proteins were identified, one was an α-amylase
inhibitor, identified by protein homology. A follow-up study showed that most celiacs have anti-avenin antibodies(AVA), with a specificity and sensitivity comparable to anti-gliadin antibodies
. A subsequent study found that these AVA did not result from cross-reaction with wheat. However recently it has been found that AVA drop as soon as Triticeae glutens
are removed from the diet. Anti-avenin antibodies decline in treated celiacs on an oat diet in 136 individuals this suggests that oats can be involved in celiac disease when wheat is present, but is not involved when wheat is removed from the diet. The study however did find an increase number of patients with higher intraepithelial lymphocytes (IEL, a type of white bloodcell) in the oat-eating cohort. Regardless of whether or not this observation is a direct allergic immune response, by itself this is essentially benign
.
confer autoimmunity via covalent attachment to gliadin. In 16 examined coeliacs, none produced a significant Th1 response. Th1 responses are needed to stimulate T-helper cells that mediate disease. This could indicate that coeliac disease does not directly involve avenin or that the sample size was too small to detect the occasional responder.
Evidence that there are exceptional cases came in a 2004 study on oats. The patients drafted for this study were those who had symptoms of celiac disease when on a 'pure-oat' challenge, therefore not representative of a celiac sample. This study found that 4 patients had symptoms after oat ingestion, 3 had elevated Marsh scores for histology, and avenin responsive T-cells, indicating avenin-sensitive enteropathy(ASE). All three patients were DQ2.5/DQ2
(HLA DR3-DQ2
/DR7-DQ2) phenotype. Patients with DQ2.5/DQ2.2 tend to be the most prone toward GSE, have the highest risk for GS-EATL, and shows signs of more severe disease at diagnosis.
While DQ2.5/DQ2 phenotype represents only 25% of celiac patients, it accounts for all of the ASE celiacs, and 60-70% of patients with GS-EATL.
Synthetic avenin peptides were synthesized either in native or deamidated form, the deamidated peptides showed higher response.
DQ2.5/T-cell receptor recognition from 2 Oat-sensitive coeliacs
TCR-Site1 Y Q P Y P E Q E~E~P F V
TCR-Site2 Q Y Q P Y P E Q Q Q P F V Q Q Q Q
Antibody recognition site(see above)
CIP2 (γ-avenin) T T T V Q Y D P S E Q Y Q P Y P E Q Q Q P F V Q Q Q P P F
The overlap of the antibody and T-cell sites, given trypsin digestion of avenin, suggest this region is dominant in immunity. The TCR-site1 was synthetically made as deamidated ("~E~") and native peptide requires transglutaminase to reach full activation. Two studies to date have looked at the ability for different oat-strains to promote various immunochemical aspects of celiac disease. While preliminary these studies indicate different strains may have different risk for avenin-sensitivity
Algorithms that successfully predict T cell stimulatory peptides in gluten identified many similar peptides in hordeins and secalins but not in oat avenins.
The Canadian Celiac Association suggests that adults can consume up to 70g of oats and children up to 25g per day, however, two studies indicated that adults could consume 93 grams (3.3 ounces) of oats per day. There is no evidence that oats can trigger GSE, only that in a small number of celiacs disease can be sustained or reinitiated by oats once triggered by wheat. A recent paper examining the IEL of celiac patients in remission showed a significantly higher number of IEL in oat-eating celiacs, in addition antibodies to avenin remain low as long as the diet is gluten-free but higher anti-avenin antibodies can increase with a diet containing wheat.
Some coeliacs respond adversely to oats. Estimates range from 0.5 to 20% of the GSE population. With coeliac disease non-compliance to achieve normal intestinal morphology is a risk factor for refractory disease and cancer.
OATS
OATS - Open Source Assistive Technology Software - is a source code repository or "forge" for assistive technology software. It was launched in 2006 with the goal to provide a one-stop “shop” for end users, clinicians and open-source developers to promote and develop open source assistive...
, Avena sativa. Sensitivity to oats
as a result of allergy or to the seed storage proteins either inhaled or ingested. A more complex condition results to individuals who have gluten-sensitive enteropathy in which there is also a response to avenin, the glutinous protein in oats similar to the gluten within wheat.
Oat allergy
Studies on farmers with grain dust allergy and children with atopyAtopy
Atopy or atopic syndrome is a predisposition toward developing certain allergic hypersensitivity reactions.Atopy may have a hereditary component, although contact with the allergen must occur before the hypersensitivity reaction can develop ....
dermatitis
Dermatitis
-Etymology:Dermatitis derives from Greek derma "skin" + -itis "inflammation" and genetic disorder.-Terminology:There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called...
reveal that oat proteins can act as both respiratory and skin allergens. Oat-dust sensitivity in farms found 53% showed reactivity to dust second only to barley (70%) and almost double that of wheat dust. The 66 kDa protein in oats was visualized by 28 out of 33 sera (84%), however, there was evident non-specific binding to this region and thus it may also represent lectin-like binding. However, IgA and IgG responses, like those seen to anti-gliadin antibodies
Anti-gliadin antibodies
Antigliadin antibodies are produced in response to gliadin, a prolamin found in wheat. In bread wheat it is encoded by three different alleles, AA, BB, and DD. These alleles can produce slightly different gliadins, which can cause the body to produce different antibodies...
in celiac disase or dermatitis herpetiformis, are not seen to avenins in atopic dermatitis patients. Food allergies to oats can accompany atopy dermatitis. Oat avenins share similarities with γ and ω-gliadins of wheat, based on these similarities they could potentiate both enteropathic response and anaphylactic responses. Oat allergy in gluten-sensitive enteropathy can explain an avenin sensitive individual who no histological abnormality, no T-cell reaction to avenin, bore the rarer DQ2.5trans phenotype and had anaphylactic reaction to avenin.
and Wheat dependent exercise-induced anaphylaxis
Avenin-sensitive enteropathy
Gluten-sensitive enteropathy and its common and more severe form, coeliac diseaseCoeliac disease
Coeliac disease , is an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages from middle infancy onward...
, results in the increased inflammation of the tissues of the small bowel eventually leading to villus atrophy. The disease progresses from increase lymphocyte counts to eventual flattening of the villi and crypt hyperplasia. Originally, oats were believed to cause coeliac disease. However this confusion was largely due to significant contamination of oats with wheat, barley or rye. A recent review of controlled oat tolerance studies indicated only one documented avenin-sensitive enteropathy (ASE) in 165, placing the risk of ASE at 0.6% of coeliac disease population. However, during the controlled studies, 17 candidates dropped out due to symptoms after ingestion of GF oats and were not tested at the completion of their respective studies. As a result, the actual risk of ASE in the coelic disease population may be slightly higher.
Anti-avenin antibodies
In 1992, 6 protein were extracted from oats that reacted with a single coeliac sera. The proteins, prolaminProlamin
Prolamins are a group of plant storage proteins having a high proline content and found in the seeds of cereal grains: wheat , barley , rye , corn , sorghum and as a minor protein, avenin in oats. They are characterised by a high glutamine and proline content and are generally soluble only in...
s, were called CIP 1 (gamma avenin), CIP 2, and CIP3. They had the following amino-acid sequences:
Antibody recognition sites on three avenins
CIP1 (γ-avenin) P S E Q Y Q P Y P E Q Q Q P F
CIP2 (γ-avenin) T T T V Q Y D P S E Q Y Q P Y P E Q Q Q P F V Q Q Q P P F
CIP3 (α-avenin) T T T V Q Y N P S E Q Y Q P Y
within the same paper 3 other proteins were identified, one was an α-amylase
Amylase
Amylase is an enzyme that catalyses the breakdown of starch into sugars. Amylase is present in human saliva, where it begins the chemical process of digestion. Food that contains much starch but little sugar, such as rice and potato, taste slightly sweet as they are chewed because amylase turns...
inhibitor, identified by protein homology. A follow-up study showed that most celiacs have anti-avenin antibodies(AVA), with a specificity and sensitivity comparable to anti-gliadin antibodies
Anti-gliadin antibodies
Antigliadin antibodies are produced in response to gliadin, a prolamin found in wheat. In bread wheat it is encoded by three different alleles, AA, BB, and DD. These alleles can produce slightly different gliadins, which can cause the body to produce different antibodies...
. A subsequent study found that these AVA did not result from cross-reaction with wheat. However recently it has been found that AVA drop as soon as Triticeae glutens
Triticeae glutens
Triticeae glutens are seed storage proteins found in mature seeds of grass tribe Triticeae. Seed glutens of non-Triticeae plants have varieties of similar properties, but none singly can perform on a par with those of the Triticeae taxa, particularly the triticum species...
are removed from the diet. Anti-avenin antibodies decline in treated celiacs on an oat diet in 136 individuals this suggests that oats can be involved in celiac disease when wheat is present, but is not involved when wheat is removed from the diet. The study however did find an increase number of patients with higher intraepithelial lymphocytes (IEL, a type of white bloodcell) in the oat-eating cohort. Regardless of whether or not this observation is a direct allergic immune response, by itself this is essentially benign
Benign
A benign tumor is a tumor that lacks the ability to metastasize. Common examples of benign tumors include moles and uterine fibroids.The term "benign" implies a mild and nonprogressive disease. Indeed, many kinds of benign tumors are harmless to human health...
.
Cellular immunity
In gluten-sensitive enteropathy, prolamins mediate between T-cells and antigen presenting cells, whereas anti-transglutaminase antibodiesAnti-transglutaminase antibodies
Anti-transglutaminase antibodies are autoantibodies against the transglutaminase protein. Antibodies serve an important role in the immune system by detecting cells and substances that the rest of the immune system then eliminates. These cells and substance can be foreign and also can be producd...
confer autoimmunity via covalent attachment to gliadin. In 16 examined coeliacs, none produced a significant Th1 response. Th1 responses are needed to stimulate T-helper cells that mediate disease. This could indicate that coeliac disease does not directly involve avenin or that the sample size was too small to detect the occasional responder.
Evidence that there are exceptional cases came in a 2004 study on oats. The patients drafted for this study were those who had symptoms of celiac disease when on a 'pure-oat' challenge, therefore not representative of a celiac sample. This study found that 4 patients had symptoms after oat ingestion, 3 had elevated Marsh scores for histology, and avenin responsive T-cells, indicating avenin-sensitive enteropathy(ASE). All three patients were DQ2.5/DQ2
HLA-DQ2
HLA-DQ2 is a serotype group within HLA-DQ serotyping system. The serotype is determined by the antibody recognition of β2 subset of DQ β-chains. The β-chain of DQ is encoded by HLA-DQB1 locus and DQ2 are encoded by the HLA-DQB1*02 allele group. This group currently contains two common alleles,...
(HLA DR3-DQ2
HLA DR3-DQ2
HLA DR3-DQ2 is double serotype that specifically recognizes cells from individuals who carry a multigene HLA DR, DQ haplotype.Certain HLA DR and DQ genes have known involvementin autoimmune diseases. DR3-DQ2, a multigene...
/DR7-DQ2) phenotype. Patients with DQ2.5/DQ2.2 tend to be the most prone toward GSE, have the highest risk for GS-EATL, and shows signs of more severe disease at diagnosis.
While DQ2.5/DQ2 phenotype represents only 25% of celiac patients, it accounts for all of the ASE celiacs, and 60-70% of patients with GS-EATL.
Synthetic avenin peptides were synthesized either in native or deamidated form, the deamidated peptides showed higher response.
DQ2.5/T-cell receptor recognition from 2 Oat-sensitive coeliacs
TCR-Site1 Y Q P Y P E Q E~E~P F V
TCR-Site2 Q Y Q P Y P E Q Q Q P F V Q Q Q Q
Antibody recognition site(see above)
CIP2 (γ-avenin) T T T V Q Y D P S E Q Y Q P Y P E Q Q Q P F V Q Q Q P P F
The overlap of the antibody and T-cell sites, given trypsin digestion of avenin, suggest this region is dominant in immunity. The TCR-site1 was synthetically made as deamidated ("~E~") and native peptide requires transglutaminase to reach full activation. Two studies to date have looked at the ability for different oat-strains to promote various immunochemical aspects of celiac disease. While preliminary these studies indicate different strains may have different risk for avenin-sensitivity
Oats and coeliac disease
There is a great deal of conflicting information regarding the inclusion of oats within a gluten-free diet. Although cross-contamination in the field and during processing partially explains the different reactions that celiacs can have to oat, a recent study indicates that there are also different amounts of gluten present in different cultivars of oat. The G12 antibody, used in the study, is currently the only one that can reliably distinguish between varieties of oat. Previous studies have indicated both children and adult coeliacs are largely tolerant of oats. Other studies have followed both children and adults for 1, 2 and 5 years on the 'uncontaminated'-oat containing gluten-free diet. These studies failed to show significant changes in intestinal morphology indication a relapse of celiac disease. Anti-gliadin and reticulin antibodies as well as numbers of intraepithelial lymphocytes (IELs) did not differ significantly between oat-eating celiacs and non-oat eating controls in remission. Invitro tests that are sensitive to wheat gluten found that tryptic peptides of avenin could not induce EMA production in supernatant fluid from cultured duodenal mucosa specimen from celiac patients.Algorithms that successfully predict T cell stimulatory peptides in gluten identified many similar peptides in hordeins and secalins but not in oat avenins.
The Canadian Celiac Association suggests that adults can consume up to 70g of oats and children up to 25g per day, however, two studies indicated that adults could consume 93 grams (3.3 ounces) of oats per day. There is no evidence that oats can trigger GSE, only that in a small number of celiacs disease can be sustained or reinitiated by oats once triggered by wheat. A recent paper examining the IEL of celiac patients in remission showed a significantly higher number of IEL in oat-eating celiacs, in addition antibodies to avenin remain low as long as the diet is gluten-free but higher anti-avenin antibodies can increase with a diet containing wheat.
Some coeliacs respond adversely to oats. Estimates range from 0.5 to 20% of the GSE population. With coeliac disease non-compliance to achieve normal intestinal morphology is a risk factor for refractory disease and cancer.