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Nutritional approach may reduce recurrent eye inflammation
The diseased eye may signal a more general state of food-related inflammation.
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Recurrent severe keratitis and other forms of ocular inflammation may be food-related and may benefit from a nutritional approach, according to an immunologist speaking at the joint Refractive.online and SICCSO meeting.
Attilio Francesco Speciani, MD, presented the case of a 7-year-old girl who had recurrent keratitis with severe symptoms for more than 3 years that did not respond to conventional treatment.
“She had symptomatic epithelial dystrophy requiring frequent eye patching. Due to intense photophobia, she was forced to wear sunglasses also indoors. She had problems wearing contact lenses and needed two-hourly eye drop administration also at night, which disrupted her normal sleeping pattern,” Speciani said.
Speciani tested the patient’s levels of B cell-activating factor and platelet-activating factor, cytokines that are specific markers of food-related inflammation, and food-specific IgG levels.
“The girl had developed an inflammatory response to yeast and nickel-containing food. Once we found that this was the root of the problem, we put her on a specific diet aimed at gradually reactivating tolerance in a way similar to the weaning process,” he said.
Regaining food tolerance
According to Stockinger’s studies, newborns are intolerant to all foods, Speciani said. The gradual process of weaning aims to build up tolerance through stimulation of the anti-inflammatory protein interleukin 10.
“Our dietary plan, the RecallerProgram (GEK), retraces the physiological path of nutritional and immunological tolerance. The food groups that have been found responsible for the inflammatory reaction are entirely avoided some days of the week but mandatorily reintroduced some other days, typically Wednesday, Saturday evening and Sunday,” he said.
In this way, inflammation is reduced and tolerance is regained without unnecessary restrictions.
“No food should be eliminated, because the body needs to be re-educated to acceptance,” he said. “Having free meals with no restrictions is also psychologically and socially important.”
As the symptoms disappear, tests are repeated. If the patient’s levels are back to normal values, a maintenance regimen is used, with some restricted meals in which the immune-reactive foods are avoided entirely.
“This should be the principle of any healthy diet. Religions have given their own theological interpretation to this basic rule of nutritional hygiene. We become intolerant to the food we eat habitually in considerable quantities. Abstaining from it one day a week is a healthy habit that prevents building up intolerance,” Speciani said.
New treatment paradigm
To further boost the patient’s immune system, an oral immune therapy using a low-dose inducer for tolerance to house dust mites was administered in concomitance with the diet.
Low-dose tolerance inducers act at the level of T regulatory cells, Speciani said, reducing the overall reactivity rather than just the allergen-specific reaction of the organism.
The positive effects of the therapy were seen almost immediately. After 3 months, the patient’s signs and symptoms of keratitis had completely cleared.
“Understanding the hidden causes of chronic inflammation and the correlation between inflammation and nutrition is an important step forward,” Speciani said. “I’ve seen the benefits of this approach in the treatment of autoimmune diseases as well as all chronic inflammatory diseases. It’s a new treatment paradigm that can help us work better in many fields of medicine.”
In ophthalmology, excellent results can be obtained in inflammatory diseases such as Sjögren syndrome, overcoming the notion that the disease is in the eye and instead seeing it as a sign of a general state of inflammation, Speciani said.
“Great benefits can also come from using this nutritional approach with patients who undergo corneal transplantation. By down-regulating inflammation and immune reactivity, we promote fast healing and the settling of the graft, greatly reducing the chances of graft failure,” he said. – by Michela Cimberle