ImuPro – unconscionable

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Posted 07 May 2014

ImuPro, a blood test offered by  WellPro, a division of Molecular Diagnostic Services (Pty) Ltd, is bringing Dr Camille Lieners to South Africa in order to promote this blood test for assessing “hypersensitiivies”. It should be noted that Dr Lieners is neither a medical doctor nor a dietitian. She has a PhD from Luxembourg. She is, in other words, not a clinician, and does not directly care for healthy people or patients. But she is dispensing clinical ‘advice’. It is unclear what her ‘PhD’ was about, and it is unclear why she should be regarded as an expert in the clinical setting.

The owner of  Molecular Diagnostic Services, Dr Dennis York, continues to promote this product for assessing “hypersensitivies” in spite of ASA rulings against the claims, and in spite of international consensus and position statements from allergy societies and representative organisations throughout the world including the Allergy Society of South Africa. This has resulted in a formal complaint being laid against Dr Dennis York with the Health Professions Council of South Africa.

In science, one may have a conflicting opinion on evidence when open to a different interpretation – and debate is welcomed. However, when evidence is in agreement and convincing, this becomes problematical. When researchers however take evidence and twist it, that becomes unconscionable.

Dr Lieners, in a personal communication to me, argued that “I agree that there is a discrepancy between academic opinion and practical experience concerning the importance and impact on human health of IgG against food. What counts at the end is the patient. Progress is science and medicine is guaranteed by controversial discussion not by avoiding them.” My response was “Therefore your claim that there is a ‘discrepancy between academic opinion and practical experience’ is false. Our practical experience fits in very well with our academic opinion based on scientific support.

Note, IgG testing is a valid test for a specific range of conditions (“illnesses”) – but not for  delayed allergy or “hypersensitivies” – the evidence does not support this claim.

WellPro has advertised Dr Lieners upcoming presentations in May, in support of ImuPro, to health professionals. An advert was placed in a newsletter. I have asked for the right to reply. I am copying the contents of that letter to CamCheck.

Dear xxxx,

WellPro, a division of Molecular Diagnostic Services (Pty) Ltd has a presentation titled, “Diverse impact of Food Hypersensitivities on Health” by Dr Lieners (“from R-Biopharm (ImuPro), Germany” and “a leading international voice on the topic of hypersensitivities”.) Dr Lieners is promoting the ImuPro test, claimed to be effective in assessing food hypersensitivity. ImuPro measures IgG.

As advertising has been directed, inter alia, at members of xxxx, I have requested a right to reply.

Although IgG is a valid test in a range of other conditions, e.g., recurrent infections, in fact there is no evidence that the ImuPro test is predictive or helpful in assessing hypersensitivities. Prof. Mike Levin of the Allergy Clinic at the Red Cross Hospital has recently stated: “In fact, in our clinical experience, constructing a diet based on IgG testing may be to the detriment of patients and adversely affect their health, as restriction diets based on poor evidence can not only lead to malnutrition of specific micronutrients as well as macronutrients, but the avoidance of food may even lead to loss of natural tolerance and the paradoxical acquisition of food allergies.”

Major allergy societies and representative groups, including the Allergy Society of South Africa, the Australasian Society of Clinical Immunology and Allergy, the European Academy of Allergology and Clinical Immunology and the American Academy of Allergy Asthma & Immunology have discounted the usefulness of IgG testing for hypersensitivity reactions.[1]

The Advertising Standards Authority has upheld multiple complaints against the claims being made for the ImuPro.[2] Robyn Duarte, WellPro’s dietician, claims that my complaints against IgG had been withdrawn but this is false.

Dr Lieners claims that all allergy societies, including the major representative organisations, have got it wrong. At the ImuPro Australian website [3], she makes the following claims:

The papers brought forward by the Allergy Society to show the uselessness of IgG is strictly dealing with type 1 allergy. None of the papers cited (13, 14, 15, 16, 17, 18,19, 20, 21, 26) rely on scientific works of IgG mediated immune response. No published scientific papers are in support of the claims of allergy societies. All statements done are polemic and represent the personnel opinion of some individuals without support of scientific works.”; and,

The statement and comments made in several publications (13, 14, 15, 16, 17,18,19, 20, 21) are misleading, as they all relate to type 1 allergy. Nobody in the field of IgG testing is referring to type 1 allergy; ImuPro is definitely not addressing allergy type 1 issues.

This is misinformation at its best and cherry picking at its worst. I have written to the executive members of three of the Allergy Societies whose position statements she dismisses. All have repudiated her claims. The responses are available at your request.

The facts are:

  1. Allergy Societies have NOT claimed that IgG is related to type 1 allergy but that that a large body of research has demonstrated that its usefulness in predicting or assessing the foods involved in the conditions being investigated was inadequate. The efficacy of IgG was not evaluated only in relation to type 1 allergy alone but in the wide context all food/hypersensitivity reactions.
  2. There are no adequate studies demonstrating the effectiveness of IgG in hypersensitivity reactions but a vast body of studies directly or indirectly demonstrating its lack of usefulness.
  3. The claims that IgG testing has benefit in IBS has been discounted in a recent review.[4] Dr Lieners was involved in a 2010 study demonstrating the efficacy of IgG testing in reducing migraine attacks (a statistical significant reduction from 10.5 to 7.5 days, and 9 to 6.2 attacks – not of high clinical significance) [5] but discounted in the same journal by more credible scientists. [6]

It is unconscionable to be offering IgG tests for financial gain when there is no robust data to support the claims being made.

Her statement that “All statements done are polemic and represent the personnel opinion of some individuals without support of scientific works” in itself is disingenuous and demonstrates intent to misinform. For example, the combined American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology position statement was constructed by 20 senior scientists and approved by an extended review panel.[7]

I therefore caution health professionals who do attend these events, to be cautious in accepting Dr Liener’s opinion at face value: it is not supported by the facts.

Dr Harris Steinman

  1. http://www.allergysa.org/pdfs/intolerance_tests.pdf
  2. http://www.camcheck.co.za/tag/imupro/
  3. http://www.imupro.com.au/2012-igg-food-intolerance-a-controversial-discussion-by-dr-camille-lieners
  4. http://www.camcheck.co.za/imupro-not-good-again/
  5. Alpay K1, Ertas M, Orhan EK, Ustay DK, Lieners C, Baykan B. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010 Jul;30(7):829-37. http://www.ncbi.nlm.nih.gov/pubmed/20647174
  6. Pascual J, Oterino A. IgG-mediated allergy: a new mechanism for migraine attacks? Cephalalgia. 2010 Jul;30(7):777-9. http://cep.sagepub.com/content/30/7/777.full
  7. Bernstein IL, et al.; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008 Mar;100(3 Suppl 3):S1-148. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/allergydiagnostictesting.pdf
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