Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Allergy
Published in: Clinical and Translational Allergy 1/2014

Open Access 01-12-2014 | Research

Patterns of suspected wheat-related allergy: a retrospective single-centre case note review in 156 patients

Authors: Morten J Christensen, Esben Eller, Charlotte G Mortz, Carsten Bindslev-Jensen

Published in: Clinical and Translational Allergy | Issue 1/2014

Login to get access

Abstract

Background

Allergy to wheat can present clinically in different forms: Sensitization to ingested wheat via the gastrointestinal tract can cause traditional food allergy or in combination with exercise, Wheat-Dependent Exercise-Induced Anaphylaxis (WDEIA). Sensitization to inhaled wheat flour may lead to occupational rhinitis and/or asthma.

Methods

We retrospectively reviewed the case notes of 156 patients (age 0.7 – 73.3 years) with a case history of wheat allergy. The population was divided into three groups, 1: Wheat allergy elicited by ingestion, 2: By inhalation and 3: WDEIA. All patients were examined with detailed case history, specific IgE (sIgE), Skin Prick Test (SPT) and wheat challenge (nasal or oral ± exercise). Details of the case history were extracted from the patients´ case records.

Results

Group 1: Twenty one of 95 patients were challenge positive (15 children, 6 adults). All children had atopic dermatitis, and most (13/15) outgrew their wheat allergy. Most children (13/15) had other food allergies. Challenge positive patients showed significantly higher levels of sIgE to wheat and significantly more were SPT positive than challenge negative.
Group 2: Eleven out of 13 adults with occupational asthma or rhinitis were challenge positive. None outgrew their allergy. Seven had positive sIgE and 10 had positive SPT to wheat.
Group 3: Ten of 48 (adolescent/adults) were positive when challenged during exercise. Challenge positive patients showed significantly higher levels of sIgE to ω-5-gliadin. The natural course is presently unknown.

Conclusion

Wheat allergy can manifest in different disease entities, rendering a detailed case history and challenge mandatory. Patient age, occupation, concomitant allergies (food or inhalant) and atopic dermatitis are important factors for evaluation.
Appendix
Available only for authorised users
Literature
1.
Battais F, Richard C, Jacquenet S, Denery-Papini S, Moneret-Vautrin DA: Wheat grain allergies: an update on wheat allergens. Eur Ann Allergy Clin Immunol. 2008, 40: 67-76.PubMed
2.
Palosuo K: Update on wheat hypersensitivity. Curr Opin Allergy Clin Immunol. 2003, 3: 205-209. 10.1097/00130832-200306000-00009.CrossRefPubMed
3.
Morita E, Kunie K, Matsuo H: Food-dependent exercise-induced anaphylaxis. J Dermatol Sci. 2007, 47: 109-117. 10.1016/j.jdermsci.2007.03.004.CrossRefPubMed
4.
Brant A: Baker's asthma. Curr Opin Allergy Clin Immuno. 2007, 7: 152-155. 10.1097/ACI.0b013e328042ba77.CrossRef
5.
Moscato G, Vandenplas O, Gerth Van Wijk R, Malo JL, Quirce S, Walusiak J, Castano R, De Groot H, Folletti I, Gautrin D, Yacoub MR, Perfetti L, Siracusa A: Occupational rhinitis. Allergy. 2008, 63: 969-980.CrossRefPubMed
6.
Castano R, Malo JL: Occupational rhinitis and asthma: where do we stand, where do we go?. Curr Allergy Asthma Rep. 2010, 10: 135-142. 10.1007/s11882-010-0092-4.CrossRefPubMed
7.
Sampson HA: Anaphylaxis and emergency treatment. Pediatrics. 2003, 111: 1601-1608.PubMed
8.
Eller E, Hansen TK, Bindslev-Jensen C: Clinical thresholds to egg, hazelnut, milk and peanut: results from a single-center study using standardized challenges. Ann Allergy Asthma Immunol. 2012, 108: 332-336. 10.1016/j.anai.2012.03.010.CrossRefPubMed
9.
Bruce RA, Blackmon JR, Jones JW, Strait G: Exercising testing in adult normal subjects and cardiac patients. Pediatrics. 1963, 32 (Suppl): 742-756.PubMed
10.
Perkins NJ, Schisterman EF: The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006, 163: 670-675. 10.1093/aje/kwj063.PubMedCentralCrossRefPubMed
11.
Niggemann B, Sielaff B, Beyer K, Binder C, Wahn U: Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy. 1999, 29: 91-96. 10.1046/j.1365-2222.1999.00454.x.CrossRefPubMed
12.
Sicherer SH, Morrow EH, Sampson HA: Dose–response in double-blind, placebo-controlled oral food challenges in children with atopic dermatitis. J Allergy Clin Immunol. 2000, 105: 582-586. 10.1067/mai.2000.104941.CrossRefPubMed
13.
Scibilia J, Pastorello EA, Zisa G, Ottolenghi A, Bindslev-Jensen C, Pravettoni V, Scovena E, Robino A, Ortolani C: Wheat allergy: a double-blind, placebo-controlled study in adults. J Allergy Clin Immunol. 2006, 117: 433-439. 10.1016/j.jaci.2005.10.014.CrossRefPubMed
14.
Airaksinen LK, Tuomi TO, Tuppurainen MO, Lauerma AI, Toskala EM: Inhalation challenge test in the diagnosis of occupational rhinitis. Am J Rhinol. 2008, 22: 38-46. 10.2500/ajr.2008.22.3117.CrossRefPubMed
15.
Dohi M, Suko M, Sugiyama H, Yamashita N, Tadokoro K, Juji F, Okudaira H, Sano Y, Ito K, Miyamoto T: Food-dependent, exercise-induced anaphylaxis: a study on 11 Japanese cases. J Allergy Clin Immunol. 1991, 87: 34-40. 10.1016/0091-6749(91)90210-F.CrossRefPubMed
16.
Romano A, Di Fonso M, Giuffreda F, Papa G, Artesani MC, Viola M, Venuti A, Palmieri V, Zeppilli P: Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol. 2001, 125: 264-272. 10.1159/000053825.CrossRefPubMed
17.
Aihara Y, Takahashi Y, Kotoyori T, Mitsuda T, Ito R, Aihara M, Ikezawa Z, Yokota S: Frequency of food-dependent, exercise-induced anaphylaxis in Japanese junior-high-school students. J Allergy Clin Immunol. 2001, 108: 1035-1039. 10.1067/mai.2001.119914.CrossRefPubMed
18.
Pacharn P, Jirapongsananuruk O, Daengsuwan T, Vichyanond P, Visitsunthorn N: Wheat-dependent, exercise-induced anaphylaxis in Thai children: a report of 5 cases. Asian Pac J Allergy Immunol. 2009, 27: 115-120.PubMed
19.
Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA: The natural history of wheat allergy. Ann Allergy Asthma Immunol. 2009, 102: 410-415. 10.1016/S1081-1206(10)60513-3.CrossRefPubMed
20.
Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA: Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. 1998, 101: E8-CrossRefPubMed
21.
Maghni K, Lemière C, Ghezzo H, Yuquan W, Malo J-L: Airway inflammation after cessation of exposure to agents causing occupational asthma. Am J Respir Crit Care Med. 2004, 169: 367-372. 10.1164/rccm.200309-1238OC.CrossRefPubMed
22.
Ring J, Behrendt H, de Weck A: History and classification of anaphylaxis. Chem Immunol Allergy. 2010, 95: 1-11.CrossRefPubMed
23.
Quirce S, Fernandez-Nieto M, Escudero C, Cuesta J, de Las HM, Sastre J: Bronchial responsiveness to bakery-derived allergens is strongly dependent on specific skin sensitivity. Allergy. 2006, 61: 1202-1208. 10.1111/j.1398-9995.2006.01189.x.CrossRefPubMed
24.
Majamaa H, Moisio P, Holm K, Turjanmaa K: Wheat allergy: diagnostic accuracy of skin prick and patch tests and specific IgE. Allergy. 1999, 54: 851-856. 10.1034/j.1398-9995.1999.00081.x.CrossRefPubMed
25.
Martens M, Schnoor HJ, Malling HJ, Poulsen LK: Sensitization to cereals and peanut evidenced by skin prick test and specific IgE in food-tolerant, grass pollen allergic patients. Clin Transl Allergy. 2011, 1: 15-10.1186/2045-7022-1-15.PubMedCentralCrossRefPubMed
26.
Matsuo H, Dahlstrom J, Tanaka A, Kohno K, Takahashi H, Furumura M, Morita E: Sensitivity and specificity of recombinant omega-5 gliadin-specific IgE measurement for the diagnosis of wheat-dependent exercise-induced anaphylaxis. Allergy. 2008, 63: 233-236. 10.1111/j.1398-9995.2007.01504.x.CrossRefPubMed
27.
Matsuo H, Kohno K, Niihara H, Morita E: Specific IgE determination to epitope peptides of omega-5 gliadin and high molecular weight glutenin subunit is a useful tool for diagnosis of wheat-dependent exercise-induced anaphylaxis. J Immunol. 2005, 175: 8116-8122. 10.4049/jimmunol.175.12.8116.CrossRefPubMed
28.
Pahr S, Constantin C, Mari A, Scheiblhofer S, Thalhamer J, Ebner C, Vrtala S, Mittermann I, Valenta R: Molecular characterization of wheat allergens specifically recognized by patients suffering from wheat-induced respiratory allergy. Clin Exp Allergy. 2012, 42: 597-609. 10.1111/j.1365-2222.2012.03961.x.CrossRefPubMed
29.
Pastorello EA, Farioli L, Conti A, Pravettoni V, Bonomi S, Iametti S, Fortunato D, Scibilia J, Bindslev-Jensen C, Ballmer-Weber B, Robino AM, Ortolani C: Wheat IgE-mediated food allergy in European patients: alpha-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins. Allergenic molecules recognized by double-blind, placebo-controlled food challenge. Int arch Allergy Immun. 2007, 144: 10-22. 10.1159/000102609.CrossRef
Metadata
Title
Patterns of suspected wheat-related allergy: a retrospective single-centre case note review in 156 patients
Authors
Morten J Christensen
Esben Eller
Charlotte G Mortz
Carsten Bindslev-Jensen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Clinical and Translational Allergy / Issue 1/2014
Electronic ISSN: 2045-7022
DOI
https://doi.org/10.1186/2045-7022-4-39

Other articles of this Issue 1/2014

Clinical and Translational Allergy 1/2014 Go to the issue

Review

Sensitizing properties of proteins: executive summary

Brief communication

Influence of alpine mountain climate of Bavaria on patients with atopic diseases: studies at the Environmental Research Station Schneefernerhaus (UFS - Zugspitze) – a pilot study

Review

Role of the skin microbiome in atopic dermatitis

Review

Schnitzler’s syndrome: lessons from 281 cases

Research

High-dose intravenous immunoglobulin therapy for eosinophilic granulomatosis with polyangiitis

Research

Positive serum specific IgE has a short half-life in patients with penicillin allergy and reversal does not always indicate tolerance