Background-A key immunological feature of food allergy (FA) is the presence of a T-helper-2 (Th2)-type cytokine bias. Ligation of the invariant natural killer T cell (iNKT) T cell receptor (TCR) by sphingolipids (SL) presented via the CD1d molecule leads to copious secretion of Th2-type cytokines. Major food allergens (e.g. milk, egg) are the richest dietary source of SL (food-SL). Nonetheless, the role of iNKTs in FA is unknown.

Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency associated with an increased susceptibility

BackgroundWheat allergy is among the most common food allergy in children, but few publications are available assessing the risk of anaphylaxis due to wheat.MethodsIn this study, we report the case of near-fatal anaphylaxis to wheat in a patient undergoing an oral food challenge (OFC) after the ingestion of a low dose (256 mg) of wheat. Moreover, for the first time, we analyzed the risk of anaphylaxis during an OFC to wheat in 93 children, compared to other more commonly challenged foods such as milk, egg, peanuts, and soy in more than 1000 patients.ResultsThis study, which includes a large number of OFCs to wheat, shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration (Odds Ratio [OR] = 2.4) and anaphylaxis requiring epinephrine administration to low dose antigen (OR = 8.02). Other risk factors for anaphylaxis, anaphylaxis requiring epinephrine administration, and anaphylaxis to low dose antigen was a history of a prior reaction not involving only the skin (OR = 1.8, 1.9 and 1.8 respectively). None of the clinical variables available prior to performing the OFC could predict which children among those undergoing OFCs to wheat would develop anaphylaxis or anaphylaxis for low dose antigen.ConclusionThis study shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration and anaphylaxis requiring epinephrine administration to low dose antigen.

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