Celiac Disease and Sensitization to Wheat, Rye, and Barley: Should We Be Concerned?

Abstract

<b><i>Background:</i></b> Concomitance of celiac disease (CD) and IgE-mediated wheat allergy is described in some case reports. The objective was to evaluate the frequency of sensitization to wheat, rye, barley, and malt in children and adolescents with CD. <b><i>Methods:</i></b> Measurement of serum levels of specific IgE to wheat, rye, barley, and malt (ImmunoCAP; sensitization IgE ≥0.35 kUA/L) in CD patients followed in specialized clinics to verify allergy history, general characteristics, small bowel biopsy characteristics, compliance with gluten-free diet (GFD), and occurrence of symptoms in case of noncompliance. <b><i>Results:</i></b> We evaluated 74 patients; the median of age and age at diagnosis of CD were 8.6 years (5.0–12.8) and 3.6 years (1.6–7.0), respectively. Median time of GFD was 3.5 years (1.4–5.8). History of asthma occurred in 17.3% of subjects, allergic rhinitis in 13.5%, and AD in 5.4%. Frequency of sensitization was 4% for wheat, 10.8% for rye, 5.4% for barley, and 2.7% for malt. There was no association between wheat sensitization and age at diagnosis, time of GFD, small bowel biopsy characteristics, allergy history, and gluten consumption. There was no relationship between sensitization to wheat and occurrence of immediate symptoms when not complying with GFD. <b><i>Conclusion:</i></b> In conclusion, the frequency of sensitization to wheat, rye, barley, and malt in CD patients was 4, 10.8, 5.4, and 2.7%, respectively. Therefore, to ensure that cutaneous and respiratory contact with wheat is safe, we advise patients with CD to investigate their sensitivity to wheat, rye, and barley because not all patients with CD are allergic to these cereals.

IgE-Dependent Allergy in Patients with Celiac Disease: A Systematic Review

“…An analysis of six original studies ( Table 2 ) revealed a possible coexistence of CD and A-IgE in four of them; however, two of them did not confirm this correlation. Among the papers confirming the possibility of an A-IgE occurrence in subjects with CD, two papers concerned allergies [ 14 , 15 ] and another two concerned sensitization [ 12 , 16 ]. Among the studies included in the analysis, there were four prospective [ 14 , 15 ] and two retrospective research studies [ 12 , 16 ].…”

“…Among the papers confirming the possibility of an A-IgE occurrence in subjects with CD, two papers concerned allergies [ 14 , 15 ] and another two concerned sensitization [ 12 , 16 ]. Among the studies included in the analysis, there were four prospective [ 14 , 15 ] and two retrospective research studies [ 12 , 16 ]. Five of the six studies were conducted in Europe [ 12 , 14 , 15 , 17 , 18 ].…”

“…The groups of patients in the analyzed studies were also not homogeneous. In four out of the six analyzed original papers, the study groups included both adults and children [ 15 , 16 , 17 , 18 ]. However, in one of them, there were children over 14 years of age and adults [ 17 ]; the second included subjects from 1 to 20 years of age [ 16 ].…”

“…In four out of the six analyzed original papers, the study groups included both adults and children [ 15 , 16 , 17 , 18 ]. However, in one of them, there were children over 14 years of age and adults [ 17 ]; the second included subjects from 1 to 20 years of age [ 16 ]. In the other two studies, only children [ 12 ] and adults [ 14 ] were analyzed.…”

“…In the subjects with CD included in this analysis, sensitization (based on the measurement of the concentration of specific immunoglobulin E (sIgE) in the blood serum) ranged from 16.6–20.0% when sIgE was tested to more than one allergen [ 12 , 14 ]. The most frequently tested allergens were those containing gluten (e.g., wheat, rye, and barley) [ 15 , 16 , 18 ]. The analysis showed that the frequency of a wheat allergy in subjects with CD ranged from 4.0–7.0% [ 15 , 16 ].…”