Clinical Features of Wheat Allergy Are Significantly Different between Tri a 14 Sensitized Patients and Tri a 19 Sensitized Ones

Abstract

<b><i>Introduction:</i></b> Wheat is the most important cereal for human nutrition but its high consumption is associated to an increasing complaint of wheat-related disorders, many of which are allergic in nature and different in respect to the involved allergens. In this study, we compared the clinical aspects of wheat allergy presented by patients sensitized to Tri a 19 in respect to those presented by patients sensitized to Tri a 14. <b><i>Methods:</i></b> With this aim, we selected patients sensitized to 1 or both of the 2 allergens, and among these we identified those who were really wheat allergic and reactive on the basis of a standardized methodology. We evaluated the clinical features such as the kind and severity of symptoms, the coexistence of triggering factors such as physical exercise and NSAIDs and alcohol consumption, and the association with other allergens and with various immunologic parameters. Wheat allergy in Tri a 19 sensitized patients was confirmed through a questionnaire while the patients sensitized to Tri a 14 underwent wheat challenge with 100 g of pasta followed by exercise on a treadmill. <b><i>Results:</i></b> Seventy-nine patients sensitized to Tri a 14 and 40 patients sensitized to Tri a 19 were recruited. The 2 sensitizations were independent with a significant inverse relation (<i>p</i> < 0.00001). The Tri a 19 sensitized patients presented, in respect to the Tri a 14 sensitized ones, an older age (<i>p</i> = 0.0017), a higher risk to be wheat allergic (<i>p</i> < 0.0001), a higher severity of the reactions (<i>p</i> < 0.00001) and a higher association with some cofactors, namely alcohol (<i>p</i> < 0.0005) and physical exercise (<i>p</i> = 0.003). On the contrary, Tri a 14 sensitization was associated with atopy (<i>p</i> < 0.0001), with a higher probability of patients being asymptomatic (<i>p</i> < 0.0001) and being sensitized to other foods, in particular to nuts and cereals (<i>p</i> < 0.00001). <b><i>Conclusions:</i></b> Sensitization to Tri a 19 or Tri a 14 determines different clinical pictures. In particular, sensitization to Tri a 19 implies a higher probability of severe reactions, even dependent on daily triggers, while that to Tri a 14 implies a higher cross-reactivity with other foods but it’s more frequently asymptomatic, making a food challenge necessary to prevent useless food avoidance.

Changes in IgG4 and IL-10 expression in adults with eosinophilic esophagitis on a two-food elimination diet

“…48 Thus, IgG4 production in response to distinct milk or wheat components may follow diverging trajectories and associate with distinct clinical phenotypes, as shown in IgE-dependent conditions. 49,50 The dynamics of IgG4 generation and effector function is still largely unknown and demands more work in suitable models. 28,51 Regardless, IgG4 production in EoE, while related to food antigen intake, could be a side occurrence rather than an active player of the ensuing histopathology in at least some cases.…”

Elicitors and phenotypes of adult patients with proven IgE‐mediated food allergy and non‐immune‐mediated food hypersensitivity to food additives

“…Most studies, however, have been performed in paediatric cohorts and their role in adulthood has not been completely established. For example, Tri a 19 has been suggested for wheat allergy, 27,28 whereas for other allergens, like celery, the availability of recombinant allergen diagnostics is still limited.…”

Adult anaphylaxis: A state-of-the-art review

“…The pathogenesis of this food allergy is still elusive. As opposed to other forms of food allergy, such as "classical" IgE-mediated allergy to wheat, the presence of comorbid atopic disorders seems not be a relevant factor, at least in Central and Northern Europe, and has no gender prevalence [45] [46]. Exercise is thought to increase allergen absorption by modifying gastric and intestinal permeability, or through an increased plasma osmolarity, favoring mast cell activation [44].…”