Wheat allergy in celiac children

Introduction: Celiac disease and wheat allergy (WA) are infrequent diseases in the general population, and a combination of the 2 is particularly rare. Celiac disease occurs in around 1% of the general population and WA in around 1% of all children. Case Report: We report 2 patients with celiac disease and a gluten-free diet who developed WA consistent in anaphylaxis and an eyelid angioedema, respectively, through accidental wheat exposure. A serum study and an intestinal biopsy confirmed celiac disease. Both patients were studied with a skin prick test and serum-specific IgE, with a diagnosis of WA. Discussion: In patients with celiac disease, the trace amounts of cereals present in gluten-free food could act as a sensitization factor, and probably patients with persistent symptoms (despite a gluten-free diet) are experiencing WA symptoms rather than celiac disease symptoms. The number of patients diagnosed with celiac disease has increased in the recent decades: the association between celiac disease and WA, exceedingly rare to date, could increase as well, prompting special attention to the possibility of inadvertent intake of cereals.

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“…CD and WA are infrequent diseases in the general population, and a combination of the 2 is particularly rare [3-5]. …”

Section: Discussionmentioning

confidence: 99%

Celiac Disease and Wheat Allergy: A Growing Association?

Micozzi¹,

Infante²,

Fuentes‐Aparicio³

et al. 2018

Int Arch Allergy Immunol

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“…Micozzi et al presented two cases of children with coeliac disease who subsequently had allergic reactions to wheat due, it is proposed, by sensitization to the trace amounts of wheat in gluten-free foods (82). Another group from Spain also published case reports of two children with coeliac disease who developed allergic reactions immediately after accidental exposure to wheat, with the wheat allergen Tri a 14 (wheat LTP) the responsible allergen (83). There are few documented case reports of milk substitutes provoking anaphylaxis, but Gly m 4, the allergen in soy milk which cross-reacts to the main birch pollen allergen Bet v 1, has been shown to be capable of provoking severe reactions (84).…”

Section: Resultsmentioning

confidence: 99%

Food-Induced Anaphylaxis: Role of Hidden Allergens and Cofactors

Skypala

2019

Front. Immunol.

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Food anaphylaxis is on the increase, with those who have an allergy to peanuts, tree nuts, milk, and seafood at the highest risk of developing such a reaction. However, the diet in many societies is increasingly varied, much of the food consumed is prepared outside the home, and meals are often composed of many different ingredients. Anaphylaxis may occur to a composite food, and it may be unclear whether the reaction is due to contamination or to a culprit allergen present in an added ingredient. Composite foods can contain many allergic proteins present in small amounts, which do not always have to be labeled, unless they feature in European or US labeling regulations. These “hidden” allergens include mustard, celery, spices, lupine, pea, natural food colourings, and preservatives, but can occasionally include allergenic material from contaminants such as cereal mites. Hidden allergens can provoke severe reactions to seemingly unconnected foods which might then lead to a diagnosis of idiopathic anaphylaxis. The same problem can arise with two well-known types of food allergy; wheat-dependant exercise induced anaphylaxis and allergy to non-specific Lipid Transfer Protein allergens, both of which might only manifest when linked to a cofactor such as exercise. Many of these risk factors for food anaphylaxis have a common link; the public's engagement with popular concepts of health and fitness. This includes the development of a food and exercise culture involving the promotion and marketing of foods for their health-giving properties i.e., meat substitutes, wheat substitutes, supplements and alternative, or “natural” remedies for common ailments. Some of these foods have been reported as the cause of severe allergic reactions, but because they are often viewed as benign unlikely causes of severe allergic reactions, could be considered to be hidden allergens. The best resource to elicit the likelihood of a hidden allergen provoking an allergic reaction is to take a detailed history of the allergic reaction, presence of co-factors, foods suspected, type of food and where it was consumed. A good knowledge of commonly used ingredients, and list of potential hidden allergen suspects are essential tools for the food allergy detective.

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“…Other studies evaluating sensitization to wheat and/or rye, barley, and malt in CD patients did so as case reports (n = 9) [9][10][11][12][13][14][15]. Anaphylaxis episodes have been reported in 3 patients [12,14,15], 1 of whom died [12].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Anaphylaxis episodes have been reported in 3 patients [12,14,15], 1 of whom died [12]. In these reports, sIgE levels for wheat ranged from 2.99 to 100 kUA/L, for barley between 11.3 and 15.1 kUA/L, and for rye between 1.91 and 33.9 kUA/L [9][10][11][12][13][14][15]. The sIgE for malt was evaluated in only one patient and reached 24.5 kUA/L [9].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Studies show a higher occurrence of atopic dermatitis (AD), asthma, and rhinitis in CD patients [6][7][8]. Concomitance of CD and IgE-mediated WA, including anaphylaxis, is described in case reports and coexistence of Th1 and Th2 lymphocyte-mediated diseases is still under debate [8][9][10][11][12][13][14][15]. A Finnish study showed a high frequency of wheat sensitization (WS) (specific IgE ≥0.35 kUA/L) in CD patients, that is, 11.9% [8].…”

Section: Introductionmentioning

confidence: 99%

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

Lanzarin¹,

Silva²,

Venturieri³

et al. 2020

Int Arch Allergy Immunol

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Background: 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. Methods: 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. Results: 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. Conclusion: 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.

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Wheat allergy in celiac children

Cited by 6 publications

References 8 publications

Celiac Disease and Wheat Allergy: A Growing Association?

Celiac Disease and Wheat Allergy: A Growing Association?

Food-Induced Anaphylaxis: Role of Hidden Allergens and Cofactors

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

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