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Wheat allergy: diagnosis and management

Authors Cianferoni A

Received 21 August 2015

Accepted for publication 22 October 2015

Published 29 January 2016 Volume 2016:9 Pages 13—25

DOI https://doi.org/10.2147/JAA.S81550

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Prof. Dr. Saeed Kolahian

Peer reviewer comments 4

Editor who approved publication: Dr Amrita Dosanjh

Antonella Cianferoni

Department of Pediatrics, Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, PA, USA

Abstract: Triticum aestivum (bread wheat) is the most widely grown crop worldwide. In genetically predisposed individuals, wheat can cause specific immune responses. A food allergy to wheat is characterized by T helper type 2 activation which can result in immunoglobulin E (IgE) and non-IgE mediated reactions. IgE mediated reactions are immediate, are characterized by the presence of wheat-specific IgE antibodies, and can be life-threatening. Non-IgE mediated reactions are characterized by chronic eosinophilic and lymphocytic infiltration of the gastrointestinal tract. IgE mediated responses to wheat can be related to wheat ingestion (food allergy) or wheat inhalation (respiratory allergy). A food allergy to wheat is more common in children and can be associated with a severe reaction such as anaphylaxis and wheat-dependent, exercise-induced anaphylaxis. An inhalation induced IgE mediated wheat allergy can cause baker’s asthma or rhinitis, which are common occupational diseases in workers who have significant repetitive exposure to wheat flour, such as bakers. Non-IgE mediated food allergy reactions to wheat are mainly eosinophilic esophagitis (EoE) or eosinophilic gastritis (EG), which are both characterized by chronic eosinophilic inflammation. EG is a systemic disease, and is associated with severe inflammation that requires oral steroids to resolve. EoE is a less severe disease, which can lead to complications in feeding intolerance and fibrosis. In both EoE and EG, wheat allergy diagnosis is based on both an elimination diet preceded by a tissue biopsy obtained by esophagogastroduodenoscopy in order to show the effectiveness of the diet. Diagnosis of IgE mediated wheat allergy is based on the medical history, the detection of specific IgE to wheat, and oral food challenges. Currently, the main treatment of a wheat allergy is based on avoidance of wheat altogether. However, in the near future immunotherapy may represent a valid way to treat IgE mediated reactions to wheat.

Keywords: IgE mediated food allergy, non-IgE mediated food allergy, wheat allergy, baker’s asthma, wheat dependent exercise induced anaphylaxis, eosinophilic esophagitis, eosinophilic gastritis

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