title: Wheat allergy in children evaluated with challenge and IgE antibodies to wheat components.
abstract: BACKGROUND
  Wheat sensitization is common but IgE antibodies (IgE-abs) to wheat are not predictive of clinical symptoms in children with suspected wheat allergy. Wheat allergen components other than ω-5 gliadin have not been well studied. Our aim was to characterize the clinical profile and investigate the value of adding measurements of IgE-abs to wheat components in a group of children with a doctor's diagnosed wheat allergy.
  
  
  METHODS
  Sixty-three children with a doctor's diagnosis of wheat allergy confirmed sensitization to wheat and, on a wheat elimination diet, went through oral wheat challenges or had a convincing recent history of wheat allergy. IgE-ab to ω-5 gliadin, low molecular weight glutenin (LMW-glutenin), high molecular weight glutenin (HMW-glutenin) and a native gliadin preparation containing α-, β-, γ-, and ω-gliadin (gliadin) were analyzed.
  
  
  RESULTS
  Twenty-six children were positive in challenge, while six children were regarded as wheat allergic due to recent anaphylactic reactions. The IgE-ab levels to all four wheat components were significantly higher in the group with wheat allergy compared to the group with no wheat allergy (p < 0.0001). Also, the severity of symptoms at challenge correlated with the IgE-ab levels to all four components (p < 0.05). IgE-ab levels to ω-5 gliadin correlated best with challenge outcome, and by additional analysis of gliadin, HMW- and LMW-glutenin IgE-abs all challenge positive children could be identified.
  
  
  CONCLUSIONS
  Many children diagnosed as wheat allergic have outgrown their allergy and are unnecessarily on a wheat-free diet. The levels of IgE-ab to wheat gluten-derived components correlated well with wheat challenge outcome and severity.
authors.affiliation: Q204 Lung/Allergy Department, Karolinska Institutet and Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Nora
authors.initials: N
authors.lastname: Nilsson
authors.forename: Sigrid
authors.initials: S
authors.lastname: Sjölander
authors.forename: Alexandra
authors.initials: A
authors.lastname: Baar
authors.forename: Malin
authors.initials: M
authors.lastname: Berthold
authors.forename: Sandra
authors.initials: S
authors.lastname: Pahr
authors.forename: Susanne
authors.initials: S
authors.lastname: Vrtala
authors.forename: Rudolf
authors.initials: R
authors.lastname: Valenta
authors.forename: Eishin
authors.initials: E
authors.lastname: Morita
authors.forename: Gunilla
authors.initials: G
authors.lastname: Hedlin
authors.forename: Magnus P
authors.initials: MP
authors.lastname: Borres
authors.forename: Caroline
authors.initials: C
authors.lastname: Nilsson
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007159:Immunologic Tests / Q000379:methods*; D007223:Infant; D008297:Male; D021182:Wheat Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: IgE; allergy; children; food challenge; gliadin; glutenin; wheat; ω-5 gliadin