title: Patterns of suspected wheat-related allergy: a retrospective single-centre case note review in 156 patients.
abstract: BACKGROUND
  Allergy to wheat can present clinically in different forms: Sensitization to ingested wheat via the gastrointestinal tract can cause traditional food allergy or in combination with exercise, Wheat-Dependent Exercise-Induced Anaphylaxis (WDEIA). Sensitization to inhaled wheat flour may lead to occupational rhinitis and/or asthma.
  
  
  METHODS
  We retrospectively reviewed the case notes of 156 patients (age 0.7 - 73.3 years) with a case history of wheat allergy. The population was divided into three groups, 1: Wheat allergy elicited by ingestion, 2: By inhalation and 3: WDEIA. All patients were examined with detailed case history, specific IgE (sIgE), Skin Prick Test (SPT) and wheat challenge (nasal or oral ± exercise). Details of the case history were extracted from the patients´ case records.
  
  
  RESULTS
  Group 1: Twenty one of 95 patients were challenge positive (15 children, 6 adults). All children had atopic dermatitis, and most (13/15) outgrew their wheat allergy. Most children (13/15) had other food allergies. Challenge positive patients showed significantly higher levels of sIgE to wheat and significantly more were SPT positive than challenge negative. Group 2: Eleven out of 13 adults with occupational asthma or rhinitis were challenge positive. None outgrew their allergy. Seven had positive sIgE and 10 had positive SPT to wheat. Group 3: Ten of 48 (adolescent/adults) were positive when challenged during exercise. Challenge positive patients showed significantly higher levels of sIgE to ω-5-gliadin. The natural course is presently unknown.
  
  
  CONCLUSIONS
  Wheat allergy can manifest in different disease entities, rendering a detailed case history and challenge mandatory. Patient age, occupation, concomitant allergies (food or inhalant) and atopic dermatitis are important factors for evaluation.
authors.affiliation: Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark.
authors.forename: Morten J
authors.initials: MJ
authors.lastname: Christensen
authors.affiliation: Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark.
authors.forename: Esben
authors.initials: E
authors.lastname: Eller
authors.affiliation: Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark.
authors.forename: Charlotte G
authors.initials: CG
authors.lastname: Mortz
authors.affiliation: Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Bindslev-Jensen
keywords: Age dependency; Natural course of wheat allergy; Wheat allergy; Wheat challenge; ω-5 gliadin