Abstract | BACKGROUND: The detection of wheat-specific IgE in children often leads to a suspicion of wheat allergy, but little information is available on the most reliable wheat allergens for predicting clinical reactivity. OBJECTIVE: To evaluate the role of allergenic components of wheat in wheat allergy diagnostics. METHODS: One hundred and eight children (median age 1.5 years; range 0.6-17.3 years) with suspected wheat allergy underwent open or double-blinded, placebo-controlled oral wheat challenges. Responsiveness to different allergenic components of wheat was studied by skin prick tests and by determination of serum IgE antibodies using a semi-quantitative microarray assay. RESULTS: Thirty (28%) children reacted with immediate symptoms, and 27 (25%) with delayed symptoms to ingested wheat, whereas 51 (47%) children exhibited no reactions in oral wheat challenges. Positive IgE responses to any of the 12 allergenic components of wheat was seen in 93%, 41%, and 43% of those with immediate, delayed or no reactions to ingested wheat, respectively (P < 0.001 to P < 0.05 in every comparisons between those with immediate reactions and those with no reactions). Positive IgE responses to ≥5 different allergenic components improved significantly the diagnostic accuracy (with a positive likelihood ratio (LR+) of 5.10). Alpha-amylase inhibitors (AAI), in particular dimeric AAI 0.19 (LR+ 6.12), alpha-, beta-, and gamma- gliadins (LR+ from 3.57 to 4.53), and high-molecular-weight (HMW) glutenin subunits (LR+ 4.37) were the single allergenic components of wheat differentiating most effectively those with immediate symptoms from those who did not exhibit any reactions. CONCLUSIONS AND CLINICAL RELEVANCE:
Wheat allergy diagnostics is difficult, even using sophisticated component methods. Our results confirm earlier findings about gliadins and identify the dimeric AAI 0.19, as a relevant allergen in clinically reactive patients when compared to non-reactive subjects. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several components of wheat.
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Authors | M J Mäkelä, C Eriksson, A Kotaniemi-Syrjänen, K Palosuo, J Marsh, M Borres, M Kuitunen, A S Pelkonen |
Journal | Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
(Clin Exp Allergy)
Vol. 44
Issue 11
Pg. 1420-30
(Nov 2014)
ISSN: 1365-2222 [Electronic] England |
PMID | 25146380
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | © 2014 John Wiley & Sons Ltd. |
Chemical References |
- Allergens
- Plant Proteins
- Immunoglobulin E
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Topics |
- Administration, Oral
- Adolescent
- Allergens
(administration & dosage, immunology)
- Antibody Specificity
(immunology)
- Child
- Child, Preschool
- Female
- Humans
- Immunoglobulin E
(blood, immunology)
- Infant
- Male
- Plant Proteins
(administration & dosage, immunology)
- ROC Curve
- Risk Factors
- Severity of Illness Index
- Skin Tests
- Triticum
(immunology)
- Wheat Hypersensitivity
(diagnosis, immunology)
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