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Favorable Prognosis of Wheat Allergy in Adults

Scibilia J1, Rossi Carlo M1, Losappio Laura M1, Mirone C1, Farioli L2, Pravettoni V3, Pastorello EA1

1Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
2Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
3Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy

J Investig Allergol Clin Immunol 2019; Vol 29(2) : 118-123
doi: 10.18176/jiaci.0296

Background: Wheat ingestion can lead to disorders such as IgE-mediated food allergy and wheat-dependent exercise-induced anaphylaxis (WDEIA), both of which are associated with impaired quality of life and significant morbidity. Allergy to wheat is relatively benign in children, although its natural history in adults is still unknown.
Objective: We used placebo-controlled challenge to evaluate the natural history of wheat hypersensitivity in atopic patients with adultonset
wheat allergy.
Methods: We enrolled 13 patients from an initial cohort of adult patients with IgE-mediated wheat allergy (mean age, 40 years). After diagnosis, the patients observed a wheat-free diet and were followed as outpatients for 5 years to evaluate wheat exposure. Wheat-IgEtiters were determined at the end of follow-up, and a second wheat-challenge was performed.
Results: Ten out of 13 patients took part in the study. The mean period of wheat avoidance was 4.2 years. Three patients had spontaneously reintroduced wheat before the second evaluation, after a mean (IQR) of 28 (18-36) months, with only mild gastrointestinal discomfort at reintroduction. At the end of follow-up, 9 of the 10 patients were wheat-tolerant. Two patients had a history of WDEIA. We observed a reduction in IgE levels, with median (IQR) IgE falling from 2.77 (0.35-100) kU/L at diagnosis to 0.88 (0.1-20.8) kU/L. The association between IgE and a negative challenge result was not statistically significant.
Conclusion: IgE-mediated wheat allergy in adults is benign and represents a temporary break in gastrointestinal tolerance. Future studies may improve our knowledge of wheat allergens, routes of and factors leading to sensitization, and prognostic biomarkers.

Key words: Wheat allergy, Adult food allergy, Food tolerance, Double-blind placebo-controlled food challenge