Wheat allergy: diagnosis and management.

Area of Science:

• Immunology
• Gastroenterology
• Allergology
• Occupational Health

Background:

• Triticum aestivum (bread wheat) is a global staple crop, but can trigger immune responses in susceptible individuals.
• Wheat allergy manifests as immunoglobulin E (IgE) and non-IgE mediated reactions, impacting both food ingestion and inhalation pathways.
• These reactions range from immediate, potentially life-threatening IgE responses to chronic gastrointestinal inflammation in non-IgE mediated conditions.

Purpose of the Study:

• To elucidate the diverse clinical presentations and diagnostic approaches for wheat allergy.
• To differentiate between IgE-mediated and non-IgE mediated wheat allergic reactions.
• To review current management strategies and explore future therapeutic avenues for wheat allergy.

Main Methods:

• Diagnosis of IgE-mediated wheat allergy involves medical history, specific IgE antibody detection, and oral food challenges.
• Non-IgE mediated conditions like eosinophilic esophagitis (EoE) and eosinophilic gastritis (EG) are diagnosed via elimination diets and tissue biopsies.
• Diagnostic procedures include esophagogastroduodenoscopy for tissue sampling to confirm inflammation.

Main Results:

• IgE-mediated reactions include immediate food allergies (anaphylaxis) and respiratory allergies (baker's asthma) from inhalation.
• Non-IgE mediated reactions primarily involve chronic eosinophilic inflammation in the gastrointestinal tract (EoE, EG).
• Wheat-dependent, exercise-induced anaphylaxis is a severe manifestation of IgE-mediated wheat allergy.

Conclusions:

• Wheat allergy presents with varied symptoms, necessitating precise diagnostic methods for accurate identification.
• Current primary treatment involves strict wheat avoidance, particularly crucial for managing severe allergic reactions.
• Immunotherapy holds promise as a future treatment option for IgE-mediated wheat allergy.