Wheat allergy, a new and emerging threat of food allergy for children

Compared to cow's milk, eggs and peanut, knowledge on wheat allergy is limited. During the past 2 decades, IgE-mediated wheat allergy in children has been frequently observed all over the World, especially in Asia. Wheat allergy usually presents in infants between 6 and 12 months of age. Common clinical manifestations are skin rashes (maculopapular rash, urticaria and angioedema). Atopic dermatitis is a less common presenting manifestation in wheat allergy compared to those with egg and cow's milk allergy. Anaphylaxis occurs in up to 50% of wheat allergy in children. Wheat-dependent, exercise-induced anaphylaxis is more common among older children, teenagers and adults. Skin prick testing with water-soluble extract of wheat gave low diagnostic sensitivity. This is because major wheat allergens are alcohol-soluble proteins. Specific IgE to components of wheat such as ω-5 gliadin could increase diagnostic accuracy. The use of these component-resolved wheat allergens both in singleplex and multiplex tests is available but the accuracy of these tests remains to be verified. Wheat avoidance is difficult to carry out since wheat is used for cooking in a wide variety of daily diets. Oral immunotherapy to wheat has been extensively investigated over the past 15 years among children with varying degrees of wheat sensitivities. Most of these children achieved some degree of desensitization to wheat but only a few attained sustained unresponsiveness. To date, it is unclear how long wheat oral immunotherapy should be maintained. Recently, an outbreak in Japan on allergy to soap containing hydrolyzed-wheat suggested that the route of sensitization of wheat was through skin. Discontinuation of marketing of this soap led to cessation of the epidemic. Such knowledge warrants further investigation in children so that a prevention measure for wheat allergy among high-risk infants can be designed.