Anaphylaxis and loss of wheat tolerance after two weeks of wheat deprivation

BACKGROUND: The best practices for childhood allergy prevention are continually evolving. We do not know the optimal frequency for continued exposure of common allergenic foods after the initial introduction into a child’s diet. Home-based oral immunotherapy is a promising treatment avenue for childhood food allergies. CASE PRESENTATION: We describe the case of a child who was tolerating wheat and underwent a 2-week unintentional deprivation period wherein they were not exposed to any wheat. After this period, they experienced an anaphylactic reaction to wheat upon re-introduction. The child had a history of other allergies for which they were receiving oral immunotherapy and they now are receiving oral immunotherapy for wheat as well. CONCLUSIONS: Our case is unique as, to the best of our knowledge, there has yet to be a case published wherein a deprivation period as short as 2 weeks has resulted in an anaphylactic reaction, despite previous tolerance of the allergen. Clearer labelling of gluten free versus gluten-containing products as confusion regarding labelling contributed to the unintentional deprivation period is needed. Families should also be counselled on thorough food product label reading. Finally, further research is warranted regarding the optimal frequency of potential allergen dietary reintroduction.