Prevalence and Clinical Picture of Wheat Allergy in Children: Two Observational Studies in Germany

Wheat is a staple food and an important allergen in childhood, yet data on the prevalence and clinical characteristics of wheat allergy remain limited.

To determine the prevalence of pediatric wheat allergy in Berlin, Germany, and to characterize allergic reactions, intraindividual trajectories, and the diagnostic relevance of wheat-specific IgE.

We assessed the prevalence of wheat allergy in the population-based EuroPrevall birth cohort study in Berlin up to age 2 years by regular standardized parental telephone interviews. In a second cross-sectional study of 5 German hospitals, clinical characteristics of allergic reactions to wheat were determined in children undergoing oral food challenges. Furthermore, changes in clinical symptoms and reaction severity in rechallenged children were evaluated.

In the population-based birth cohort study, wheat allergy was diagnosed in 3 (0.2%) of 1381 children until age 2 years. In the cross-sectional study (n = 334; median age, 15 months, range [7; 213]), 137 children (41%; median age, 13 months, range [7; 127]) showed allergic reactions. No child reacted to less than 32 mg of wheat protein. Wheat-specific IgE was neither helpful to determine clinical reactivity, nor to predict clinical severity or threshold levels. On following up 50 children (median age at diagnosis, 13 months), we found that 23 (46%) developed clinical tolerance up to the median age of 37 months.

Wheat allergy was not as common in German infants and showed a fast tolerance development. The threshold eliciting allergic reactions seemed to be higher than for other food allergens. Wheat-specific IgE was not helpful in diagnostics of wheat allergy.