Wheat allergy K52.2

Like all cereals, wheat belongs to the sweet grass family (Poaceae). Food allergies to wheat products are caused by the different protein fractions such as:

• Water-soluble wheat albumins (15%)
• Salt-soluble globulins (5%)
• Water- and salt-insoluble glutens (80%) (gluten protein)
• Monomeric gliadins
• polymeric gliadins

The symptoms of wheat allergy (see also wheat sensitivity) are often only triggered in connection with co-factors. Co-factors are: exertion (see below food-dependent exertion-induced anaphylaxis), alcohol, other foods, medication (e.g. acetylsalicylic acid). The "glue" in wheat, gluten, occupies a special position as a cause of coeliac disease and as a contributory cause of dermatitis herpetiformis Duhring (see below Coeliac disease skin changes). In this context, non-celiac wheat sensitivity must also be considered in the differential diagnosis.

• Tri a 14 lipid transfer protein (9 kDa). Considered a trigger of baker's asthma.
• Tri a 19 omega-5 gliadin (65kDa); considered a marker allergen for"wheat-dependent effort-induced anaphylaxis" = WDEIA. This allergen belongs to the (electrophoretically) fast-migrating, water- and salt-insoluble omega-gliadins.
• Tria a 21 alpha/beta gliadin (major allergen), marker allergen for WDEIA
• Tria a 26 HMW (high molecular weight) glutenin (major allergen), marker allergen for WDEIA
• Tria a 36 LMW (low molecular weight) glutenin (major allergen), marker allergen for WDEIA
• Tria a gamma-gliadin (major allergen), marker allergen for WDEIA
  

The classic food allergy to wheat has a low prevalence in adults and is more likely to occur in children (prevalence of about 9%), who usually outgrow the allergy, resulting in an estimated prevalence of 0.1% to 0.3% in adults (Nwaru B et al. (2014).

Like all cereals, wheat belongs to the sweet grass family (Poaceae). Food allergies to wheat products are caused by the different protein fractions such as:

Water-soluble wheat albumins (15%)

• Salt-soluble globulins (5%)
• Water- and salt-insoluble glutens (80%) (gluten protein)
• Monomeric gliadins
• polymeric gliadins

The symptoms are often only triggered in connection with co-factors. Co-factors are: exertion (see below food-dependent exertion-induced anaphylaxis), alcohol, other foods, medication (e.g. acetylsalicylic acid).

The "glue" in wheat, gluten, occupies a special position as a cause of coeliac disease and as a contributory cause of dermatitis herpetiformis Duhring (see below Coeliac disease skin changes). In this context, non-celiac wheat sensitivity must also be considered in the differential diagnosis.

Amylase trypsin inhibitors obviously also play an important role here.

The best therapy method for a nutritive sensitization to wheat proteins is the maternity leave. This requires a considerable change in eating habits. It should only be recommended and carried out after a clear diagnosis has been made. Basically, all foods containing wheat in any form should be avoided.

Cave! Edible oils: Wheat germ oils are often used in this process. If the allergy is only to wheat protein, wheat can be easily replaced by other cereal flours. Cross-reactions must be considered.

1. Nwaru B et al. (2014) Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy 69:992-1007.

2. Nilsson N et al. (2015) Wheat allergy in children evaluated with challenge and IgE antibodies to wheat components. Pediatr Allergy Immunol 26:119-125.
3. Rodríguez del Río Pet al. (2014) Oral immunotherapy in children with IgE-mediated wheat allergy: outcome and molecular changes. J Investig Allergol Clin Immunol 24: 240-248.
4. Sievers S et al. (2016) Wheat protein recognition pattern in tolerant and allergic children. Pediatr Allergy Immunol 27:147-155.