Anaphylaxis and IgE-mediated allergens

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Successful wheat-specific oral immunotherapy in highly sensitive individuals with a novel multirush/maintenance regimen

Our first patient was a 4-year-old Thai boy who had several wheat anaphylaxis since 9 month of age. The episode involved swelling of eyes and mouth, dyspnea, and abdominal cramping 5 minutes after licked a piece of cake roll.

At 18 months of age, he had similar symptoms after eating a French toast (size, 0.5 cm), then was diagnosed as wheat allergy. Later, he had another anaphylactic episode after eating macaroni soup. The investigations were performed when he was 3 years of age. Specific immunoglobulin E (IgE) to wheat and ω-5 gliadin were 518 kAU/L and 37.8 kAU/L, respectively. He also had allergic to egg white (specific IgE, 15.5 kAU/L), but not allergic to cow's milk, soy, or peanut.

Due to the severe nature of the symptoms after repeated unintentional exposures, the parent requested OIT which was conducted after informed consent was obtained from his father.

The patient underwent oral wheat challenge in semi-intensive care unit. The challenge procedure started with 1 mg of wheat flour (Kite All-purpose flour, 100% wheat; UFM Food Centre Co., Bangkok, Thailand), that was mixed with tomato sauce (all ingredients had been tested to assure that the patient does not allergic to them). Anaphylaxis was elicited at the dose of 300 mg. On the next day, oral montelukast, intravenous chlorpheniramine, and ranitidine were given 1 hour prior to OIT as premedications. The OIT was started with 150 mg of wheat flour, was then doubled every 2 hours, 2 or 3 times per day. The protocol, adverse events, and treatments are shown in Fig. 1A. After 1 week, he was discharged with daily maintenance dose of wheat 500 mg for two months.

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The natural history of wheat allergy

A little depressing about persistence prediction from RAST since barley is off the chart.  But encouraging that even high IgE will likely resolve.

Abstract
BACKGROUND:
Wheat allergy is 1 of the most common food allergies in children, yet few data are available regarding its natural history.

OBJECTIVES:
To define the natural course of wheat allergy and identify factors that help predict outcome in a large referral population of children with wheat allergy.

METHODS:
Patients were included in the study if they had a history of a symptomatic reaction to wheat and a positive wheat IgE test result. Clinical history, laboratory results, and final outcome were recorded for 103 patients who met the inclusion criteria. Resolution of wheat allergy was determined based on food challenge results. Kaplan-Meier survival curves were generated to depict resolution of wheat allergy.

RESULTS:
Rates of resolution were 29% by 4 years, 56% by 8 years, and 65% by 12 years. Higher wheat IgE levels were associated with poorer outcomes. The peak wheat IgE level recorded was a useful predictor of persistent allergy (P < .001), although many children outgrew wheat allergy with even the highest levels of wheat IgE.

CONCLUSION:
The median age of resolution of wheat allergy is approximately 6 1/2 years in this population. In a significant minority of patients, wheat allergy persists into adolescence.

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Barley's lipid transfer protein: a new emerging allergen in pediatric anaphylaxis.

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IgE mediated food allergy in Korean children: focused on plant food allergy

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Wheat-induced anaphylaxis

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Beer-induced anaphylaxis due to barley sensitization: two case reports