IgE-Mediated allergy to wheat in a child with celiac disease – a case report

Allergy, Asthma & Clinical Immunology

Tiffany Wong¹  Hin Hin Ko²  Edmond S Chan¹ 

[1] BC Children’s Hospital, Allergy Clinic, Room 1C31B, 4480 Oak St, Vancouver, BC V6H 3 V4, Canada

[2] Department of Medicine, Division of Gastroenterology, 770-1190 Hornby Street, Vancouver, BC V6Z 2 K5, Canada

关键词: Wheat;    Allergy;    Celiac disease;   

Others  :  1082117
DOI  :  10.1186/1710-1492-10-56

 received in 2014-06-18, accepted in 2014-10-20,  发布年份 2014

【 摘 要 】

Introduction

Celiac disease and immediate type hypersensitivity to wheat are immune responses with different pathogenic mechanisms. Both diseases are well known entities but their coexistence in the same patient is rarely reported. This is a unique case presentation of a patient with celiac disease who developed concomitant IgE-mediated wheat allergy and presented with immediate symptoms in two body systems.

Case presentation

We report the case of a girl with celiac disease who subsequently developed IgE-mediated hypersensitivity to wheat. The patient is a Caucasian female who was diagnosed with celiac disease at 18 months of age after presenting with recurrent vomiting and failure to thrive. Her anti-tTG antibody level was greater than 200 E.U. and biopsy results from endoscopy were consistent with celiac disease. Specific IgE antibody to wheat was negative at 2 years of age. Around seven years of age, she developed immediate symptoms of urticaria, cough and shortness of breath with accidental exposures to wheat. Specific IgE antibody testing was repeated and positive to wheat (42.5 kU/L), as well as rye (33.9 kU/L), barley (53.4 kU/L) and oat (11.3 kU/L). At 9 years of age, skin prick testing was positive to wheat, barley and rye but negative to oat. The patient has subsequently tolerated an open oral food challenge to oat. She continues to avoid wheat, rye and barley and carries an epinephrine autoinjector at all times.

Conclusion

To our knowledge, this is the first report of a patient with celiac disease and concomitant IgE-mediated allergy to wheat presenting with immediate symptoms in two body systems. Although the pathophysiology of these diseases is different, this case demonstrates that they are not exclusive of one another. In patients who develop unexplained symptoms consistent with IgE-mediated allergy, an allergy assessment should be considered.

【 授权许可】

   
2014 Wong et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, Kaukinen K, Rostami K, Sanders DS, Schumann M, Ullrich R, Villalta D, Volta U, Catassi C, Fasano A: Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 2012, 10:13. BioMed Central Full Text
• [2]Torres JA, Sastre J, Heras MD, Cuesta J, Lombardero M, Ledesma A: IgE-mediated cereal allergy and latent celiac disease. J Invest Allerg Clin 2008, 18(5):412-414.
• [3]Sampson HA: Food allergy. J Allergy Clin Immunol 1989, 84(6 Pt 2):1062-1067.
• [4]Armentia A, Arranz E, Hernandez N, Garrote A, Panzani R, Blanco A: Allergy after inhalation and ingestion of cereals involve different allergens in allergic and celiac disease. Recent Pat Inflamm Allergy Drug Discov 2008, 2(1):47-57.
• [5]Björkstén F, Backman A, Järvinen KA, Lehti H, Savilahti E, Syvänen P, Kärkkäinen T: Immunoglobulin E specific to wheat and rye flour proteins. Clin Allergy 1977, 7(5):473-483.
• [6]Baldo BA, Wrigley CW: IgE antibodies to wheat flour components. Studies with sera from subjects with baker's asthma or coeliac condition. Clin Allergy 1978, 8(2):109-124.
• [7]Jones SM, Magnolfi CF, Cooke SK, Sampson HA: Immunologic cross-reactivity among cereal grains and grasses in children with food hypersensitivity. J Allergy Clin Immunol 1995, 96(3):341-351.
• [8]James JM, Sixbey JP, Helm RM, Bannon GA, Burks AW: Wheat alpha-amylase inhibitor: a second route of allergic sensitization. J Allergy Clin Immunol 1997, 99(2):239-244.
• [9]Shan L, Molberg Ø, Parrot I, Hausch F, Filiz F, Gray GM, Sollid LM, Khosla C: Structural basis for gluten intolerance in celiac sprue. Science 2002, 297(5590):2275-2279.
• [10]Jacquenet S, Morisset M, Battais F, Denery-Papini S, Croizier A, Baudouin E, Bihain B, Moneret-Vautrin DA: Interest of ImmunoCAP system to recombinant omega-5 gliadin for the diagnosis of exercise-induced wheat allergy. Int Arch Allergy Immunol 2009, 149(1):74-80.
• [11]Matsuo H, Dahlström J, Tanaka A, Kohno K, Takahashi H, Furumura M, Morita E: Sensitivity and specificity of recombinant omega-5 gliadin-specific IgE measurement for the diagnosis of wheat-dependent exercise-induced anaphylaxis. Allergy 2008, 63(2):233-236.
• [12]Baar A, Pahr S, Constantin C, Giavi S, Manoussaki A, Papadopoulos NG, Ebner C, Mari A, Vrtala S, Valenta R: Specific IgE reactivity to Tri a 36 in children with wheat food allergy. J Allergy Clin Immunol 2014, 133(2):585-587.
• [13]Shibata R, Nishima S, Tanaka A, Borres MP, Morita E: Usefulness of specific IgE antibodies to omega-5 gliadin in the diagnosis and follow-up of Japanese children with wheat allergy. Ann Allergy Asthma Immunol 2011, 107(4):337-343.
• [14]Constantin C, Quirce S, Poorafshar M, Touraev A, Niggemann B, Mari A, Ebner C, Akerström H, Heberle-Bors E, Nystrand M, Valenta R: Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy 2009, 64(7):1030-1037.
• [15]Lack G: Update on risk factors for food allergy. J Allergy Clin Immunol 2012, 129(5):1187-1197.