We reported a successful oral immunotherapy (OIT) in 2 children with high wheat sensitivity (4 and 14 years old boys). Oral challenges indicated eliciting doses of 300 mg, and wheat flour of 30 mg. The OIT protocol includes 5 days of build-up phase in the hospital, intervening with 2 to 5 months of home maintenance phase. Patients could tolerate 45 g, and 60 g of wheat flour per day, respectively. We have demonstrated that OIT to a large amount of wheat in extremely sensitized patients could be achieved with a stepwise multi oral/maintenance regimen.
Child ; Desensitization, Immunologic ; Flour ; Humans ; Immunotherapy ; Triticum ; Wheat Hypersensitivity

Wheat is a common cause of food allergy. Wheat-induced anaphylaxis (WIA) and wheat-dependent exercise induced anaphylaxis (WDEIA) are severe forms of immunoglobulin E (IgE) mediated allergic reaction to wheat protein. As the diagnosis of WIA or WDEIA is not easy because of the risk of oral challenge, identification of specific IgE of various wheat proteins is helpful for diagnosis. In Korea, there are only a few reports on WIA in adults. We report six cases of WIA diagnosed on the basis of clinical history and specific IgE of wheat proteins or provocation test. For immunologic evaluation of severe wheat allergy including WIA and WDEIA, it is important to measure specific IgE to each component of wheat including gluten and omega-5 gliadin not just measuring wheat-specific IgE.
Adult* ; Anaphylaxis* ; Diagnosis ; Food Hypersensitivity ; Gliadin ; Glutens ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Korea ; Triticum ; Wheat Hypersensitivity

PURPOSE: The aim of this study was to assess the clinical usefulness and added diagnostic value of specific IgE antibodies to wheat, gluten, and ω-5 gliadin in diagnosing wheat allergy and distinguishing wheat anaphylaxis. METHODS: This study included 196 children who visited Ajou University Hospital for suspicious food allergy. The subjects were divided into 2 groups: the wheat allergy (WA) and non-wheat allergy (non-WA) groups. Patients with wheat allergy were further divided into 2 subgroups according to their symptoms: the wheat allergy with anaphylaxis (WA(Ana)) and wheat allergy without anaphylaxis (WA(Non-Ana)) groups. Serum concentrations of total IgE and specific IgE antibodies to wheat, gluten and ω-5 gliadin were measured. RESULTS: The median values of specific IgE antibodies to wheat, gluten and ω-5 gliadin were significantly higher in the WA group than in the non-WA group, and the positive decision points (95% specificity) were at 3.12, 2.61, and 0.21 kUA/L, respectively. The combination of specific IgE antibodies to wheat and ω-5 gliadin resulted in the highest accuracy of 93.9% in diagnosing wheat allergy. In differentiating the WA(Ana) group from the WA(Non-Ana) group, only specific IgE antibody to ω-5 gliadin showed a significant difference at the optimal cutoff point of 1.56 kUA/L. CONCLUSION: Our results show that the individual levels of specific IgE antibodies to wheat, gluten or ω-5 gliadin may have a considerably high accuracy in diagnosing wheat allergy and that specific IgE antibody to ω-5 gliadin may be particularly useful in predicting wheat anaphylaxis.
Anaphylaxis ; Antibodies ; Child* ; Food Hypersensitivity ; Gliadin* ; Glutens* ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Triticum* ; Wheat Hypersensitivity*

Corticosteroids are widely used in treatment of allergic or idiosyncratic anaphylactic reactions, paradoxically, they can be responsible for anaphylactic reactions. Although several reports of suspected allergic reactions to corticosteroids had already appeared, Mendelson et al reported the first instance of immediate anaphylaxis ascribed to solucortef in 1974. We present a review of the literature, and report on one patient with wheat allergy suffered from anaphylactic shock after injection of hydrocortisone sodium succinate. In patients with systemic severe reactions to injectable corticosteroids, we recommend careful and comprehensive skin testing with most available corticosteroids, as well as the components of the injectables.
Adrenal Cortex Hormones ; Anaphylaxis* ; Humans ; Hydrocortisone* ; Hypersensitivity ; Skin Tests ; Sodium* ; Succinic Acid* ; Triticum* ; Wheat Hypersensitivity*

Wheat allergy is one of the commonest food allergies in childhood and it typically presents with IgE mediated reactions, including anaphylaxis. Seizures are not typically reported to be a direct manifestation of anaphylaxis, though it can occur secondary to hypoxia following significant haemodynamic compromise. We describe a case of a previously well infant, who presented with anaphylactic shock to wheat and responded well to the initial management, but subsequently developed a cluster of brief generalised tonic clonic seizures without any ongoing haemodynamic instability. The tryptase level that was performed at 4–5 hours post reaction was raised at 49.1 µg/L. Skin prick test to wheat, wheat specific IgE, the omega-5 gliadin IgE were positive. Extensive work-up was performed to look for an underlying cause of seizures and all returned negative. To our knowledge, this is the first case report describing an unusual presentation of multiple seizures in a young infant, in association with an anaphylactic episode. In the absence of any other seizure provoking factor and underlying cause, we believe the association is more likely causative than coincidental.
Anaphylaxis ; Anoxia ; Child ; Food Hypersensitivity ; Gliadin ; Humans ; Immunoglobulin E ; Infant ; Seizures ; Skin ; Triticum ; Tryptases ; Wheat Hypersensitivity

Asia is a populous and diverse region and potentially an important source of information on food allergy. This review aims to summarize the current literature on food allergy from this region, comparing it with western populations. A PubMed search using strategies "Food allergy AND Asia", "Food anaphylaxis AND Asia", and "Food allergy AND each Asian country" was made. Overall, 53 articles, published between 2005 and 2012, mainly written in English were reviewed. The overall prevalence of food allergy in Asia is somewhat comparable to the West. However, the types of food allergy differ in order of relevance. Shellfish is the most common food allergen from Asia, in part due to the abundance of seafood in this region. It is unique as symptoms vary widely from oral symptoms to anaphylaxis for the same individual. Data suggest that house dust mite tropomysin may be a primary sensitizer. In contrast, peanut prevalence in Asia is extremely low compared to the West for reasons not yet understood. Among young children and infants, egg and cow's milk allergy are the two most common food allergies, with prevalence data comparable to western populations. Differences also exist within Asia. Wheat allergy, though uncommon in most Asian countries, is the most common cause of anaphylaxis in Japan and Korea, and is increasing in Thailand. Current food allergy data from Asia highlights important differences between East and West, and within the Asian region. Further work is needed to provide insight on the environmental risk factors accounting for these differences.
Anaphylaxis ; Arachis ; Asia ; Asian Continental Ancestry Group ; Child ; Epidemiology ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Infant ; Japan ; Korea ; Milk Hypersensitivity ; Ovum ; Prevalence ; Pyroglyphidae ; Risk Factors ; Seafood ; Shellfish ; Thailand ; Wheat Hypersensitivity

PURPOSE: This study was performed to evaluate the current status of food allergy (FA) and to analyze the relationship between allergy to individual foods and other allergic diseases in elementary school children. METHODS: We performed a questionnaire survey for FA, asthma, allergic rhinitis, and atopic dermatitis using International Study of Asthma and Allergies in Childhood questionnaires. A total of 1,929 students in 3 elementary schools were enrolled. RESULTS: A total of 324 students (16.8%) had ever suffered from FA symptoms more than once. Only 64 out of 324 students (19.8%) were diagnosed with FA by doctors. The presence of soy allergy was associated with the increased risk of bronchial asthma (adjusted odds ratio [aOR], 5.90; 95% confidence interval [CI], 1.87 to 18.59). The presence of egg (aOR, 1.91; 95% CI, 1.04 to 3.52) and wheat allergy (aOR, 5.45; 95% CI, 1.94 to 15.36) were associated with the increased prevalence of allergic rhinitis. The allergic symptoms to fruits/tomato was associated with the increased risk of allergic rhinoconjunctivitis symptoms (aOR, 2.98; 95% CI, 1.18 to 7.47). The allergic symptoms to egg (aOR, 2.29; 95% CI, 1.22 to 4.29), wheat (aOR, 4.91; 95% CI, 1.86 to 12.95), and shrimp/crab (aOR, 2.48; 95% CI, 1.37 to 4.49) were associated with the presence of atopic dermatitis. CONCLUSION: The prevalence of FA of elementary school students in Bucheon-city was 16.8%. A significant positive association between the suspected foods and the other allergic diseases was found. Soy allergy was significantly correlated to having bronchial asthma and fruits/tomato allergy correlated with allergic rhinoconjunctivitis.
Asthma ; Child ; Dermatitis, Atopic ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Odds Ratio ; Ovum ; Prevalence ; Rhinitis ; Rhinitis, Allergic, Perennial ; Triticum ; Wheat Hypersensitivity ; Surveys and Questionnaires

BACKGROUND: Prevalence of food allergy is increasing all over the world including in Asia. Diagnosis of food allergy in Asia is usually made after family complaints or by elimination and/or reintroduction foods. This could lead to an inaccurate diagnosis and to incorrect information on epidemiology of food allergy. We, herein, reported results of a 16-year experience (1996–2012) of oral food challenge (OFC) performed in pediatric patients at a major teaching hospital in Thailand. OBJECTIVE: The major objectives of this report are to review types of foods selected for oral challenges, frequency of positive/negative challenges to these foods and the clinical reactions during challenges among these children. METHODS: Medical records of 206 children underwent OFC between 1996 and 2012 for various indications at the Allergy clinic of Pediatric Department, Siriraj Hospital, Mahidol University (age range, 4 months to 17 years) were retrospectively reviewed. Data including clinical data, skin prick test results and specific IgE levels were analyzed with respect to challenge results (positive/negative). During the period of the study, 2 separate investigations on shrimp allergy and wheat allergy were conducted. RESULTS: Sixty of 206 children (29%) had positive OFC, whereas 84 out of 306 OFC (27.5%) were positive. The most common food giving positive challenges in this study was shrimp (40%). Among children less than 3 years of age, the most common food with positive challenge was wheat (70%) whereas among children 3 years of age or older, shellfish was the most common food (42%). Cutaneous reactions were the most common reactions observed. CONCLUSION: Only 1 of 3 of children underwent OFC in this study had positive challenges. Shrimp was the most common food causing challenge in this study especially among children older than 3 year of age. Wheat has become another leading food besides cow's milk and egg in causing positive OFC in younger children in Thailand.
Asia ; Child ; Diagnosis ; Epidemiology ; Food Hypersensitivity ; Hospitals, Teaching ; Humans ; Hypersensitivity ; Immunoglobulin E ; Medical Records ; Milk ; Ovum ; Prevalence ; Retrospective Studies ; Shellfish ; Skin ; Thailand ; Triticum ; Wheat Hypersensitivity

hypersensitivity reactions to beer, but there is no barley allergy study in children. This study aimed to identify the phenotype and immunologic findings in Korean children with barley allergy.METHODS: Forty-two participants with a history of ingesting barley who underwent serum specific immunoglobulin E to barley (barley-sIgE) assay at the Department of Pediatrics in Ajou Medical Center were enrolled through a retrospective analysis of medical records from March 2008 to February 2018. The demographic characteristics, symptoms, and immunologic parameters of the patients were assessed.RESULTS: Twenty subjects presented with clinical barley allergy (B-allergic group), and 22 were atopic controls without allergic reactions after the ingestion of barley (B-tolerant group). The median ages of the B-allergic and B-tolerant groups were 1 and 3 years, respectively. In the B-allergic group, the cutaneous system (90.0%) was most frequently affected, followed by the respiratory system (40.0%). Anaphylaxis was observed in 35.0% of the B-allergic group. The median level of barley-sIgE was 13.90 kU(A)/L (range, 0.14–101.00 kU(A)/L) in the B-allergic group, and this value was significantly higher (P < 0.001) than that of the B-tolerant group (0.30 kU(A)/L; range, 0.01–24.40 kU(A)/L), with an optimal cutoff level of 1.24 kU(A)/L (sensitivity, 85.0%; specificity, 86.4%). A positive correlation was found between the serum levels of barley-sIgE and wheat-sIgE in the B-allergic group with clinical wheat allergy.CONCLUSION: Barley is an important allergen for children in Korea. This study showed the clinical characteristics of barley allergy and suggested optimal cut-off levels of barley-sIgE for clinical barley allergy. Clinically, cross-reactivity or co-sensitization is often observed between barley and wheat.]]>
Anaphylaxis ; Asia ; Beer ; Child ; Eating ; Food Hypersensitivity ; Hordeum ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Korea ; Medical Records ; Pediatrics ; Phenotype ; Respiratory System ; Retrospective Studies ; Sensitivity and Specificity ; Triticum ; Wheat Hypersensitivity

BACKGROUND/AIMS: The existence of non-celiac gluten sensitivity has been debated. Indeed, the intestinal and extra-intestinal symptoms of many patients with irritable bowel syndrome (IBS) but without celiac disease or wheat allergy have been shown to improve on a gluten-free diet. Therefore, this study set out to evaluate the effects of gluten on IBS symptoms. METHODS: We performed a double-blind randomized placebo-controlled rechallenge trial in a tertiary care hospital with IBS patients who fulfilled the Rome III criteria. Patients with celiac disease and wheat allergy were appropriately excluded. The participants were administered a gluten-free diet for 4 weeks and were asked to complete a symptom-based questionnaire to assess their overall symptoms, abdominal pain, bloating, wind, and tiredness on the visual analog scale (0-100) at the baseline and every week thereafter. The participants who showed improvement were randomly assigned to one of two groups to receive either a placebo (gluten-free breads) or gluten (whole cereal breads) as a rechallenge for the next 4 weeks. RESULTS: In line with the protocol analysis, 60 patients completed the study. The overall symptom score on the visual analog scale was significantly different between the two groups (P<0.05). Moreover, the patients in the gluten intervention group scored significantly higher in terms of abdominal pain, bloating, and tiredness (P<0.05), and their symptoms worsened within 1 week of the rechallenge. CONCLUSIONS: A gluten diet may worsen the symptoms of IBS patients. Therefore, some form of gluten sensitivity other than celiac disease exists in some of them, and patients with IBS may benefit from gluten restrictions.
Abdominal Pain ; Celiac Disease ; Diet ; Diet, Gluten-Free ; Edible Grain ; Glutens* ; Humans ; Irritable Bowel Syndrome* ; Prospective Studies* ; Tertiary Healthcare ; Visual Analog Scale ; Wheat Hypersensitivity ; Wind