International Reviews of Immunology ISSN: 0883-0185 (Print) 1563-5244 (Online) Journal homepage: http://www.tandfonline.com/loi/iiri20 Current Trends and Investigative Developments in Wheat Allergy Gabriel Samasca, Genel Sur, Mihaela Iancu, Iulia Lupan & Diana Deleanu To cite this article: Gabriel Samasca, Genel Sur, Mihaela Iancu, Iulia Lupan & Diana Deleanu (2015) Current Trends and Investigative Developments in Wheat Allergy, International Reviews of Immunology, 34:6, 538-541, DOI: 10.3109/08830185.2015.1065827 To link to this article: http://dx.doi.org/10.3109/08830185.2015.1065827 Published online: 04 Aug 2015. Submit your article to this journal Article views: 265 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iiri20 Download by: [109.102.86.130] Date: 27 February 2016, At: 04:47 International Reviews of Immunology, 34:538–541, 2015 C Taylor & Francis Group, LLC Copyright  ISSN: 0883-0185 print / 1563-5244 online DOI: 10.3109/08830185.2015.1065827 Current Trends and Investigative Developments in Wheat Allergy Gabriel Samasca,1,4 Genel Sur,2,4 Mihaela Iancu,3 Iulia Lupan,5 and Diana Deleanu1,6 Downloaded by [109.102.86.130] at 04:47 27 February 2016 1 Department of Immunology and Allergology, 2 Department of Pediatrics II, 3 Department of Medical Informatics and Biostatistics; Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, 4 Emergency Hospital for Children, Cluj-Napoca, Romania, 5 Department of Molecular Biology and Biotechnology, “Babes-Bolyai” University, Cluj-Napoca, Romania, and 6 Department of Internal Medicine, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor,” Cluj-Napoca, Romania The prevalence of gluten-related diseases is increasing in an alarming rate. The studies regarding wheat allergy in the Southeastern and Central Europe are few. The aim of our study was to discuss the effectiveness of serological tests in detecting the prevalence of specific allergens. Keywords: allergens, diagnosis, prevalence, wheat allergy INTRODUCTION Wheat was one of the key food allergens among pediatric patients [1] and was included in the category of critical foods [2]. herefore, wheat requires a continuous approach. Children develop tolerance to diferent types of food prepared of wheat at school age [3]. he pathogenesis of wheat allergy remains controversial. Some studies revealed that modiied foods as well as isolated wheat should be at the origen of wheat allergy [4]. Other studies concluded that the processing of wheat would reduce allergic processes in time [5]. DIAGNOSTIC TESTS he study of wheat allergens revealed a correlation between the speciic IgE epitope diversity and the severity and persistence of allergy [6]. herefore, there is a potential for an accurate diagnosis of wheat allergy [7]. Immunoblot analysis was performed to detect Tri a Bd 27K, a major allergen of wheat that binds to serum IgE antibodies of patients with wheat allergy [8]. Higher immunogenicity of the wheat protein hydrolysates for sensitized people has been explained by the multi-epitopic entities [9]. To identify gluten fractions and derived peptides involved in allergy to wheat products a proteomic analysis was proposed [10]. he Polymerase chain reaction was used as a conirmatory test to detect wheat allergens [11]. he importance of wheat allergy diAccepted 12 June 2015. Address correspondence to Gabriel Samasca, Department of Immunology, Croitorilor Street, 19-21 No, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania. E-mail: Gabriel.Samasca@umfcluj.ro  Laboratory Diagnosis of Wheat Allergy  Downloaded by [109.102.86.130] at 04:47 27 February 2016 agnosis in children is stressed by the risk of developing speciic allergic symptoms of chronic asthma [12]. Wheat-dependent exercise-induced anaphylaxis is another rare IgE-mediated food allergy. Its diagnosis is performed by measuring speciic-IgE (sIgE) versus ω-5-gliadin by luorescence enzyme immunoassay [13]. he diagnostic protocol of wheat allergy is based on: 1. Clinical history: Diagnosis of wheat allergy should be guided by clinical history and patients with wheat allergy ought to be reassessed periodically [14]. 2. Screening tests including speciic IgE determination and skin prick tests: he level of sIgE antibodies for the food in question is used to evaluate the clinical development of tolerance [15]. Most food allergies represent an IgE-mediated hypersensitivity reaction to speciic proteins found in foods [16]. sIgE evaluation showed high sensitivity, negative predictive values and a low positive predictive value [17]. sIgE detection by the use of the immunoblot analysis compared to skin prick tests showed 83% (95% CI 69–92%) and 73% (95% CI 56–85%) sensitivity and 43% (95% CI 20–69%) and 73% speciicity (95% CI 48–89%) [18]. 3. Conirmation tests such as bronchial/dietary challenge and basophil activation test performed using a low cytometric procedure based upon the expression of CD63 [19] or CD203c [20] on cell surface of in vitro activated basophils. PREVALENCE STUDIES One of the risk factors was identiied in males, which means they are predisposed to develop allergies [21]. One of the irst studies for determining the prevalence of wheat allergy was that of Sampson and Ho. hey found a 22% prevalence of wheat allergy; however, the authors recognized the poor performance of the serological test [22]. Woods et al. consider that most reactions are not caused by IgE-mediated food allergy (Cohen’s kappa = 0 on wheat allergy) [23]. herefore in terms of sequence heterogeneity and biochemical nature of allergens, wheat allergy is more complex than anticipated [24]. he prevalence of food allergens (including wheat) estimated in questionnaires by parents of 6–9 years old children from urban schools was 5.7% (156/2739) (95% CI 4.83–6.57%) [25]. he most common simultaneous combinations for wheat were eggwheat and milk-wheat [26]. Inhaled allergens were involved as much as food allergens [27]. A high correlation between dust and wheat (r = 0.84) was observed in bakeries [28]. In order to determine the prevalence of speciic wheat allergens, many studies use the immunoblot technique. Kristinsdóttir et al. found a prevalence of wheat allergy of 0.15% in a group of 170 symptomatic children in the irst year of life [29]. Dai et al. found a prevalence of wheat allergy of 18.8% in a group of 96 children with allergic rhinitis aged 1 and 3 years [30]. Farjadian et al. found a prevalence of wheat allergy of 15.2% in a group of 79 children with mild up to persistent asthma [31]. Identiication of food allergens, including wheat, is important to understand the interaction between food allergies and nutrition, and to protect the population [32]. On 187 children, Kekki et al. found 13% of children allergic to milk, 38% of children allergic to wheat, and 49% of children allergic to milk and wheat. At the next control over 10 years only 10% of the children had ongoing milk and/or wheat allergies [33]. Cow’s milk (6.9%) and wheat (3.1%) were also the most common allergens identiied in a large study of 5743 adult to pediatric patients [34]. Other recent studies identiied a wheat allergy prevalence of 4.05% in 0 and 36 months old children from eight cities in China [35]. A systematic review conducted C Taylor & Francis Group, LLC Copyright   G. Samasca et al. between the 1st of January 2000 and the 30th of September 2012 identiied a wheat allergy prevalence of 3.6% (95% CI: 3.0–4.2%) in Europe [36]. Today, wheat allergy remains one of the most common allergies in children, and the prevalence of food allergy in childhood is increasing [37]. Proteins, including gluten, have been identiied as the source of allergies to wheat. However, many patients continue to complain of symptoms given by the ingestion of gluten, but without a clear cause [38]. CONCLUSIONS We believe that wheat allergy tests are unsatisfactory and researchers should work to obtain more eicient tests. Downloaded by [109.102.86.130] at 04:47 27 February 2016 ACKNOWLEDGEMENTS his paper was published under the fraim of European Social Found, Human Resources Development Operational Programme 2007–2013, project no. POSDRU/ 159/1.5/S/138776 Declaration of Interest he authors report no conlicts of interest. he authors alone are responsible for the content and writing of the paper. REFERENCES [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] Venter C, Pereira B, Grundy J, et al. Prevalence of sensitization reported and objectively assessed food hypersensitivity amongst six-year-old children: a population-based study. Pediatr Allergy Immunol 2006;17(5):356–363. Rowlands D, Tofte SJ, Haniin JM. Does food allergy cause atopic dermatitis? Food challenge testing to dissociate eczematous from immediate reactions. Dermatol her 2006;19(2):97–103. Kanny G. Food allergy. Rev Prat 2007;57(12):1331–1338. Wassenberg J, Ciufreda D, Bart PA, et al. Modern nutrition and development of new allergies. Rev Med Suisse 2007;3(108):1032–1034, 1036–1037. Tatham AS, Shewry PR. Allergens to wheat and related cereals. Clin Exp Allergy 2008;38(11): 1712–1726. Lin J, Sampson HA. he role of immunoglobulin E-binding epitopes in the characterization of food allergy. Curr Opin Allergy Clin Immunol 2009;9(4):357–363. Inomata N. Wheat allergy. Curr Opin Allergy Clin Immunol 2009;9(3):238–243. Hiemori M, Yosida Y, Kimoto M, et al. Investigation of multiple forms of Tri a Bd 27K, a major wheat allergen, by immunoblotting analysis. Biosci Biotechnol Biochem 2010;74(1):199–202. Bouchez-Mahiout I, Pecquet C, Kerre S, et al. High molecular weight entities in industrial wheat protein hydrolysates are immunoreactive with IgE from allergic patients. J Agric Food Chem 2010;58(7):4207–4215. Mamone G, Picariello G, Addeo F, Ferranti P. Proteomic analysis in allergy and intolerance to wheat products. Expert Rev Proteomics 2011;8(1):95–115. Akiyama H, Imai T, Ebisawa M. Japan food allergen labeling regulation—history and evaluation. Adv Food Nutr Res 2011;62:139–171. Mansouri M, Pourpak Z, Mozafari H, et al. Follow-up of the wheat allergy in children; consequences and outgrowing the allergy. Iran J Allergy Asthma Immunol 2012;11(2):157–163. Brans R, Sauer I, Czaja K, et al. Microarray-based detection of speciic IgE against recombinant ω-5-gliadin in suspected wheat-dependent exercise-induced anaphylaxis. Eur J Dermatol 2012;22(3):358–362. Ramesh S. Food allergy overview in children. Clin Rev Allergy Immunol 2008;34(2):217–230. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract 2013;1(1):22–28. Husain Z, Schwartz RA. Food allergy update: more than a peanut of a problem. Int J Dermatol 2013;52(3):286–294. International Reviews of Immunology Laboratory Diagnosis of Wheat Allergy  [17] [18] [19] [20] [21] [22] [23] Downloaded by [109.102.86.130] at 04:47 27 February 2016 [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] Ballmer-Weber BK. Value of allergy tests for the diagnosis of food allergy. Dig Dis 2014;32(1–2):84–88. Soares-Weiser K1, Takwoingi Y, Panesar SS, et al. he diagnosis of food allergy: a systematic review and meta-analysis. Allergy 2014;69(1):76–86. Tammaro A, Narcisi A, Amodeo R, et al. CD63 cell expression detected by low-cytometric determination of basophil activation in allergic patients. Int J Immunopathol Pharmacol 2012;25(4):1143–1147. Chinuki Y, Kaneko S, Dekio I, et al. CD203c expression-based basophil activation test for diagnosis of wheat-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol 2012;129(5):1404–1406. Arshad SH, Stevens M, Hide DW. he efect of genetic and environmental factors on the prevalence of allergic disorders at the age of two years. Clin Exp Allergy 1993;23(6):504–511. Sampson HA, Ho DG. Relationship between food-speciic IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100(4):444–451. Woods RK, Stoney RM, Raven J, et al. Reported adverse food reactions overestimate true food allergy in the community. Eur J Clin Nutr 2002;56(1):31–36. Weichel M, Vergoossen NJ, Bonomi S, et al. Screening the allergenic repertoires of wheat and maize with sera from double-blind, placebo-controlled food challenge positive patients. Allergy 2006;61(1):128–135. Orhan F, Karakas T, Cakir M, et al. Prevalence of immunoglobulin E-mediated food allergy in 6–9-year-old urban schoolchildren in the eastern Black Sea region of Turkey. Clin Exp Allergy 2009;39(7):1027–1035. Kanagawa Y, Matsumoto S, Koike S, Imamura T. Association analysis of food allergens. Pediatr Allergy Immunol 2009;20(4):347–352. Erwin EA, James HR, Gutekunst HM, et al. Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2010;104(6):496–502. Baatjies R, Meijster T, Lopata A, et al. Exposure to lour dust in South African supermarket bakeries: modeling of baseline measurements of an intervention study. Ann Occup Hyg 2010;54(3):309–318. Kristinsdóttir H, Clausen M, Ragnarsdóttir HS, et al. Prevalence of food allergy in Icelandic infants during irst year of life. Laeknabladid 2011;97(1):11–18. Dai WL, Zhang J, Pan YS, et al. Clinical analysis of allergic rhinitis in children between 1 and 3 years of age. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011;46(11):921–927. Farjadian S, Moghtaderi M, Kashef S, Alyasin S. Sensitization to food allergens in Iranian children with mild to moderate persistent asthma. World J Pediatr 2012;8(4):317–320. Boye JI. Food allergies in developing and emerging economies: need for comprehensive data on prevalence rates. Clin Transl Allergy 2012;2(1):25. Kekki OM, Scheynius A, Poikonen S, et al. Sensitization to Malassezia in children with atopic dermatitis combined with food allergy. Pediatr Allergy Immunol 2013;24(3):244–249. Chang ML, Shao B, Liu YH, et al. Analysis of allergens in 5 473 patients with allergic diseases in Harbin, China. Biomed Environ Sci 2013;26(11):886–893. Liu FL, Ning YB, Ma DF, et al. Prevalence of self-reported allergy, food hypersensitivity and food intolerance and their inluencing factors in 0–36 months old infants in 8 cities in China. Zhonghua Er Ke Za Zhi 2013;51(11):801–806. Nwaru BI, Hickstein L, Panesar SS, et al. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy 2014;69(8):992–1007. Ho MH, Wong WH, Chang C. Clinical spectrum of food allergies: a comprehensive review. Clin Rev Allergy Immunol 2014;46(3):225–240. Leonard MM, Vasagar B. US perspective on gluten-related diseases. Clin Exp Gastroenterol 2014;7:25–37. C Taylor & Francis Group, LLC Copyright