Clinical utility of IgE antibodies to ω-5 gliadin in the diagnosis of wheat allergy: a pediatric multicenter challenge study.
ABSTRACT There are contradictory results regarding the clinical usefulness of the determination of IgE antibodies to ω-5 gliadin in children with a suspicion of wheat allergy (WA).
The study comprised 311 children and young adults with suspected wheat intolerance treated at three separate pediatric clinics and, with the exception of 25, were found to be positive in specific IgE antibody determinations to wheat. Their ages ranged from 6 months to 20.4 years (median age, 2.3 years). Possible relationships between IgE antibodies to ω-5 gliadin and a physician's diagnosis of WA and challenge symptoms were studied.
The mean concentration of IgE antibodies to ω-5 gliadin was 1.2 kU(A)/l in WA patients and <0.35 kU(A)/l in patients without WA (p < 0.0001). Seventy-two percent of the WA patients had positive ω-5 gliadin levels and 75% of the patients without WA had negative levels. Logistic regression showed a significant relationship between the probability of WA and the concentration of IgE antibodies to ω-5-gliadin with a 2.6-fold (95% CI: 2.0-3.3) increased risk. Age was an important factor to consider as the risk of WA increased 5.4-fold (95% CI: 1.4-21) for children ≤1 year of age and 2.5-fold (95% CI: 2.0-3.2) for children >1 year of age with increasing levels of IgE.
Detection of IgE to ω-5 gliadin seems to be associated with responsiveness to the challenge test and is particularly useful in infants with a suspicion of WA.
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ABSTRACT: Wheat is one of the most common food allergens in children. The purpose of this study is to define the natural course of wheat allergy in children with dominant gastrointestinal symptoms and identify factors that help predict development of tolerance. The prospective analysis covered 50 children with positive food challenge results (DBPCFC) and positive wheat IgE test result. Resolution of wheat allergy was determined on the basis of food challenge results (open challenge). The impact of each of the studied factors on the age when tolerance developed was assessed by means of the Cox proportional hazard regression model. The median age of tolerance development was 69.5 months (37-192 mo.). The rates of resolution were 20% by the age of 4 years, 52% by the age of 8 years, and 66% by 12 years, and 76% by 18 years. The median age of the tolerance development in children with peak wheat IgE level below10 kU/L was 41.4 months, with peak wheat IgE from 10 to 19.9 kU/L was 44.5 months, with peak IgE from 20 to 49.9 kU/L - 84,9 months and with peak IgE >= 50 kU/L - 190.5 months. The median of the age when the highest levels of IgE for wheat were reached was 33 months (2-52 mo.) in children with resolved wheat allergy and 67 months (36-178 mo.) in children with persistent allergy (p = .001). 1. The majority of children with wheat allergy can tolerate wheat by adolescence. 2. The age when tolerance to wheat developed depended on the level and the age of reaching the highest levels of specific IgE for wheat. The higher the values of the above parameters, the older a child was when they developed tolerance to wheat.Allergy Asthma and Clinical Immunology 02/2014; 10(1):12.
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ABSTRACT: This chapter explains the ttle of the book and highlights the importance of recognizing the Nonceliac Gluten Sensitvity. Briefy discuss the topics covered in the diferent chapters within the context of a new defniton with recent advances in China, Mexico, El Salvador and Costa Rica. We review the immunological diferences between celiac disease and non-celiac gluten sensitvity as well as the clinical and pathological diferences among celiac disease, gluten allergy, gluten sensitvity and non-celiac gluten intolerance. The physiological and immunological efects that can trigger wheat products are also briefy summarized without mentoning somatzaton disorders that may apply to some patents with sensitvity or food intolerance. In this light we describe new concepts over placebo and nocebo. This new insight suggests the need to incorporate protocols to understand the efects of a gluten-free diet. It is clear that the two opposing mechanisms, placebo and nocebo may be important not only when administering drugs but when specifc diets are used as a treatment. Subsequently, attenton is drawn to the chapters of diagnostc techniques such as celiac disease serology, endoscopy and histopathology as well as various clinical forms in children and adults. Finally, we briefy review the diferent and clinically important topics in celiac disease that is described by authors that are experts in their respectve issues.
- The Journal of allergy and clinical immunology 12/2013; · 12.05 Impact Factor