Article

Clinical Utility of IgE Antibodies to ω-5 Gliadin in the Diagnosis of Wheat Allergy: A Pediatric Multicenter Challenge Study

Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan.
International Archives of Allergy and Immunology (Impact Factor: 2.67). 12/2011; 158(1):71-6. DOI: 10.1159/000330661
Source: PubMed

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.

Full-text

Available from: Motohiro Ebisawa, Jan 23, 2015
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Original Paper
Int Arch Allergy Immunol 2012;158:71–76
DOI: 10.1159/000330661
Clinical Utility of IgE Antibodies to -5
Gliadin in the Diagnosis of Wheat Allergy:
A Pediatric Multicenter Challenge Study
Motohiro Ebisawa
a
Rumiko Shibata
b
Sakura Sato
a
Magnus P. Borres
d, e
Komei Ito
c
a
Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National
Hospital, Sagamihara ,
b
Department of Pediatrics, Fukuoka National Hospital, Fukuoka , and
c
Department of Allergy,
Aichi Children‘s Health and Medical Center, Obu , Japan;
d
Medical Department, Phadia AB, Uppsala , and
e
Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg , Sweden
consider as the risk of WA increased 5.4-fold (95% CI: 1.421)
for children ^ 1 year of age and 2.5-fold (95% CI: 2.0–3.2) for
children 1 1 year of age with increasing levels of IgE. Conclu-
sion: Detection of IgE to -5 gliadin seems to be associated
with responsiveness to the challenge test and is particularly
useful in infants with a suspicion of WA.
Copyright © 2011 S. Karger AG, Basel
Introduction
Wheat is one of the six most common foods causing al-
lergy in children and the third most common food aller-
gen in Japanese children
[1] . IgE antibodies to egg, cow’s
milk and peanut have been useful in predicting clinical
reactivity
[24] . Furthermore, the correlation between the
outcome of oral food challenges and levels of IgE antibod-
ies to wheat was established in Japanese children with sus-
pected wheat allergy (WA)
[5] . -5 gliadin has been iden-
tified as the major antigen in children with wheat-depen-
dent, exercised-induced anaphylaxis
[6] . Furthermore, IgE
antibodies to -5 gliadin have been found in children with
immediate reactions to ingested wheat
[7] , and recently
published results show that increased levels of IgE anti-
bodies to -5 gliadin correlate with the outcome of oral
Key Words
Allergy tests Food challenge IgE -5 gliadin Pediatric
allergy Wheat
Abstract
Background: There are contradictory results regarding the
clinical usefulness of the determination of IgE antibodies to
-5 gliadin in children with a suspicion of wheat allergy (WA).
Methods: 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 (me -
dian age, 2.3 years). Possible relationships between IgE anti-
bodies to -5 gliadin and a physician’s diagnosis of WA and
challenge symptoms were studied. Results: The mean con-
centration of IgE antibodies to -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 posi-
tive -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 concen-
tration of IgE antibodies to -5-gliadin with a 2.6-fold (95%
CI: 2.0–3.3) increased risk. Age was an important factor to
Received: March 3, 2011
Accepted after revision: June 30, 2011
Published online: December 29, 2011
Correspondence to: Dr. Motohiro Ebisawa
Clinical Research Center for Allergy and Rheumatology
Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku
Sagamihara, Kanagawa 252-0392 (Japan)
Tel. +81 42 742 8311, E-Mail m-ebisawa
@ sagamihara-hosp.gr.jp
© 2011 S. Karger AG, Basel
1018–2438/12/1581–0071$38.00/0
Accessible online at:
www.karger.com/iaa
Page 1
Ebisawa /Shibata /Sato /Borres /Ito
Int Arch Allergy Immunol 2012;158:71–76
72
wheat challenge [8] . The level of antibodies to -5 gliadin
has thus been suggested to serve as a marker for clinical
reactivity and an aid for the decision for or against wheat
challenge. Contradictory results have been reported from
two populations of German and American children where
no correlation between -5 gliadin antibody levels and the
outcome of oral food challenge could be demonstrated
[9] .
The objective of this survey was to evaluate the pos-
sible clinical usefulness of IgE antibody concentrations to
-5 gliadin in relation to WA in a large cohort of food-
challenged children.
Patients and Methods
This retrospective study was performed in 311 children and
young adults with suspected wheat intolerance treated at three
different clinics in Japan. The clinics were the Fukuoka National
Hospital (n = 88, site 1), Fukuoka, the Aichi Children’s Hospital
(n = 114, site 2), and the Ohbu and Sagamihara National Hospital
(n = 109, site 3), Sagamihara. The three participating departments
were representative for pediatric allergology in Japan. Inclusion
criteria were suspicion of WA based either on clinical history and/
or serology. All individuals, except for 25, had specific IgE anti-
body to wheat. The children had been referred from primary care
physicians or enrolled at the outpatient clinic due to immediate
hypersensitivity reactions following wheat ingestion. Clinical his-
tory comprised skin, gastrointestinal tract and/or respiratory
tract symptoms following wheat ingestion. The age of the patients
ranged from 6 months to 20.4 years (median age, 2.3 years), and
215 of the individuals were males. Informed consent was given by
the child or childs parents prior to enrolment.
Clinically, each patient was subjected to a detailed medical ex-
amination and medical history data were collected. In order to
confirm or exclude WA, the diagnosis was based on either oral
food challenges or case history or, in most cases, a combination of
both. Blood was sampled for baseline determination of IgE anti-
bodies to wheat and -5 gliadin. Serum samples were analyzed
for IgE antibodies to wheat and -5 gliadin using the Immuno-
CAP System FEIA (Phadia AB, Uppsala, Sweden). The detection
limit of the assays was 0.35 kU
A
/l.
All wheat-food challenges were open challenges performed in
a hospital setting and supervised by physicians in accordance
with the guidelines for the diagnosis and management of pediat-
ric food allergy in Japan
[10, 11] . In children with a strong con-
vincing history for high-risk responses, including severe symp-
toms on challenge, the challenge procedure was not carried out
(n = 36). When a child had no objective WA symptoms and/or was
eating wheat (n = 60), a challenge was not carried out and the child
was classified as no WA (NoWA). Based on case history, physical
examination and, in most cases, challenge outcome, each child
was classified as having an immediate hypersensitivity reaction
to ingested wheat or NoWA.
Statistical Methods
The Mann-Whitney non-parametric test was used to test dif-
ferences between the groups. A p value of 0.05 was regarded as
significant. Performance characteristics, i.e. sensitivity and spec-
ificity, were calculated for various cutoff values, including the op-
timal cutoff values proposed by the receiver-operating character-
istic (ROC) plots. For quantitative evaluation, a logistic regression
model was formulated as the probability of receiving a positive
clinical diagnosis as a function of the logarithm of the specific IgE
concentration:
logit(Pr[Y = 1/ln IgE (kU/l)]) = + ln IgE (kU/l)
This quantitative model describes the relationship between
sensitization and clinical diagnosis of WA. Statistical analysis was
carried out using SAS System V9.1.
R e s u l t s
The diagnosis of WA was confirmed in 173 children by
symptoms following oral wheat challenge or a convincing
case history of anaphylaxis in relation to wheat intake.
Five of these children had specific IgE to wheat ! 0.35
kU
A
/l. The remaining 138 children were classified as
NoWA. The demographic characteristics and outcome of
oral wheat challenges are presented in table1 for both WA
and NoWA patients. The median concentrations of IgE
antibodies to wheat and -5 gliadin in children with con-
firmed WA were 18.1 (range ! 0.35 to 1 100) and 1.2 (range
! 0.35100) kU
A
/l, respectively. The corresponding values
0.1
IgE antibody concentration (kU
A
/l)
NoWA
Wheat ω-5 gliadin
WA NoWA
Response to oral food challenge
WA
1
10
100
Fig. 1. Allergen-specific IgE titers for wheat and -5 gliadin for
WA and NoWA patients.
Color version available online
Page 2
Clinical Utility of IgE Antibodies to -5
Gliadin
Int Arch Allergy Immunol 2012;158:71–76
73
for the children classified as NoWA were 5.2 (range ! 0.35
86.8) and ! 0.35 (range ! 0.35–4.8) kU
A
/l, respectively
( fig.1 ). This difference in allergen-specific IgE concentra-
tions between the two groups was significant (p ! 0.0001).
Seventy-two percent (125 of 173) of the WA patients had
positive -5 gliadin levels and 75% (104 of 138) of the
NoWA patients had negative -5 gliadin levels. In total,
137 of the 173 WA patients were challenged, and symptom
responses following challenge are presented in figure 2 for
each of the clinics separately and for all three combined.
Skin reactions (erythema, urticaria and eczema) were pre-
dominating, amounting to 1 75%. As shown for site 1,
1 10% of the patients experienced an anaphylactic reaction
during the challenge. In the remaining WA patients that
were not challenged but had a convincing history (n = 36),
skin reactions (94%), cough (17%), wheezing (14%) and
anaphylaxis (5%) were the most frequent symptoms.
ROC analyses were performed to evaluate the diagnos-
tic ability of the in vitro tests. The area under the curve
(AUC) for -5 gliadin was 78.5% ( fig.3 ). At an estimated
cutoff of 0.41 kU
A
/l, values of 72% (sensitivity), 79% (spec-
ificity), 81% (PPV), 69% (NPV), 3.4 (positive likelihood
ratio) and 0.5 (negative likelihood ratio) were obtained for
the assay. The corresponding figures for wheat were: AUC
73.0%, 61% (sensitivity), 74% (specificity), 75% (PPV), 60%
(NPV), 2.4 (positive likelihood ratio) and 0.5 (negative
likelihood ratio) at a cutoff of 10.1 kU
A
/l. The concentra-
tion difference between the two pediatric groups was fur-
ther investigated using a logistic regression model. A sig-
nificant relationship between the probability of WA and
0
10
20
30
40
50
60
70
80
90
100
Wheeze
Gastrointestinal symptoms
Nasal allergy
Oral allergy
Anaphylaxis
Site 3
%
Cough
Erythema, ur ticaria,
eczema
0
10
20
30
40
50
60
70
80
90
100
Wheeze
Gastrointestinal symptoms
Nasal allergy
Oral allergy
Anaphylaxis
All
%
Cough
Erythema, ur ticaria,
eczema
0
10
20
30
40
50
60
70
80
90
100
Wheeze
Gastrointestinal symptoms
Nasal allergy
Oral allergy
Anaphylaxis
Site 1
%
Cough
Erythema, ur ticaria,
eczema
0
10
20
30
40
50
60
70
80
90
100
Wheeze
Gastrointestinal symptoms
Nasal allergy
Oral allergy
Anaphylaxis
Site 2
%
Cough
Erythema, ur ticaria,
eczema
Color version available online
Fig. 2. Symptom frequencies in WA pa-
tients at food challenge. Numbers of pa-
tients are given in table1.
Page 3
Ebisawa /Shibata /Sato /Borres /Ito
Int Arch Allergy Immunol 2012;158:71–76
74
the concentration of IgE antibodies to -5 gliadin was
thus found. The risk increased 2.6-fold (95% CI: 2.03.3)
with increasing levels of IgE ( fig.4 a). Furthermore, when
grouping the children into different age groups, there was
a significant difference between ^ 1 and 1 1 year of age in
the probability of WA for the concentration of IgE anti-
bodies to -5 gliadin. The risk of WA increased for chil-
dren ^ 1 year of age 5.4-fold (95% CI: 1.421) and 2.5-fold
(95% CI: 2.0–3.2) for children 1 1 year of age with increas-
ing levels of IgE, as illustrated in figure 4 a. The relation-
ship between the concentration of IgE antibodies to wheat
and -5 gliadin was also investigated in a logistic regres-
sion model. A significant association to WA was found for
-5 gliadin with a 2.1-fold increased risk (95% CI: 1.9–
3.6). Figure 4 b shows the probability of WA at nine differ-
ent values of -5 gliadin increased with increasing anti-
body concentrations of specific IgE to wheat.
Discussion
Our results confirmed a difference in the IgE levels of
-5 gliadin between WA and NoWA children in this mul-
ticenter challenge study. Further, we demonstrate that IgE
antibodies to -5 gliadin are particularly useful in pre-
dicting food challenge outcome in children ! 1 year of age.
Our findings based on 311 Japanese children are not
in agreement with the recent findings of Beyer et al.
[9] ,
who could not find a correlation between -5 gliadin lev-
0
Sensitivity (true positive)
0 0.1 0.2 0.3 0.4 0.5
1 – Specificity (false positive)
0.6 0.7 0.8 0.9 1.0
ω-5 gliadin = 78.5%
AUC:
Wheat = 73.0%
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Fig. 3. ROC curve based on all patients.
Table 1. Demographic and background characteristics of the patients (numbers, medians and ranges)
Wheat allergy N o wheat allergy
sex age, years challenge/
convincing history
sex age, years challenge/
convincing
history
Site 1 Male (n = 79)
Female (n = 35)
Total (n = 114)
31
14
2.4 (1.0–8.7)
3.5 (1.0–7.1) 22/23
48
21
3.9 (1.0–20.4)
4.5 (1.4–15.4)
24/45
Site 2 Male (n = 62)
Female (n = 26)
Total (n = 88)
48
19
1.6 (0.6–7.1)
2.1 (0.6–8.8)
63/4
14
7
1.9 (0.8–7.6)
3.0 (0.9–6.9)
21/0
Site 3 Male (n = 71)
Female (n = 38)
Total (n = 109)
38
23
2.8 (1.1–12.0)
2.3 (0.8–8.6)
52/9
33
15
1.8 (0.6–14.8)
2.1 (0.5–8.2)
33/15
All sites Male (n = 212)
Female (n = 99)
Total (n = 311)
117
56
2.0 (0.6–12.0)
2.2 (0.6–8.8)
137/36
95
43
2.8 (0.6–20.4)
3.3 (0.5–15.4)
78/60
Page 4
Clinical Utility of IgE Antibodies to -5
Gliadin
Int Arch Allergy Immunol 2012;158:71–76
75
els and the outcome of oral wheat challenges in a group
of 57 German and 29 American children. One explana-
tion could be the sample size, as our study contains 5 and
10 times more children, respectively. Another explana-
tion could be that the inclusion criteria of the study pop-
ulation differed and the study participants had different
phenotypes. With regard to the German group, almost
half of the children (9 of 19) reacted to wheat challenge
but were not sensitized to wheat. In our study, only 5 of
137 challenge-positive children were not sensitized to
wheat. The German study population thus included more
individuals with non-IgE-mediated WA with delayed
symptoms than our study.
Further, no child had -5 gliadin levels 1 20 kU
A
/l in
their study compared to 11 individuals in our study. A
third explanation as to why we arrived at a different con-
clusion could be the age factor. WA, which usually begins
in early childhood, is outgrown in most cases by 35 years
of age
[12] , whereas 35% show a persistent WA into ado-
lescence
[13] . The children in our study had a median age
of 2.3 years and they were representative of typical pedi-
atric cases of immediate allergy to wheat in our opinion.
We speculate that -5 gliadin may differ among popu-
lations in Asia and Europe due to dietary habits and the
genetic background. Our study is however in agreement
with the Finnish study, which demonstrated earlier that
IgE to -5 gliadin is highly predictive of immediate al-
lergy to ingested wheat in children
[7] . Further studies are
needed to clarify the impact of different races, food hab-
its and genetic variations on immediate allergy to wheat.
Measuring IgE to -5 gliadin is useful in the diagnos-
tic workup when investigating immediate-type WA in
children and young adults. In Japan, both IgE to wheat
and -5 gliadin are now routinely assessed when investi-
gating these patients. Patients sensitized to -5 gliadin
are not challenged with wheat as it is most likely to fail.
Patients responsive to the test are asked to strictly avoid
wheat. The serology of these patient is then followed pro-
spectively in order to have an indication that tolerance
had developed and wheat challenge should be performed.
The other scenario is the patient sensitized to wheat but
not to -5 gliadin during the initial investigation. A
wheat challenge is performed as soon as possible in order
to confirm or exclude a diagnosis of WA.
In conclusion, the detection of IgE to -5 gliadin
seems to be associated with responsiveness to the chal-
lenge test and is particularly useful in infants with a sus-
picion of WA.
Acknowledgments
This study was supported by Health and Labor Sciences Re-
search Grants for Research on Allergic Diseases and Immunology
from the Ministry of Health, Labor and Welfare.
0
>1 year (n = 291)
≤1 year (n = 20)
All patients (n = 311)
Probability (%)
0.1 1 10
ω-5 gliadin: IgE antibody concentration (kU
A
/l)a
100
10
20
30
40
50
60
70
80
90
100
45
Probability (%)
0.5 5
100
ω-5 gliadin (kU
A
/l)
52.2 27.2 14.4 7.4 3.9 2.0 1.1
0.6
50 100
Wheat (kU
A
/l)b
50
55
60
65
70
75
80
85
90
95
100
Color version available online
Fig. 4. Fitted predicted probability curves for the outcome of WA at a given IgE value for -5 gliadin for all chil-
dren and for children ^ 1 and 1 1 years of age (
a ) and for nine concentrations of -5 gliadin in relation to spe-
cific IgE to wheat (
b ).
Page 5
Ebisawa /Shibata /Sato /Borres /Ito
Int Arch Allergy Immunol 2012;158:71–76
76
References
1 Imai T: The national survey of immediate
type of food allergy (in Japanese). Arerugi
2004;
53: 689–695.
2 Celik-Bi lg i li S, Mehl A, Verstege A, Staden U,
Nocon M, Beyer K, et al: The predictive value
of specific immunoglobulin E levels in se-
rum for the outcome of oral food challenges.
Clin Exp Allergy 2005;
35: 268273.
3 Perry TT, Matsui EC, Kay Conover-Walker
M, Wood RA: The relationship of allergen-
specific IgE levels and oral food challenge
outcome. J Allergy Clin Immunol 2004;
114:
144–149.
4 Sampson HA: Utility of food-specific IgE
concentrations in predicting symptomatic
food allergy. J Allergy Clin Immunol 2001;
107(5 suppl):891–896.
5 Komata T, Söderström L, Borres MP, Tachi-
moto H, Ebisawa M: Usefulness of wheat and
soybean specific IgE antibody titers for the
diagnosis of food allergy. Allergol Int 2009;
58: 599603.
6 Daengsuwan T, Palosuo K, Phankingthong-
kum S, Visitsunthorn N, Jirapongsananuruk
O, Alenius H, et al: IgE antibodies to -5 gli-
adin in children with wheat-induced ana-
phylaxis. Allergy 2005;
60: 506–509.
7 Palosuo K, Varjonen E, Kekki OM, Klemola
T, Kalkkinen N, Alenius H, et al: Wheat -
gliadin is a major allergen in children with
immediate allergy to ingested wheat. J Al-
lergy Clin Immunol 2001;
108: 634638.
8 Ito K, Futamura M, Borres MP, Takaoka Y,
Dahlstrom J, Sakamoto T, et al: IgE antibod-
ies to -5 gliadin associate with immediate
symptoms on oral wheat challenge in Japa-
nese children. Allergy 2008;
63: 1536–1542.
9 Beyer K, Chung D, Schulz G, Mishoe M,
Niggemann B, Wahn U, et al: The role of
wheat -5 gliadin IgE antibodies as a diag-
nostic tool for wheat allergy in childhood. J
Allergy Clin Immunol 2008;
122: 419421.
10 Ebisawa M: Management of food allergy in
Japan ‘food allergy management guideline
2008 (revision from 2005)’ and ‘guidelines
for the treatment of allergic diseases in
schools’. Allergol Int 2009;
58: 475–483.
11 Ito K, Urisu A: Diagnosis of food allergy
based on oral food challenge test. Allergol Int
2009;
58: 467474.
12 Inomata N: Wheat allergy. Curr Opin Aller-
gy Clin Immunol 2009;
9: 238–243.
13 Keet CA, Matsui EC, Dhillon G, Lenehan P,
Paterakis M, Wood RA: The natural history
of wheat allergy. Ann Allergy Asthma Im-
munol 2009;
102: 410415.
Page 6
  • Source
    • "In recent years a new wheat allergen, the recombinant rω-5-gliadin (Tri a 19), has been discovered in patients with anaphylaxis and with WDEIA. High concentrations of IgE for the recombinant rω-5-gliadin correlate with the severity of response as well as with the wheat volume in a food challenge test., which gives hope that the cut-off value can be determined giving the maximum efficiency of the rω-5-gliadin test for the positive wheat challenge [8,10,27-29]. In other forms of WA the rω-5 gliadin-specific IgE is less frequent – it is observed in just 30% of patients. "
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  • Source
    • "It also appears that IgE against different epitopes may be responsible for different phenotypes of wheat-related allergy as well as its severity [36,39-46]. Indeed, recently there have been two reports that indicate that omega-5 gliadin predicts for severe reactions in OFC to wheat [47,48]. Furthermore, wheat has been also increasingly reported to be a risk factor for exercise-induced anaphylaxis [8]. "
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