Open Access, Peer-reviewed
pISSN 2288-0402
eISSN 2288-0410
    Allergy Asthma Respir Dis. 2016 Mar;4(2):119-125. Korean.
    Published online Mar 31, 2016.
    https://doi.org/10.4168/aard.2016.4.2.119
    © 2016 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
    Original Article

    Usefulness of specific IgE antibody levels to wheat, gluten, and ω-5 gliadin for wheat allergy in Korean children

    Jongseo Yoon, Kyunguk Jeong and Sooyoung Lee
      • Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.
    • Correspondence to: Sooyoung Lee. Department of Pediatrics, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-5164, Fax: +82-31-219-5169, Email: jsjs87@ajou.ac.kr
    Received August 04, 2015; Revised September 24, 2015; Accepted October 01, 2015.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

    Abstract

    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 (WAAna) and wheat allergy without anaphylaxis (WANon-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 WAAna group from the WANon-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.

    Keywords
    Wheat hypersensitivity; Wheat; Glutens; Gliadin; Anaphylaxis

    Figures

    Fig. 1
    Receiver operating characteristic curves represent sensitivity and specificity of specific IgE to wheat (solid), gluten (dotted), and ω-5 gliadin (dashed). (A) WA vs. Non-WA, (B) WAAna vs. WANon-Ana. WA, wheat allergy; Non-WA, non-wheat allergy; WAAna, wheat allergy with anaphylaxis; WANon-Ana, wheat allergy without anaphylaxis; AUC, area under the curve.

    Tables

    Table 1
    Clinical characteristic of study subjects

    Table 2
    IgE antibody levels to wheat, ω-5 gliadin, and gluten in subjects

    Table 3
    Diagnostic performance of specific IgE to wheat, gluten and ω-5 gliadin at different cutoff points

    Table 4
    Comparison of 3 diagnostic methods for clinical prediction of wheat allergy

    References

      1. Boyce JA, Assaad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Allergy Clin Immunol 2010;126:1105–1118.
      1. Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PA, Ebisawa M, et al. ICON: food allergy. J Allergy Clin Immunol 2012;129:906–920.
      1. Ahn K, Kim J, Hahm MI, Lee SY, Kim WK, Chae Y, et al. Prevalence of immediate-type food allergy in Korean schoolchildren: a population-based study. Allergy Asthma Proc 2012;33:481–487.
      1. Kim J, Chang E, Han Y, Ahn K, Lee SI. The incidence and risk factors of immediate type food allergy during the first year of life in Korean infants: a birth cohort study. Pediatr Allergy Immunol 2011;22:715–719.
      1. Lee SY, Kim KW, Lee HH, Lim DH, Chung HL, Kim SW, et al. Incidence and clinical characteristics of pediatric emergency department visits of children with severe food allergy. Korean J Asthma Allergy Clin Immunol 2012;32:169–175.
      1. Korea Flour Mills Industrial Association. Annual per capita flour consumption [Internet]. Seoul: Korea Flour Mills Industrial Association; c2015 [cited 2015 April 20].
        Available from: http://www.kofmia.org.
      1. Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, et al. The prevalence of plant food allergies: a systematic review. J Allergy Clin Immunol 2008;121:1210–1218.e4.
      1. Lee AJ, Thalayasingam M, Lee BW. Food allergy in Asia: how does it compare? Asia Pac Allergy 2013;3:3–14.
      1. Inomata N. Wheat allergy. Curr Opin Allergy Clin Immunol 2009;9:238–243.
      1. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001;107:891–896.
      1. Nilsson N, Sjolander S, Baar A, Berthold M, Pahr S, Vrtala S, et al. Wheat allergy in children evaluated with challenge and IgE antibodies to wheat components. Pediatr Allergy Immunol 2015;26:119–125.
      1. Morita E, Matsuo H, Chinuki Y, Takahashi H, Dahlstrom J, Tanaka A. Food-dependent exercise-induced anaphylaxis -importance of omega-5 gliadin and HMW-glutenin as causative antigens for wheat-dependent exercise-induced anaphylaxis-. Allergol Int 2009;58:493–498.
      1. Ebisawa M, Shibata R, Sato S, Borres MP, Ito K. Clinical utility of IgE antibodies to ω-5 gliadin in the diagnosis of wheat allergy: a pediatric multicenter challenge study. Int Arch Allergy Immunol 2012;158:71–76.
      1. Beyer K, Chung D, Schulz G, Mishoe M, Niggemann B, Wahn U, et al. The role of wheat omega-5 gliadin IgE antibodies as a diagnostic tool for wheat allergy in childhood. J Allergy Clin Immunol 2008;122:419–421.
      1. Lee SE, Lee SY, Jo EJ, Kim MY, Kim SH, Chang YS. Wheat-induced anaphylaxis in korean adults: a report of 6 cases. Clin Nutr Res 2013;2:76–79.
      1. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006;117:391–397.
      1. Canonica GW, Ansotegui IJ, Pawankar R, Schmid-Grendelmeier P, van Hage M, Baena-Cagnani CE, et al. A WAO - ARIA - GA2LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J 2013;6:17.
      1. Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA. The natural history of wheat allergy. Ann Allergy Asthma Immunol 2009;102:410–415.
      1. Pourpak Z, Mansouri M, Mesdaghi M, Kazemnejad A, Farhoudi A. Wheat allergy: clinical and laboratory findings. Int Arch Allergy Immunol 2004;133:168–173.
      1. 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.
      1. Shibata R, Nishima S, Tanaka A, Borres MP, Morita E. Usefulness of specific IgE antibodies to ω-5 gliadin in the diagnosis and follow-up of Japanese children with wheat allergy. Ann Allergy Asthma Immunol 2011;107:337–343.
      1. Palosuo K, Varjonen E, Kekki OM, Klemola T, Kalkkinen N, Alenius H, et al. Wheat omega-5 gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol 2001;108:634–638.
      1. Makela MJ, Eriksson C, Kotaniemi-Syrjanen A, Palosuo K, Marsh J, Borres M, et al. Wheat allergy in children - new tools for diagnostics. Clin Exp Allergy 2014;44:1420–1430.
      1. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100:444–451.
      1. Ito K, Futamura M, Borres MP, Takaoka Y, Dahlstrom J, Sakamoto T, et al. IgE antibodies to omega-5 gliadin associate with immediate symptoms on oral wheat challenge in Japanese children. Allergy 2008;63:1536–1542.
    Cited by
    Crossref 2
    Google Scholar 
    MeSH Terms
    Anaphylaxis
    Antibodies
    Child*
    Food Hypersensitivity
    Gliadin*
    Glutens*
    Humans
    Hypersensitivity
    Immunoglobulin E*
    Triticum*
    Wheat Hypersensitivity*
    Metrics
    Share
    Figures
    slide

    1 / 1

    Tables
    slide
    slide
    slide
    slide

    1 / 4

    ORCID IDs
    PERMALINK