Concomitant Celiac Disease and Wheat Allergy: 2 Case Reports.

Abstract

Wheat flour (Triticum aestivum) is a major food source throughout the world. It is used in the manufacture of bread, pasta, and cereals. Wheat can cause various diseases, including IgE-mediated food allergy, wheat-dependent exercise-induced anaphylaxis, respiratory allergy (baker’s asthma), celiac disease, and nonceliac gluten sensitivity. Wheat allergy is an IgE-mediated response to any of the proteins present in wheat, including gluten. Its prevalence varies depending on age and region from 0.4% to 4% [1]. Around 65% of children outgrow this allergy by the age of 12 months. Celiac disease is an autoimmune disorder with an aberrant response to gluten proteins (present in wheat, barley, and rye) with subsequent atrophy of intestinal villi, impaired intestinal absorption, and malnutrition. The symptoms of wheat allergy can range from mild to life-threatening and include skin rash, nausea, abdominal pain, vomiting/diarrhea, respiratory symptoms, and even anaphylaxis. Onset is usually within minutes, more rarely within 1-2 hours. A tentative diagnosis can be made using skin prick testing or a specific serum IgE assay. Nonetheless, the assessment of IgE with the whole wheat extract is poorly sensitive and specific owing to crossreactivity with other allergenic molecules. Wheat proteins are classified into albumins, salt-soluble globulins, and insoluble prolamins (gliadins and glutenins). Molecular tests can identify the presence of specific IgE against individual components: glutenins, gliadin, ω-5 gliadin, α-amylase inhibitors, lipid transfer proteins, and Tri a 14 [2,3]. We report what could be the first 2 cases of concomitant celiac disease and IgE-mediated allergy to wheat proteins. The first patient was a 15-year-old girl who was diagnosed with celiac disease at the age of 6 years based on symptoms, positive antitransglutaminase IgA level (240 IU/mL, [normal value <7 IU/mL], Thermo Fisher Scientific), antiendomysial IgA (1:256), and duodenal biopsy findings. She remained on a gluten-free diet, with clinical benefits and normal immunological test results. She came to our emergency Manuscript received November 13, 2018; accepted for publication May 20, 2019.