Favorable Prognosis of Wheat Allergy in Adults

BACKGROUND AND OBJECTIVE: Wheat ingestion can lead to different disorders such as IgE-mediated food allergy and wheat-dependent exercise-induced anaphylaxis (WDEIA), associated with impaired quality of life and significant morbidity. Allergy to wheat is relatively benign in children, however its natural history in adults is still unknown. Objective: We evaluated the natural history of wheat hypersensitivity in atopic patients with adult-onset wheat- allergy assessed by placebo-controlled-challenge. METHODS: We enrolled 13 patients from an initial cohort of adult patients (mean age 40 years) with IgE-mediated wheat allergy. After diagnosis the patients observed a wheat-free diet and were followed as outpatients for 5-years to evaluate for wheat-exposure. At the end of the follow-up, wheat-IgE titers were determined and a second wheat-challenge was performed. RESULTS: 10 out of 13 patients took part in the study. The mean period of wheat avoidance was 4.2 years. 3 patients had spontaneously re-introduced wheat before the second evaluation, after a mean of 28 months (IQR 18-36 months), with only mild gastrointestinal discomfort at wheat reintroduction. At the end of follow-up, 9/10 patients were wheat-tolerant. 2 patients had a history WDEIA. A reduction of IgE levels, median IgE from 2.77 kU/l (IQR 0.35-100 kU/L) at diagnosis to 0.88 kU/l (IQR 0.1-20.8 Ku/L) was observed. No statistical correlation was found between IgE and negative challenge outcome. CONCLUSIONS: IgE-mediated wheat allergy in adults is benign and represents a temporary break in the gastrointestinal tolerance. Future studies may improve our knowledge of wheat allergens, routes and factors leading to sensitization and prognostic biomarkers.