Wheat allergy#Baker's allergy

Most wheat allergens are proteins, including seed storage proteins, as noted above. There are four major classes of seed storage proteins: albumins, globulins, prolamins and glutenins.{{Citation |last=Chrungoo |first=N. K. |title=Chapter thirty one - Diversity in Seed Storage Proteins and Their Genes in Buckwheat |date=2016-01-01 |work=Molecular Breeding and Nutritional Aspects of Buckwheat |pages=387–399 |editor-last=Zhou |editor-first=Meiliang |url=https://www.sciencedirect.com/science/article/abs/pii/B9780128036921000316 |access-date=2025-01-06 |publisher=Academic Press |isbn=978-0-12-803692-1 |last2=Dohtdong |first2=L. |last3=Chettry |first3=U. |editor2-last=Kreft |editor2-first=Ivan |editor3-last=Woo |editor3-first=Sun-Hee |editor4-last=Chrungoo |editor4-first=Nikhil}}

{{see also|Gluten sensitivity}}The relevant prolamins in wheat are gliadins. Gliadins and glutenins form the classic glutens—the causative agents of celiac disease (CD). Distinct immune cells and antibody types differentiate gluten allergy from CD (see Comparative pathophysiology of gluten sensitivities).

Prolamins (gliadins) are associated with the more severe form of gluten allergy. Glutenin-induced allergies are often less severe.{{citation needed|date=June 2012}} A proteomics-based study found a γ-gliadin isoform gene.

Glutenin (wheat glutelin) is a predominant allergen in wheat. Nine subunits of LMW-glutenin have been found to be in connection with wheat allergies.{{Clarify | date = December 2018 | reason = Subunits of LMW-glutenin, or variations of LMW-glutenin that are subunits of glutenin?}}

At present, many of the allergens of wheat have not been characterized; however, the early studies found many to be in the albumin class.{{cite journal |vauthors=Sutton R, Hill DJ, Baldo BA, Wrigley CW | title = Immunoglobulin E antibodies to ingested cereal flour components: studies with sera from subjects with asthma and eczema | journal = Clinical & Experimental Allergy | volume = 12 | issue = 1 | pages = 63–74 | year = 1982 | pmid = 7067068 | doi =10.1111/j.1365-2222.1982.tb03127.x | s2cid = 13263808 }} A recent study in Europe confirmed the increased presence of allergies to amylase/trypsin inhibitors (serpins){{cite journal |vauthors=Armentia A, Sanchez-Monge R, Gomez L, Barber D, Salcedo G | title = In vivo allergenic activities of eleven purified members of a major allergen family from wheat and barley flour | journal = Clin. Exp. Allergy | volume = 23 | issue = 5 | pages = 410–5 | year = 1993 | pmid = 8334538 | doi =10.1111/j.1365-2222.1993.tb00347.x | s2cid = 6752902 }} and lipid transfer protein (LPT),{{cite journal |author=Pastorello EA |title=Wheat IgE-mediated food allergy in European patients: alpha-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins. Allergenic molecules recognized by double-blind, placebo-controlled food challenge |journal=Int. Arch. Allergy Immunol. |volume=144 |issue=1 |pages=10–22 |year=2007 |pmid=17496422 |doi=10.1159/000102609 |name-list-style=vanc|author2=Farioli L |author3=Conti A |display-authors=3 |last4=Pravettoni |first4=Valerio |last5=Bonomi |first5=Simona |last6=Iametti |first6=Stefania |last7=Fortunato |first7=Donatella |last8=Scibilia |first8=Joseph |last9=Bindslev-Jensen |first9=Carsten|s2cid=202644198 }} but less reactivity to the globulin fraction.{{cite journal |vauthors=Walsh BJ, Wrigley CW, Musk AW, Baldo BA | title = A comparison of the binding of IgE in the sera of patients with bakers' asthma to soluble and insoluble wheat-grain proteins | journal = J. Allergy Clin. Immunol. | volume = 76 | issue = 1 | pages = 23–8 | year = 1985 | pmid = 3839248 | doi =10.1016/0091-6749(85)90799-7 | doi-access = free }} The allergies tend to differ between populations (Italian, Japanese, Danish or Swiss),{{Citation needed|date=July 2008}} indicating a potential genetic component to these reactivities.

Respiratory allergies are an occupational disease that develops in food service workers. Previous studies detected 40 allergens from wheat; some cross-reacted with rye proteins and a few cross-reacted with grass pollens.{{cite journal |vauthors=Blands J, Diamant B, Kallós P, Kallós-Deffner L, Lowenstein H | title = Flour allergy in bakers. I. Identification of allergenic fractions in flour and comparison of diagnostic methods | journal = Int. Arch. Allergy Appl. Immunol. | volume = 52 | issue = 1–4 | pages = 392–406 | year = 1976 | pmid = 65335 | doi = 10.1159/000231706}} A later study showed that baker's allergy extends over a broad range of cereal grasses (wheat, durum wheat, triticale, cereal rye, barley, rye grass, oats, canary grass, rice, maize, sorghum and Johnson grass), though the greatest similarities were seen between wheat and rye,{{cite journal |vauthors=Baldo BA, Krilis S, Wrigley CW | title = Hypersensitivity to inhaled flour allergens. Comparison between cereals | journal = Allergy | volume = 35 | issue = 1 | pages = 45–56 | year = 1980 | pmid = 6154431 | doi =10.1111/j.1398-9995.1980.tb01716.x | s2cid = 10966071 }} and that these allergies show cross-reactivity between seed proteins and pollen proteins,{{cite journal |vauthors=Valero Santiago A, Amat Par P, Sanosa Valls J, Sierra Martínez P, Malet Casajuana A, García Calderón PA | title = Hypersensitivity to wheat flour in bakers | journal = Allergologia et Immunopathologia | volume = 16 | issue = 5 | pages = 309–14 | year = 1988 | pmid = 3228051 }} including a prominent cross-reactivity between the common environment rye pollen and wheat gluten.{{cite journal |vauthors=Donovan GR, Baldo BA | title = Crossreactivity of IgE antibodies from sera of subjects allergic to both ryegrass pollen and wheat endosperm proteins: evidence for common allergenic determinants | journal = Clin. Exp. Allergy | volume = 20 | issue = 5 | pages = 501–9 | year = 1990 | pmid = 2253081 | doi =10.1111/j.1365-2222.1990.tb03142.x | s2cid = 24293429 }}{{cite journal |vauthors=Yazicioglu M, Oner N, Celtik C, Okutan O, Pala O | title = Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey | journal = Asian Pac. J. Allergy Immunol. | volume = 22 | issue = 4 | pages = 183–90 | year = 2004 | pmid = 15783130 }}.

Proteins are made of a chain of dehydrated amino acids. When enzymes cut proteins into pieces, they add water back to the site at which they cut. This process is called enzymatic hydrolysis, or in the case of proteins it is called proteolysis. The initial products of this hydrolysis are polypeptides, and smaller products are called simply peptides; these are called wheat protein hydrolysates. These hydrolysates can create allergens out of wheat proteins that previously did not exist by the exposure of buried antigenic sites in the proteins.{{citation needed|date=April 2022}}

When proteins are cut into polypeptides, buried regions are exposed to the surface, and these buried regions may possibly be antigenic. Such hydrolyzed wheat protein is used as an additive in foods and cosmetics. The peptides are often 1 kD in size (9 amino acid residues in length) and may increase the allergic response.{{cite journal | author = Akiyama H | title = Profile analysis and immunoglobulin E reactivity of wheat protein hydrolysates | journal = Int. Arch. Allergy Immunol. | volume = 140 | issue = 1 | pages = 36–42 | year = 2006 | pmid = 16534217 | doi = 10.1159/000092000 |name-list-style=vanc| author2 = Sakata K | author3 = Yoshioka Y | display-authors = 3 | last4 = Murata | first4 = Yoshifumi | last5 = Ishihara | first5 = Yoshihiro | last6 = Teshima | first6 = Reiko | last7 = Sawada | first7 = Jun-Ichi | last8 = Maitani | first8 = Tamio | s2cid = 37040078 }} These wheat polypeptides can cause immediate contact urticaria in susceptible people.{{cite journal | author = Laurière M | title = Hydrolysed wheat proteins present in cosmetics can induce immediate hypersensitivities | journal = Contact Derm. | volume = 54 | issue = 5 | pages = 283–9 | year = 2006 | pmid = 16689814 | doi = 10.1111/j.0105-1873.2006.00830.x |name-list-style=vanc| author2 = Pecquet C | author3 = Bouchez-Mahiout I | display-authors = 3 | last4 = Snegaroff | first4 = Jacques | last5 = Bayrou | first5 = Olivier | last6 = Raison-Peyron | first6 = Nadia | last7 = Vigan | first7 = Martine | s2cid = 23991489 }}

Wheat allergies are not altogether different from other food allergies or respiratory allergies. However, two conditions, exercise/aspirin induced anaphylaxis and urticaria, occur more frequently with wheat allergies.{{citation needed|date=April 2022}}

Common symptoms of a wheat allergy include eczema (atopic dermatitis), hives (urticaria), asthma, "hay fever" (allergic rhinitis), angioedema (tissue swelling due to fluid leakage from blood vessels), abdominal cramps, nausea, and vomiting.{{cite web |url=http://www.allergysa.org/wheat.htm |title=Allergy Society of South Africa – Wheat Allergy |access-date=2008-10-20 |archive-url = https://web.archive.org/web/20080424072330/http://www.allergysa.org/wheat.htm |archive-date = 2008-04-24}} Rarer symptoms include {{Citation needed|date=May 2008}} anaphylactic shock, anxiety, arthritis, bloated stomach, chest pains, depression or mood swings, diarrhea, dizziness, headache, joint and muscle aches and pains (may be associated with progressive arthritis), palpitations, psoriasis, irritable bowel syndrome (IBS), swollen throat or tongue, tiredness and lethargy, and unexplained cough.

Reactions may become more severe with repeated exposure.{{citation needed|date=April 2022}}

{{main|Exercise-induced anaphylaxis}}

Wheat gliadins and potentially oat avenins are associated with another disease, known as wheat-dependent exercise induced anaphylaxis (WDEIA) which is similar to baker's allergy as both are mediated by IgE responses.{{cite journal | last=Cianferoni | first=Antonella | title=Wheat allergy: diagnosis and management | journal=Journal of Asthma and Allergy | volume=9 | pages=13–25 | date=29 January 2016 | issn=1178-6965 | pmid=26889090 | pmc=4743586 | doi=10.2147/jaa.s81550 | doi-access=free }} In WDEIA, however, the ω-gliadins or a high molecular weight glutenin subunit, and similar proteins in other Triticeae genera, enter the blood stream during exercise where they cause acute asthmatic or allergic reaction. Wheat may specifically induce WDEIA and certain chronic urticaria because the anti-gliadin IgE detects ω₅-gliadins expressed by most of the Gli-B1 alleles, but prolamins extracted from rye or wheat/rye translocates invoke almost no responses. The Gli-B1 gene in wheat, Triticum aestivum, comes from the progenitor species Aegilops speltoides. This indicates that nascent mutations on the B genome of wheat are from a small number of cultivated Triticeae species.{{cite journal | author = Denery-Papini S | title = Influence of the allelic variants encoded at the Gli-B1 locus, responsible for a major allergen of wheat, on IgE reactivity for patients suffering from food allergy to wheat | journal = J. Agric. Food Chem. | volume = 55 | issue = 3 | pages = 799–805 | year = 2007 | pmid = 17263477 | doi = 10.1021/jf062749k |name-list-style=vanc| author2 = Lauriére M | author3 = Branlard G | display-authors = 3 | last4 = Morisset | first4 = Martine | last5 = Pecquet | first5 = Catherine | last6 = Choudat | first6 = Dominique | last7 = Merlino | first7 = Marielle | last8 = Pineau | first8 = Florence | last9 = Popineau | first9 = Yves}}

Baker's allergy has a ω-gliadin component and thioredoxin hB component.{{cite journal |vauthors=Weichel M, Glaser AG, Ballmer-Weber BK, Schmid-Grendelmeier P, Crameri R | title = Wheat and maize thioredoxins: a novel cross-reactive cereal allergen family related to baker's asthma | journal = J. Allergy Clin. Immunol. | volume = 117 | issue = 3 | pages = 676–81 | year = 2006 | pmid = 16522470 | doi = 10.1016/j.jaci.2005.11.040| doi-access = free }} In addition, a gluten-extrinsic allergen has been identified as aspergillus amylase, added to flour to increase its baking properties.{{citation needed|date=April 2022}}

Image:Urticaria 2.jpg

Contact sensitivity,{{cite journal |vauthors=Langeland T, Nyrud M | title = Contact urticaria to wheat bran bath: a case report | journal = Acta Derm. Venereol. | volume = 62 | issue = 1 | pages = 82–3 | year = 1982 | doi = 10.2340/00015555628283 | pmid = 6175150 | s2cid = 33018967 | doi-access = free }} atopic dermatitis,{{cite journal |vauthors=Barnetson RS, Wright AL, Benton EC | title = IgE-mediated allergy in adults with severe atopic eczema | journal = Clin. Exp. Allergy | volume = 19 | issue = 3 | pages = 321–5 | year = 1989 | pmid = 2736432 | doi =10.1111/j.1365-2222.1989.tb02390.x | s2cid = 24637855 }} eczema, and urticaria appear to be related phenomena, the cause of which is generally believed to be the hydrophobic prolamin components of certain Triticeae, Aveneae cultivars. In wheat one of these proteins is ω-gliadin (Gli-B1 gene product). A study of mothers and infants on an allergen-free diet demonstrated that these conditions can be avoided if wheat sensitive cohort in the population avoid wheat in the first year of life.{{cite journal | author = Zeiger RS | title = Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: a randomized study | journal = J. Allergy Clin. Immunol. | volume = 84 | issue = 1 | pages = 72–89 | year = 1989 | pmid = 2754147 | doi =10.1016/0091-6749(89)90181-4 |name-list-style=vanc| author2 = Heller S | author3 = Mellon MH | display-authors = 3 | last4 = Forsythe | first4 = A | last5 = Oconnor | first5 = R | last6 = Hamburger | first6 = R | last7 = Schatz | first7 = M | doi-access = free }} As with exercise induced anaphylaxis, aspirin (also: tartrazine, sodium benzoate, sodium glutamate (MSG), sodium metabisulfite, tyramine) may be sensitizing factors for reactivity.{{cite journal |vauthors=Van Bever HP, Docx M, Stevens WJ | title = Food and food additives in severe atopic dermatitis | journal = Allergy | volume = 44 | issue = 8 | pages = 588–94 | year = 1989 | pmid = 2610332 | doi =10.1111/j.1398-9995.1989.tb04205.x | s2cid = 24402326 }} Studies of the wheat-dependent exercise induced anaphylaxis demonstrate that atopy and EIA can be triggered from the ingestion wheat proteins into the blood, where IgE reacts within allergens in the dermal tissues. Some individuals may be so sensitive that low dose aspirin therapy can increase risk for both atopy and WDEIA.{{citation needed|date=April 2022}}

Wheat allergies were also common with contact dermatitis. A primary cause was the donning agent used for latex gloves prior to the 1990s; however, most gloves now use protein-free starch as a donning agent.{{citation needed|date=April 2022}}

There appears to be an association of rheumatoid arthritis (RA) both with gluten sensitive enteropathy (GSE) and gluten allergies.{{cite journal |vauthors=Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P | title = The gut–joint axis: cross reactive food antibodies in rheumatoid arthritis | journal = Gut | volume = 55 | issue = 9 | pages = 1240–7 | year = 2006 | pmid = 16484508 | doi = 10.1136/gut.2005.076901 | pmc = 1860040}} RA in GSE/CD may be secondary to tissue transglutaminase (tTG) autoimmunity. In a recent study in Turkey, 8 of 20 RA patients had wheat reactivities on the radioallergosorbent test (RAST). When this allergic food and all other patient specific RAST+ foods were removed half of the patients had improved RA by serological markers. In patients with wheat allergies, rye was effectively substituted.{{cite journal | author = Karatay S | title = General or personal diet: the individualized model for diet challenges in patients with rheumatoid arthritis | journal = Rheumatol. Int. | volume = 26 | issue = 6 | pages = 556–60 | year = 2006 | pmid = 16025333 | doi = 10.1007/s00296-005-0018-y |name-list-style=vanc| author2 = Erdem T | author3 = Kiziltunc A | display-authors = 3 | last4 = Melikoglu | first4 = Meltem Alkan | last5 = Yildirim | first5 = Kadir | last6 = Cakir | first6 = Ebru | last7 = Ugur | first7 = Mahir | last8 = Aktas | first8 = Akin | last9 = Senel | first9 = Kazim| s2cid = 33308142 }} This may indicate that some proportion of RA in GSE/CD is due to downstream effects of allergic responses. In addition, cross-reactive anti-beef-collagen antibodies (IgG) may explain some rheumatoid arthritis (RA) incidents.{{cite journal |vauthors=Dieterich W, Esslinger B, Trapp D, Hahn E, Huff T, Seilmeier W, Wieser H, Schuppan D | title = Cross linking to tissue transglutaminase and collagen favours gliadin toxicity in coeliac disease | journal = Gut | volume = 55 | issue = 4 | pages = 478–84 | year = 2006 | pmid = 16188922 | doi = 10.1136/gut.2005.069385 | pmc = 1856150}}

Migraines. In the late 1970s it was reported that people with migraines had reactions to food allergens. Similarly to people with RA, the most common reaction among people with migraines was to wheat (78%), orange, eggs, tea, coffee, chocolate, milk, beef, corn, cane sugar, and yeast. When 10 foods causing the most reactions were removed, migraines fell precipitously and hypertension declined.{{cite journal | author = Grant EC | s2cid = 6965185 | title = Food allergies and migraine | journal = Lancet | volume = 1 | issue = 8123 | pages = 966–9 | year = 1979 | pmid = 87628 | doi =10.1016/S0140-6736(79)91735-5 }} Some specific instances are attributed to wheat.{{cite journal |vauthors=Pascual J, Leno C | title = A woman with daily headaches | journal = The Journal of Headache and Pain | volume = 6 | issue = 2 | pages = 91–2 | year = 2005 | pmid = 16362649 | doi = 10.1007/s10194-005-0158-1 | pmc=3452314}}

Autism. Parents of children with autism often ascribe the children's gastrointestinal symptoms to allergies to wheat and other foods. The published data on this approach are sparse, with the only double-blind study reporting negative results.{{cite journal |author= Elder JH |title= The gluten-free, casein-free diet in autism: an overview with clinical implications |journal= Nutr Clin Pract |volume=23 |issue=6 |pages=583–8 |year=2008 |pmid=19033217 |doi=10.1177/0884533608326061}}

{{More citations needed section|date=May 2021}}

Diagnoses of wheat allergy may deserve special consideration. Omega-5 gliadin, the most potent wheat allergen, cannot be detected in whole wheat preparations; it must be extracted and partially digested (similar to how it degrades in the intestine) to reach full activity.{{Cite web |title=Evaluation of Diagnosis and Management of Omega-5-Gliadin Allergy: A Retrospective Survey |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC8068513/ |website=National Library of Medicine}} Other studies show that digestion of wheat proteins to about 10 amino acids can increase the allergic response 10-fold. Certain allergy tests may not be suitable to detect all wheat allergies, resulting in cryptic allergies. Because many of the symptoms associated with wheat allergies, such as eczema and asthma, may be related or unrelated to a wheat allergy, medical deduction can be an effective way of determining the cause. If symptoms are alleviated by immunosuppressant drugs, such as prednisone, an allergy-related cause is likely. If multiple symptoms associated with wheat allergies are present in the absence of immunosuppressants then a wheat allergy is probable.

{{main|Gluten-free diet}}

Management of wheat allergy consists of complete withdrawal of any food containing wheat and other gluten-containing cereals (gluten-free diet).{{cite journal |vauthors=Hischenhuber C, Crevel R, Jarry B, Mäki M, Moneret-Vautrin DA, Romano A, Troncone R, Ward R|title=Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease |journal=Aliment Pharmacol Ther |volume=23|issue=5|pages=559–75|date=Mar 1, 2006|pmid =16480395|quote=For both wheat allergy and coeliac disease the dietary avoidance of wheat and other gluten-containing cereals is the only effective treatment. |doi=10.1111/j.1365-2036.2006.02768.x|doi-access=free}}{{cite journal|vauthors=Scherf KA, Brockow K, Biedermann T, Koehler P, Wieser H|title=Wheat-Dependent Exercise-Induced Anaphylaxis|journal=Clin Exp Allergy |volume=46|issue=1|pages=10–20|date=Sep 18, 2015|pmid=26381478|doi =10.1111/cea.12640|s2cid=25066563 |quote=Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare, but potentially severe food allergy exclusively occurring when wheat ingestion is accompanied by augmenting cofactors. (...) The most reliable prophylaxis of WDEIA is a gluten-free diet. In less severe cases, a strict limitation of wheat ingestion before exercise and avoidance of other cofactors may be sufficient.}} However, some patients can tolerate barley, rye or oats.{{cite journal|author=Pietzak M|title=Celiac disease, wheat allergy, and gluten sensitivity: when gluten free is not a fad|journal=JPEN J Parenter Enteral Nutr|volume=36|issue=1 Suppl|pages=68S–75S|date=Jan 2012|pmid=22237879|doi=10.1177/0148607111426276}}

In people with less severe forms of wheat-dependent exercise induced anaphylaxis (WDEIA), avoiding wheat consumption before exercise and other cofactors that trigger disease symptoms, such as nonsteroidal anti-inflammatory drugs and alcohol, can be sufficient to avoid an allergy.

Wheat is often a cryptic contaminant of many foods; more obvious items are bread crumbs, maltodextrin, bran, cereal extract, couscous, cracker meal, enriched flour, gluten, high-gluten flour, high-protein flour, seitan, semolina wheat, vital gluten, wheat bran, wheat germ, wheat gluten, wheat malt, wheat starch or whole wheat flour. Less obvious sources of wheat could be gelatinized starch, hydrolyzed vegetable protein, modified food starch, modified starch, natural flavoring, soy sauce, soybean paste, hoisin sauce, starch, vegetable gum, specifically beta-glucan, or vegetable starch.{{citation needed|date=April 2022}}

Triticeae gluten-free oats (free of wheat, rye or barley) may be a useful source of cereal fiber. Some wheat allergies allow the use of rye bread as a substitute. Rice flour is a commonly used alternative for those allergic to wheat. Wheat-free millet flour, buckwheat, flax seed meal, corn meal, quinoa flour, chia seed flour, tapioca starch or flour, and others can be used as substitutes.

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Treatment for accidental ingestion of wheat products by allergic individuals varies depending on the sensitivity of the person. An antihistamine such as diphenhydramine may be prescribed. Sometimes prednisone will be prescribed to prevent a possible late phase Type I hypersensitivity reaction.{{cite journal | author = Tang AW | title = A practical guide to anaphylaxis | journal = Am Fam Physician | date = October 2003 | volume = 68 | issue = 7 | pages = 1325–32| pmid =14567487}} Severe allergic reactions (anaphylaxis) may require treatment with an epinephrine pen, which is an injection device designed to be used by a non-healthcare professional when emergency treatment is warranted.{{cite journal|author=The EAACI Food Allergy and Anaphylaxis Guidelines Group|s2cid=11054771|title=Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology.|journal=Allergy|date=August 2014|volume=69|issue=8|pages=1026–45|pmid=24909803|doi=10.1111/all.12437}}

• Allergy (has diagrams showing involvement of different types of white blood cells)
• Food allergy (has images of hives, skin prick test and patch test)
• Gluten immunochemistry
• List of allergens (food and non-food)

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{{Gluten sensitivity}}

{{Allergic conditions}}

{{Hypersensitivity and autoimmune diseases|state=expanded}}

{{DEFAULTSORT:Wheat Allergy}}

Category:Food allergies

Allergy