Globally, food allergies are widespread with an incidence up to 10% in Western countries in infants and a growing occurrence in developing countries. Food allergies are very common in children as compared to adults. Certain foods include more than 80% of the reaction in food allergies such as milk, egg, wheat, soy, peanut, and tree nuts.

In pediatric patients, gluten-related disorders are very common. Wheat (Triticum aestivum) is the most extensively consumed food grain in the whole world due to its capability to grow in different climatic areas. Wheat can be responsible for a varied range of disorders that depends on allergen exposure and the underlying immunological mechanisms. Wheat is the most common food allergen seen in children and can be accountable for a number of clinical manifestations such as food-dependent exercise-induced anaphylaxis (FDEIA), contact urticaria, occupational asthma (or Baker’s asthma) or rhinitis.

Wheat allergy is triggered by an immunoglobulin E (IgE)-dependent mechanism and its incidence differs as per the age and region. Several studies have explored the potential role of various external factors, which can influence the risk of developing wheat allergy, but results are still inadequate.

In children, the prognosis of IgE-mediated wheat allergy is usually favorable, as the majority of children become tolerant by school age. Patients who had experienced an anaphylactic reaction earlier to 3 years of age and patients with higher levels of wheat- or ω-5 gliadin-specific IgE antibodies could be at higher risk of persistent wheat allergy. The present management of such patients is dietary avoidance. Currently, oral immunotherapy has been suggested for wheat allergy with promising results. Further studies are needed to create the best protocol for promoting tolerance in wheat-allergic children.

Source: Ricci G, Andreozzi L, Cipriani F, Giannetti A, Gallucci M, Caffarelli C. Wheat Allergy in Children: A Comprehensive Update. Medicina (Kaunas). 2019; 55(7):400. Published 2019 Jul 23. doi:10.3390/medicina55070400