TOPLINE:

Wheat allergy affected 0.2% of German children from birth through age 2 years. Among referred children who underwent an oral food challenge, none had reactions to < 32 mg wheat protein, and wheat-specific immunoglobulin E (IgE) levels showed only a moderate association with clinical reactivity.

METHODOLOGY:

• Researchers assessed data from 1381 children in a population-based birth cohort in Berlin to determine the prevalence of wheat allergy.
• Separately, they conducted a cross-sectional study of 334 children with suspected wheat allergy (median age, 15 months; 69.8% boys) who underwent an oral food challenge to characterize allergic reactions and determine the role of wheat-specific IgE levels in diagnosing wheat allergy.
• The challenge involved seven increasing doses of wheat protein, from 3.2 mg to a maximum of 3.2 g, administered over 30-minute intervals, with positive outcomes defined as objective clinical reactions including urticaria, vomiting, wheezing, or a decrease in blood pressure.
• Negative challenge outcomes were confirmed by tolerating a cumulative dose of 4.8 g of wheat protein on a subsequent day.

TAKEAWAY:

• Among children in the population-based birth cohort, three (0.2%) were diagnosed with wheat allergy.
• In the cross-sectional study, 41% had a positive oral food challenge, and no child had a reaction to < 32 mg wheat protein. Among 50 children who underwent a rechallenge, 46% developed tolerance to wheat protein after a median interval of 25 months.
• Wheat-specific IgE levels showed a moderate association with challenge outcomes (area under the receiver operating characteristic curve, 0.77).
• Most of the reactions were moderate. A near-fatal reaction (grade 5) was observed in one child after intake of 110 mg wheat protein, and epinephrine was administered in 5.8% of those with positive outcomes.

IN PRACTICE:

“These findings can help to improve [oral food challenge] protocols for clinical diagnostic assessments of children with suspected wheat allergy and to better advise parents on the prognosis of their children’s wheat allergy,” the authors wrote.

SOURCE:

Birgit Kalb, MD, with Charité – University Medicine Berlin in Germany, was the corresponding author of the study, which was published online on April 20 in The Journal of Allergy and Clinical Immunology: In Practice. 

LIMITATIONS:

The population-based cohort study relied on parental reporting of a physician’s diagnosis. Protocols for oral food challenges and follow ‑ up intervals varied across centers.

DISCLOSURES:

The birth cohort study was funded by the European Commission. The cross-sectional study was funded in part by the German Federal Ministry of Education and Research. One author reported receiving honoraria or consulting fees from pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.