Wheat allergy Totally Explained

Everything about Wheat Allergy totally explained

Wheat allergy, also known as Wheat hypersensitivity is most commonly a food allergy, but can also be a respiratory or contact allergy resulting from occupational exposure. Like all allergies wheat allergy involves IgE and mast cell response. Typically the allergy is limited to the seed storage proteins of wheat, some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy may be a misnomer since there are many allergenic components in wheat, for example serine proteinase inhibitors, glutelins and prolamins and different responses are often attributed to different proteins. The most severe response is exercise/aspirin induced anaphylaxis attributed to one omega gliadin that's a relative of the protein that causes Coeliac disease. Other more common system includes nausea, urticaria, atopy.

Types of allergens

There are four major classes of seed storage proteins: albumins, globulins, prolamins and glutelins. Within wheat prolamins are called gliadins and glutelins are called glutenins. These two protein groups form the classic glutens. While gluten is a causative agent of Coeliac disease (CD), coeliac disease can be contrasted to gluten allergy by the involvement of different immune cells and antibody types (See Comparative pathophysiology of gluten sensitivities), and because the list of allergens extend beyond the classic gluten category of proteins.

Gluten Allergy

Prolamin allergies

Prolamins and the closely related glutelins, a recent study in Japan found that glutinins are a more frequent allergen, however gliadins are associated with the most severe disease. A proteomics based study found a γ-gliadin isoform gene. Wheat dependent exercise induced anaphylaxis (WDEIA) is primarily mediated by ω-5 gliadin which is encoded by the Gli-1B gene derived from the Aegilops speltoides B genome within wheat.

Glutelin allergies

Glutenin (wheat glutelin) is a predominant allergen in wheat.. A recent study in Europe confirmed the increased presence of allergies to amylase/trypsin inhibitors (serpins) but less reactivity to the globulin fraction The allergies tend to differ between populations (Italian, Japanese, Danish or Swiss), indicating a potential genetic component to these reactivities.

Other allergies

Wheat pollen and grass allergies

Respiratory allergies are an occupational disease that develop in food service workers. Previous studied detected 40 allergens from wheat; some cross-reacted with rye proteins and a few cross-reacted with grass pollens. A later study showed that baker's allergy extend 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 and that these allergies show cross reactivity between seed proteins and pollen proteins including a prominent crossreactivity between the common environment rye pollen and wheat gluten

Derivative allergies

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, called enzymatic hydrolysis, for proteins it's 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 didn't exist by the exposure of buried antigenic sites in the proteins.
When proteins are cut into polypeptides, buried regions are exposed on the surface, and these buried regions can 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. These wheat polypeptides can cause immediate contact urticaria in susceptible people.

Signs and Symptoms

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.
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), and abdominal cramps. Rarer symptoms include anaphylactic shock, arthritis, bloated stomach, chest pains, depression or mood swings, diarrhea, dizziness, headache, joint and muscle aches and pains (may be associated with progressive arthritis), nausea, vomiting, palpitations, psoriasis, sneezing, irritable bowel syndrome (IBS), swollen throat or tongue, tiredness and lethargy, unexplained cough, unexplained runny nose, watery or itchy eyes.

Asthma, Anaphylaxis, Nasal Allergies

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. 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. One recent study of ω-gliadins demonstrated these gliadins are more similar to the bulk of oat avenins than α/β or γ gliadins but, so far, oat avenins have not been linked to WDEIA. 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 almost no responses prolamins extracted from rye or wheat/rye translocates. The Gli-B1 gene in wheat, Triticum aestivum comes from one of three progenitor species, Aegilops speltoides, indicating that nascent mutations on the B genome of wheat or from a small number of cultivated triticeae species..
Recent study of WDEIA shows that both aspirin and exercise increase the presence of gliadin in the blood stream and the chronic induced behavior may extend to NSAIDs, MSG, Benzoate and other synthetic chemical food additives. Baker's Allergy. Baker's allergy has a ω-gliadin component and thioredoxin hB component. In addition, a gluten-extrensic allergen has been identified as aspergillus amylase, added to flour to increase its baking properties. Food induced Asthma. Wheat is a common cause.

Urticaria, Atopy, Eczema

Contact Sensitivity, Atopic Dermatitis, Eczema, and Urticaria appear to be related phenomena the cause is generally the 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. As with exercise induced anaphylaxis aspirin (also: tartrazine, sodium benzoate, sodium glutamate (MSG), sodium metabisulfite, tyramine) may be sensitizing factors for reactivity. From the Wheat Dependent Exercise Anaphylaxis studies it appears that aspirin and probably NSAIDs allow the entry of wheat proteins into the blood, where IgE reacts within allergens in the dermal tissues.
Wheat allergies were also common with contact dermatitis. A primary cause was the donning agent used for latex gloves during prior to the 1990s, however most gloves now use protein free starch as donning agents.

Autoimmune (Rheumatoid) arthritis

There appears to be an association of autoimmune rheumatoid arthritis (ARA) both with GSE and gluten allergies. ARA in GSE/CD may be secondary to tTG autoimmunity. In a recent study in Turkey, 8 of 20 ARA patients had wheat reactivities on the RAST tests. When this allergic food and all other patient specific RAST+ foods were removed half of the patients had improved ARA by serological markers. In patients with wheat allergies, rye was effectively substituted. 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) incidences.

Neuropathies

Migraines. In the late 70s it was reported that people with migraines had reactions to food allergens, like ARA, the most common reaction 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 migranes fell precipitously, hypertension declined. Some specific instances are attributed to wheat. Infantile Autism. Worsening of neurological symptoms in autistic patients with milk and wheat consumption has been reported. However, a Swedish study reported a negative impact of a gluten free diet. Acute psychosis. Wheat and rye allergy (IgE) antibodies have also been found in acute psychosis patients.

Diagnosis

Special consideration for wheat allergen diagnosis should weigh the issue of dietary allergens and protein digests. In the case of exercise induced anaphylaxis it's known that omega-gliadin must be isolated from whole wheat or digested to achieve reactivity. This is also true with hydrolysate allergies, therefore certain allergies may not be detected with simple testing such as skin prick test. Some newer allergy tests include hydrolysate proteins, others test for specific antigens that have been isolated. Rice flour is a commonly used alternative for those allergic to wheat.

Further Information

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