• allergy;
  • asthma;
  • food challenge;
  • gliadin;
  • hypersensitivity;
  • immunoglobulin E;
  • prognosis;
  • sensitization;
  • tolerance;
  • wheat

Kotaniemi-Syrjänen A, Palosuo K, Jartti T, Kuitunen M, Pelkonen AS, Mäkelä MJ. The prognosis of wheat hypersensitivity in children. Pediatr Allergy Immunol 2010: 21: e421–e428. © 2009 John Wiley & Sons A/S

The study was aimed to determine the natural history of wheat hypersensitivity, to define risk factors for persistent wheat hypersensitivity, and to evaluate the development of respiratory allergy in children with wheat hypersensitivity. The development and subsequent disappearance of wheat hypersensitivity, clinical findings, skin prick test (SPT) reactivity, and the development of allergic rhinoconjunctivitis and asthma were charted retrospectively in 28 children with wheat hypersensitivity proven by the open oral challenge at the median age of 21 months (range 6 to 75 months). Appearance of skin symptoms during the diagnostic wheat challenge was related to SPT-positive wheat hypersensitivity, while the appearance of gastrointestinal symptoms alone was associated with SPT-negative wheat hypersensitivity (p = 0.002). Wheat was tolerated by 59%, 69%, 84%, and 96%, by age 4, 6, 10, and 16, respectively. Sensitization to gliadin with a SPT wheal of ≥5 mm at the time of the diagnostic challenge was associated with a slower course of recovery from wheat hypersensitivity (p = 0.019), and a SPT wheal of ≥3 mm to gliadin at any time was associated with the development of asthma (p = 0.022). SPT reactivity to wheat was associated with later SPT reactivity to birch pollen (p = 0.001), and the development of allergic rhinoconjunctivitis (p = 0.001). In conclusion, almost all children with wheat hypersensitivity can tolerate wheat by adolescence. Sensitization to gliadin is associated with a slower achievement of tolerance and an increased risk of asthma.