Abstract
We describe the case of a patient that developed persistent severe asthma after having started to work in a bakery. The subsequent appearance of gastrointestinal symptoms was diagnosed as celiac disease (CD). She also experienced severe asthma attacks when cooking pasta, and expe-rienced anaphylactic shock a few minutes after wheat flour inhalation. The allergologic workup was positive for several cereal products and Tri a 14 (Tricum aestivum 14), while specific IgE titer to Pru p 3 (Prunus persica 3) was negative. Our patient had no recurrence of these episodes when she avoided cooking wheat flour products and wheat in processed foods. The pathogenic mechanisms underlying CD and IgE-mediated food allergy are different and the coexistence of both diseases seems to be rare. Tri a 14 is the major wheat allergen involved in our case; this allergen can sensitize through the respiratory and the oral route, and can give way to anaphylaxis. A possible role played by interleukin-15 (IL-15) and interleukin-21 (IL-21) in the induction of IgE-mediate hypersensitivity, as well as in the pathogenesis of CD, is prospected and discussed briefly herein.
Highlights
Members of the α-amylase/trypsin inhibitor family and LTP Tri a 14 behave as major allergens in both food allergy and baker’s asthma, while thioredoxins, peroxidase and others represent minor wheat flour allergens [1] [2]. ω-5 gliadin represents the most important allergen in WDEIA; recently wheat LTP has been identified as causative allergen in WDEIA [3]
A 44-year-old woman was referred to our Department in order to investigate the causes of several anaphylactic reactions that occurred a few months before her visit
The major wheat allergen involved in our case was Tri a 14, which can sensitize either through the respiratory or the oral routes, inducing anaphylaxis
Summary
Wheat contributes 50% of the caloric intake in industrialized and developing countries. The major wheat-related disorders include wheat allergy (WA) and gluten related hypersensitivity. Among the allergic reactions to wheat we can identify baker’s asthma and food allergy, including wheat dependent exercise induced anaphylaxis. (2015) Celiac Disease in a Patient with Baker’s Asthma and Wheat Allergy Due to Tri a 14. Members of the α-amylase/trypsin inhibitor family and LTP (lipid transfer protein) Tri a 14 behave as major allergens in both food allergy and baker’s asthma, while thioredoxins, peroxidase and others represent minor wheat flour allergens [1] [2]. Other wheat induced disorders are the still being discussed non-celiac gluten sensitivity and irritable bowel syndrome worsened by FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols) [4]. The objective of the paper was to present the case of a patient who developed wheat hypersensitivity by different and contrasting immunological mechanisms
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