P0485 WHEAT ALLERGY IN A CHILD CASTING DOUBT ON CELIAC DISEASE IN MOTHER

Abstract

Introduction: Celiac disease may be wrongly considered instead of wheat allergy in infancy, leading to unnecessary familial and child burden. A case report underlines the necessity to prove celiac disease in the presence of wheat intolerance in a young child. Methods: Retrospective analysis of a patient with wheat intolerance labelled celiac disease at the age of 18 months in the early seventies. Results: A child, birth weight 3220 g, was normally fed with gluten-containing foods introduced at 1 year and a weight curve on The 85th centile. At 15 months, following feeding refusal, loose stools and failure to thrive (weight 70th centile), a medical evaluation revealed negative prick tests with various foods, a positive wheat patch test, negative markers of celiac disease and eosinophilic infiltration of the duodenal mucosa, suggesting wheat allergy. A wheat elimination diet allowed the child to regain a normal growth curve. Parents clinical history was remarkable by a condition labelled celiac disease in the mother, diagnosed at age 13 months, following a 7 months period of stunting. The duodenal biopsy, performed at that time, is not available out mother evaluation carried out together with her son’s investigation indicated the absence of celiac disease: despite a normal diet since age 10 years (negative antigliadine and anti-endomysium antibodies and a normal hemoglobin level), whereas a familial atopic background could be assessed by peanut allergy in the mother’s twin sister. Conclusion: 1) Revaluation of the data suggests that instead of celiac disease, the mother probably exhibited wheat allergy misdiagnosed celiac disease; 2) Wheat atopy patch test could be a useful tool to detect delayed reaction to wheat in the presence of digestive symptoms, diarrhea and failure to thrive, mimicking celiac disease; 3) Wheat allergy might account for some so-called celiac disease without villous atrophy and/or negative serology. Confusion between celiac disease and wheat allergy may be misleading and lead to unnecessary prolonged elimination diets.