Wheat allergy in a child casting doubt on celiac disease in mother

Abstract

Clinical case 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 labeled 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 but 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 anti-gliadine 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. Conclusions 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.