Yanagida N, Takei M, Saito A, Sato S, Ebisawa M. Clinical cross-reactivity of wheat and barley in children with wheat allergy.
Pediatr Allergy Immunol 2022;
33:e13878. [PMID:
36433849 DOI:
10.1111/pai.13878]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND
Several studies have reported in vitro cross-reactivity between wheat and barley. However, evidence regarding the clinical cross-reactivity of wheat and barley is limited. This study examined the clinical cross-reactivity of barley and wheat among children with immediate-type wheat allergies.
METHODS
We examined the threshold dose of a wheat oral food challenge for wheat-allergic children. We examined the reactivity of barley, and the oral food challenges of barley tea and barley rice were implemented as needed. We measured the specific immunoglobulin E (sIgE) levels in wheat, ω-5 gliadin, and barley.
RESULTS
We evaluated 53 children (39 [74%] boys) with a median age of 6.6 years. Among them, 39 (74%) patients had a history of anaphylaxis to wheat. The median wheat-, barley-, and ω-5 gliadin-sIgE levels were 57.3, 12.1, and 3.2 kUA /L, respectively. Twelve patients reacted to barley tea (1.8 mg), 14 reacted to barley rice (220-440 mg), and 27 were tolerant to barley tea and barley rice. Barley-allergic patients had significantly higher wheat- and ω-5 gliadin- and barley-sIgE levels and significantly lower threshold doses of wheat than barley-tolerant patients. Omega-5 gliadin-sIgE was the most useful predictor of barley allergy among wheat-allergic patients; the ω-5 gliadin-sIgE 95% positive predictive value for barley allergy was 4.6 kUA /L.
CONCLUSIONS
Half of wheat-allergic children reacted to barley. A lower threshold dose of wheat is related to cross-reactive barley allergies. Omega-5 gliadin-sIgE predicts cross-reactive barley allergy in children allergic to wheat. Clinical cross-reactivity to barley should be considered in the management of wheat-allergic children.
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