Journal List > Allergy Asthma Respir Dis > v.4(2) > 1059165

Yoon, Jeong, and Lee: Usefulness of specific IgE antibody levels to wheat, gluten, and ω-5 gliadin for wheat allergy in Korean children

Abstract

Purpose

The aim of this study was to assess the clinical usefulness and added diagnostic value of specific IgE antibodies to wheat, gluten, and ω-5 gliadin in diagnosing wheat allergy and distinguishing wheat anaphylaxis.

Methods

This study included 196 children who visited Ajou University Hospital for suspicious food allergy. The subjects were divided into 2 groups: the wheat allergy (WA) and non-wheat allergy (non-WA) groups. Patients with wheat allergy were further divided into 2 subgroups according to their symptoms: the wheat allergy with anaphylaxis (WAAna) and wheat allergy without anaphylaxis (WANon-Ana) groups. Serum concentrations of total IgE and specific IgE antibodies to wheat, gluten and ω-5 gliadin were measured.

Results

The median values of specific IgE antibodies to wheat, gluten and ω-5 gliadin were significantly higher in the WA group than in the non-WA group, and the positive decision points (95% specificity) were at 3.12, 2.61, and 0.21 kUA/L, respectively. The combination of specific IgE antibodies to wheat and ω-5 gliadin resulted in the highest accuracy of 93.9% in diagnosing wheat allergy. In differentiating the WAAna group from the WANon-Ana group, only specific IgE antibody to ω-5 gliadin showed a significant difference at the optimal cutoff point of 1.56 kUA/L.

Conclusion

Our results show that the individual levels of specific IgE antibodies to wheat, gluten or ω-5 gliadin may have a considerably high accuracy in diagnosing wheat allergy and that specific IgE antibody to ω-5 gliadin may be particularly useful in predicting wheat anaphylaxis.

Figures and Tables

Fig. 1

Receiver operating characteristic curves represent sensitivity and specificity of specific IgE to wheat (solid), gluten (dotted), and ω-5 gliadin (dashed). (A) WA vs. Non-WA, (B) WAAna vs. WANon-Ana. WA, wheat allergy; Non-WA, non-wheat allergy; WAAna, wheat allergy with anaphylaxis; WANon-Ana, wheat allergy without anaphylaxis; AUC, area under the curve.

aard-4-119-g001
Table 1

Clinical characteristic of study subjects

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Characteristic WA Non-WA
Total (n=35) WAAna (n=17) WANon-Ana (n=18) Total (n=161)
Age (mo) 19 (9–91)* 16 (9–87) 28 (9–91) 54 (4–214)
Sex
 Male:female 25:10 13:4§ 12:6 84:77
Symptoms
 Eczema 19 9 10 52
 Urticaria 35 17 18 139
 Angioedema 13 9 4 9
 Respiratory 17 16 1 19
 Gastrointestinal 5 5 0 10

Values are presented as median (25th–75th percentile) or number. Analysis was performed by using Mann-Whitney U-test.

WA, wheat allergy; Non-WA, non-wheat allergy; WAAna, wheat allergy with anaphylaxis; WANon-Ana, wheat allergy without anaphylaxis.

*P<0.001 vs. Non-WA. P-value, not significant vs. WANon-Ana. P-value, not significant vs. Non-WA. §P-value, not significant vs. WANon-Ana.

Table 2

IgE antibody levels to wheat, ω-5 gliadin, and gluten in subjects

aard-4-119-i002
Variable IgE antibody level (kUA/L)
Wheat Gluten ω-5 Gliadin
WA (n=35) 15.40 (3.65–52.70)* 22.80 (4.32–64.90) 1.49 (0.29–7.64)
WAAna (n=17) 15.40 (9.97–51.70)§ 22.80 (7.75–58.60) 3.49 (1.63–9.50)
WANon-Ana (n=18) 13.35 (1.55–52.70) 17.48 (1.31–67.90) 0.34 (0.22–1.49)
Non-WA (n=161) 0.07 (0.05–0.17) 0.03 (0.01–0.09) 0.05 (0.05–0.05)

Values are presented as median (25th–75th percentile).

WA, wheat allergy; Non-WA, non-wheat allergy; WAAna, wheat allergy with anaphylaxis; WANon-Ana, wheat allergy without anaphylaxis.

*, , P<0.001 vs. Non-WA. §P=0.409 vs. WANon-ana. P=0.447 vs. WANon-ana. P=0.013 vs. WANon-ana.

Table 3

Diagnostic performance of specific IgE to wheat, gluten and ω-5 gliadin at different cutoff points

aard-4-119-i003
Variable WA vs. non-WA WAAna vs. WANon-Ana
Specific IgE against Specific IgE against
Wheat Gluten ω5-Gliadin Wheat Gluten ω5-Gliadin
AUC/ROC 0.969 0.976 0.925 0.583 0.577 0.743
P-value < 0.001 < 0.001 < 0.001 0.40 0.438 0.014
Assay cutoff point
 Specific IgE concentration (kUA/L) 0.35 0.35 0.35 0.35 0.35 0.35
 Sensitivity (%) 100 100 71 100 100 100
 Specificity (%) 80 86 97 0 0 22
 PPV (%) 52 60 83 49 49 94
 NPV (%) 100 100 94 0 0 50
Optimal cutoff point
 Specific IgE concentration (kUA/L) 0.90 0.43 0.19 3.05 2.85 1.56
 Sensitivity (%) 97 100 89 94 100 77
 Specificity (%) 89 88 94 39 39 78
 PPV (%) 66 64 78 59 61 77
 NPV (%) 99 100 97 88 100 78
Positive decision point 95% Specificity 83% Specificity
 Specific IgE concentration (kUA/L) 3.12 2.61 0.21 73.5 87.6 6.92
 Sensitivity (%) 77 83 86 24 12 41
 Specificity (%) 95 95 95 83 83 83
 PPV (%) 77 78 79 57 40 70
 NPV (%) 95 96 97 54 50 60
Negative decision point 97% Sensitivity 94% Sensitivity
 Specific IgE concentration (kUA/L) 0.90 0.54 - 2.40 3.64 0.21
 Sensitivity (%) 97 97 - 94 94 94
 Specificity (%) 89 89 - 33 39 22
 PPV (%) 66 66 - 57 59 53
 NPV (%) 99 99 - 86 88 80

WA, wheat allergy; Non-WA, non-wheat allergy; WAAna, wheat allergy with anaphylaxis; WANon-Ana, wheat allergy without anaphylaxis; AUC, area under the curve; ROC, receiver operating characteristic; PPV, positive predictive value; NPV, negative predictive value.

Table 4

Comparison of 3 diagnostic methods for clinical prediction of wheat allergy

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Diagnostic method Positive decision point (kUA/L) Sensitivity (%) Specificity (%) Accuracy (%)
1 Component
 Wheat* 0.90 77 95 91.8
 Gluten 0.43 83 95 92.9
 ω5-Gliadin 0.19 86 95 93.4
2 Components
 Wheat, Gluten
  And - 77 97 93.4
  Or - 83 93 91.3
 Wheat, ω5-Gliadin
  And - 74 98 93.9
  Or - 89 92 91.3
 Gluten, ω5-Gliadin
  And - 80 97 93.9
  Or - 89 93 92.3
3 Components
 Wheat, Gluten, ω5-Gliadin
  3 Positive - 74 98 93.9
  2 Positive - 83 94 91.8
  1 Positive - 89 91 90.8

*, , The results are based on the positive decision point.

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Sooyoung Lee
https://orcid.org/http://orcid.org/0000-0003-1734-4101

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