Jongseo Yoon; Kyunguk Jeong; Sooyoung Lee

doi:10.4168/aard.2016.4.2.119

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

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(2): 119-125.

Published online: 31 March 2016

DOI: https://doi.org/10.4168/aard.2016.4.2.119

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

Jongseo Yoon, Kyunguk Jeong, Sooyoung Lee

Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.

Correspondence to: Sooyoung Lee. Department of Pediatrics, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-5164, Fax: +82-31-219-5169, jsjs87@ajou.ac.kr

Received 4 August 2015 Revised 24 September 2015 Accepted 1 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

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 (WA^Ana) and wheat allergy without anaphylaxis (WA^Non-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 WA^Ana group from the WA_Non-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.

Keywords: Wheat hypersensitivity, Wheat, Glutens, Gliadin, 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) WA^Ana vs. WA^Non-Ana. WA, wheat allergy; Non-WA, non-wheat allergy; WA^Ana, wheat allergy with anaphylaxis; WA^Non-Ana, wheat allergy without anaphylaxis; AUC, area under the curve.

Table 1

Clinical characteristic of study subjects

Characteristic	WA			Non-WA
Characteristic	Total (n=35)	WA^Ana (n=17)	WA^Non-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; WA^Ana, wheat allergy with anaphylaxis; WA^Non-Ana, wheat allergy without anaphylaxis.

^*P<0.001 vs. Non-WA. ^†P-value, not significant vs. WA^Non-Ana. ^‡P-value, not significant vs. Non-WA. ^§P-value, not significant vs. WA^Non-Ana.

Table 2

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

Variable	IgE antibody level (kU_A/L)
Variable	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)^‡
WA^Ana (n=17)	15.40 (9.97–51.70)^§	22.80 (7.75–58.60)^∥	3.49 (1.63–9.50)^¶
WA^Non-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; WA^Ana, wheat allergy with anaphylaxis; WA^Non-Ana, wheat allergy without anaphylaxis.

^*, ^†, ^‡ P<0.001 vs. Non-WA. ^§P=0.409 vs. WA^Non-ana. ^∥P=0.447 vs. WA^Non-ana. ^¶P=0.013 vs. WA^Non-ana.

Table 3

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

Variable	WA vs. non-WA			WA^Ana vs. WA^Non-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 (kU_A/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 (kU_A/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 (kU_A/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 (kU_A/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; WA^Ana, wheat allergy with anaphylaxis; WA^Non-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

Diagnostic method	Positive decision point (kU_A/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.

References

1. Boyce JA, Assaad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. J Allergy Clin Immunol. 2010; 126:1105–1118.

2. Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PA, Ebisawa M, et al. ICON: food allergy. J Allergy Clin Immunol. 2012; 129:906–920.

3. Ahn K, Kim J, Hahm MI, Lee SY, Kim WK, Chae Y, et al. Prevalence of immediate-type food allergy in Korean schoolchildren: a population-based study. Allergy Asthma Proc. 2012; 33:481–487.

4. Kim J, Chang E, Han Y, Ahn K, Lee SI. The incidence and risk factors of immediate type food allergy during the first year of life in Korean infants: a birth cohort study. Pediatr Allergy Immunol. 2011; 22:715–719.

5. Lee SY, Kim KW, Lee HH, Lim DH, Chung HL, Kim SW, et al. Incidence and clinical characteristics of pediatric emergency department visits of children with severe food allergy. Korean J Asthma Allergy Clin Immunol. 2012; 32:169–175.

6. Korea Flour Mills Industrial Association. Annual per capita flour consumption [Internet]. Seoul: Korea Flour Mills Industrial Association;c2015. cited 2015 April 20. Available from: http://www.kofmia.org.

7. Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, et al. The prevalence of plant food allergies: a systematic review. J Allergy Clin Immunol. 2008; 121:1210–1218.e4.

8. Lee AJ, Thalayasingam M, Lee BW. Food allergy in Asia: how does it compare? Asia Pac Allergy. 2013; 3:3–14.

9. Inomata N. Wheat allergy. Curr Opin Allergy Clin Immunol. 2009; 9:238–243.

10. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001; 107:891–896.

11. Nilsson N, Sjolander S, Baar A, Berthold M, Pahr S, Vrtala S, et al. Wheat allergy in children evaluated with challenge and IgE antibodies to wheat components. Pediatr Allergy Immunol. 2015; 26:119–125.

12. Morita E, Matsuo H, Chinuki Y, Takahashi H, Dahlstrom J, Tanaka A. Food-dependent exercise-induced anaphylaxis -importance of omega-5 gliadin and HMW-glutenin as causative antigens for wheat-dependent exercise-induced anaphylaxis-. Allergol Int. 2009; 58:493–498.

13. Ebisawa M, Shibata R, Sato S, Borres MP, Ito K. Clinical utility of IgE antibodies to ω-5 gliadin in the diagnosis of wheat allergy: a pediatric multicenter challenge study. Int Arch Allergy Immunol. 2012; 158:71–76.

14. Beyer K, Chung D, Schulz G, Mishoe M, Niggemann B, Wahn U, et al. The role of wheat omega-5 gliadin IgE antibodies as a diagnostic tool for wheat allergy in childhood. J Allergy Clin Immunol. 2008; 122:419–421.

15. Lee SE, Lee SY, Jo EJ, Kim MY, Kim SH, Chang YS. Wheat-induced anaphylaxis in korean adults: a report of 6 cases. Clin Nutr Res. 2013; 2:76–79.

16. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006; 117:391–397.

17. Canonica GW, Ansotegui IJ, Pawankar R, Schmid-Grendelmeier P, van Hage M, Baena-Cagnani CE, et al. A WAO - ARIA - GA²LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J. 2013; 6:17.

18. Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA. The natural history of wheat allergy. Ann Allergy Asthma Immunol. 2009; 102:410–415.

19. Pourpak Z, Mansouri M, Mesdaghi M, Kazemnejad A, Farhoudi A. Wheat allergy: clinical and laboratory findings. Int Arch Allergy Immunol. 2004; 133:168–173.

20. Perry TT, Matsui EC, Kay Conover-Walker M, Wood RA. The relationship of allergen-specific IgE levels and oral food challenge outcome. J Allergy Clin Immunol. 2004; 114:144–149.

21. Shibata R, Nishima S, Tanaka A, Borres MP, Morita E. Usefulness of specific IgE antibodies to ω-5 gliadin in the diagnosis and follow-up of Japanese children with wheat allergy. Ann Allergy Asthma Immunol. 2011; 107:337–343.

22. Palosuo K, Varjonen E, Kekki OM, Klemola T, Kalkkinen N, Alenius H, et al. Wheat omega-5 gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol. 2001; 108:634–638.

23. Makela MJ, Eriksson C, Kotaniemi-Syrjanen A, Palosuo K, Marsh J, Borres M, et al. Wheat allergy in children - new tools for diagnostics. Clin Exp Allergy. 2014; 44:1420–1430.

24. Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol. 1997; 100:444–451.

25. Ito K, Futamura M, Borres MP, Takaoka Y, Dahlstrom J, Sakamoto T, et al. IgE antibodies to omega-5 gliadin associate with immediate symptoms on oral wheat challenge in Japanese children. Allergy. 2008; 63:1536–1542.

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