Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy,
Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Int Arch Allergy Immunol. 2022;183(6):591-599. doi: 10.1159/000520936. Epub 2021 Dec 20.
Wheat is the most important cereal for human nutrition but its high consumption is associated to an increasing complaint of wheat-related disorders, many of which are allergic in nature and different in respect to the involved allergens. In this study, we compared the clinical aspects of wheat allergy presented by patients sensitized to Tri a 19 in respect to those presented by patients sensitized to Tri a 14.
With this aim, we selected patients sensitized to 1 or both of the 2 allergens, and among these we identified those who were really wheat allergic and reactive on the basis of a standardized methodology. We evaluated the clinical features such as the kind and severity of symptoms, the coexistence of triggering factors such as physical exercise and NSAIDs and alcohol consumption, and the association with other allergens and with various immunologic parameters. Wheat allergy in Tri a 19 sensitized patients was confirmed through a questionnaire while the patients sensitized to Tri a 14 underwent wheat challenge with 100 g of pasta followed by exercise on a treadmill.
Seventy-nine patients sensitized to Tri a 14 and 40 patients sensitized to Tri a 19 were recruited. The 2 sensitizations were independent with a significant inverse relation (p < 0.00001). The Tri a 19 sensitized patients presented, in respect to the Tri a 14 sensitized ones, an older age (p = 0.0017), a higher risk to be wheat allergic (p < 0.0001), a higher severity of the reactions (p < 0.00001) and a higher association with some cofactors, namely alcohol (p < 0.0005) and physical exercise (p = 0.003). On the contrary, Tri a 14 sensitization was associated with atopy (p < 0.0001), with a higher probability of patients being asymptomatic (p < 0.0001) and being sensitized to other foods, in particular to nuts and cereals (p < 0.00001).
Sensitization to Tri a 19 or Tri a 14 determines different clinical pictures. In particular, sensitization to Tri a 19 implies a higher probability of severe reactions, even dependent on daily triggers, while that to Tri a 14 implies a higher cross-reactivity with other foods but it's more frequently asymptomatic, making a food challenge necessary to prevent useless food avoidance.
小麦是人类营养最重要的谷物，但它的大量消费与越来越多的与小麦有关的疾病有关，其中许多是过敏性质的，与涉及的过敏原不同。在这项研究中，我们比较了对 Tri a 19 敏感的患者出现的小麦过敏的临床方面，与对 Tri a 14 敏感的患者出现的小麦过敏的临床方面。
为此，我们选择了对 1 种或 2 种过敏原均敏感的患者，并在这些患者中，根据标准化方法确定了真正的小麦过敏和反应性患者。我们评估了临床特征，如症状的种类和严重程度、物理运动和 NSAIDs 和酒精摄入等触发因素的共存，以及与其他过敏原和各种免疫参数的关联。对 Tri a 19 敏感的患者通过问卷调查确认了小麦过敏，而对 Tri a 14 敏感的患者则接受了 100 克意大利面的小麦挑战，然后在跑步机上进行运动。
共招募了 79 名对 Tri a 14 敏感的患者和 40 名对 Tri a 19 敏感的患者。这 2 种敏化是独立的，存在显著的反比关系（p < 0.00001）。Tri a 19 敏感的患者与 Tri a 14 敏感的患者相比，年龄更大（p = 0.0017），发生小麦过敏的风险更高（p < 0.0001），反应的严重程度更高（p < 0.00001），并且与一些共同因素的关联更高，即酒精（p < 0.0005）和体力活动（p = 0.003）。相反，Tri a 14 敏化与特应性有关（p < 0.0001），患者无症状的可能性更高（p < 0.0001），并且对其他食物（特别是坚果和谷物）敏感的可能性更高（p < 0.00001）。
对 Tri a 19 或 Tri a 14 的敏化导致不同的临床症状。特别是，对 Tri a 19 的敏化意味着更有可能发生严重反应，甚至取决于日常触发因素，而对 Tri a 14 的敏化则意味着与其他食物的交叉反应性更高，但更常见的是无症状，因此需要进行食物挑战以防止不必要的食物回避。
