User:Pdeitiker/Gluten allergy

From Wikipedia, the free encyclopedia

This article is part of
the Gluten sensitivity
series.
Coeliac disease
Wheat allergy
Gluten-sensitive idiopathic neuropathies
Triticeae glutens
Gluten-free diet
GSE associated conditions
Anti-gliadin antibodies
Anti-transglutaminase antibodies
HLA-DQ2, HLA-DQ8

Wheat allergy, also known as Wheat hypersensitivity is most commonly a food allergy, but can also be a respiratory or contact allergy resulting from occupational exposure. Like all allergies wheat allergy involves IgE and mast cell response. Typically the allergy is limited to the seed storage proteins of wheat, some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy may be a misnomer since there are many allergenic components in wheat, for example serine proteinase inhibitors, glutelins and prolamins and different responses are often attributed to different proteins. The most severe response is exercise/aspirin induced anaphylaxis attributed to one omega gliadin that is a relative of the protein that causes Coeliac disease.[1] Other more common system includes nausea, urticaria, atopia.[2]

Contents

[edit] Types of allergens

Briefly, there are four major classes of seed storage proteins: albumins, globulins, prolamins and glutelins. Within wheat prolamins are called gliadins and glutelins are called glutenins. These two protein groups form the classic glutens. While gluten is a causative agent of Coeliac disease(CD), coeliac disease can be contrasted to gluten allergy by the involvement of different immune cells and antibody types (See Comparative pathophysiology of gluten sensitivities), and because the list of allergens extend beyond the classic gluten category of proteins.

[edit] Gluten allergy

[edit] Prolamin allergies

Prolamins and the closely related glutelins, a recent study in Japan found that glutinins are a more frequent allergen, however gliadins are associated with the most severe disease. A proteomics based study found a γ-gliadin isoform gene.[1] Wheat dependent exercise induced anaphylaxis (WDEIA) is primarily mediated by ω-5 gliadin which is encoded by the Gli-1B gene derived from the Aegilops speltoides B genome within wheat.

[edit] Glutelin allergies

Glutenin (wheat glutelin) is a predominant allergen in wheat.[1] Nine subunits of LMW-glutinen have been found to bind to wheat allergy associated IgE.

[edit] Albumin and globulin allergy

At present many of the allergens of wheat have not been characterized, the early studies found many to the albumin class[3]. A recent study in Europe confirmed the increased presense of allergies to amylase/trypsin inhibitors (serpins)[4][1] and lipid transfer protein (LPT).[5] but less reactivity to the globulin fraction[6] The allergies tend to differ between populations (Italian, Japanese, Danish or Swiss), indicating a potential genetic component to these reactivities.

[edit] Other allergies

[edit] Wheat pollen and grass allergies

Respiratory allergies are a occupational disease that develope in food service workers. Previous studied detected 40 allergens from wheat, some cross-reacted with rye proteins and a few cross-reacted with grass pollens.[7] A later study showed that baker's allergy extend over a broad range of cereal grasses (wheat, durum wheat, triticale, cereal rye, barley, rye grass, oats, canary grass, rice, maize, sorghum and Johnson grass) though the greatest similarities were seen between wheat and rye [8] and that these allergies show cross reactivity between seed proteins and pollen proteins[9] including a prominent crossreactivity between the common environment rye pollen and wheat gluten[10][11]

[edit] Derivative allergies

Proteins are made of a chain of dehydrated amino acids. When enzymes cut proteins into pieces they add water back to the site at which they cut, called enzymatic hydrolysis, for proteins it is called proteolysis. The initial products of this hydrolysis are polypeptides and smaller products are called simply peptides, these are called wheat protein hydrolysates. These hydrolysates can create allergens out of wheat proteins that previously did not exist by the exposure of buried antigenic sites in the proteins.

When proteins are cut into polypeptides, buried regions are exposed on the surface, and these buried regions can be antigenic. Such hydrolyzed wheat protein is used as an additive in foods and cosmetics. The peptides are often 1 kD in size (9 amino acid residues in length) and may increase the allergic response. [12] These wheat polypeptides can cause immediate contact urticaria in susceptible people.[13]

[edit] Masquerading allergens

Bread contains two additives that in addition to wheat can cause severe allergies. Colitis is a common element in gluten-sensitivity particularly elevated in coeliac disease. Studies of antibodies associated with colitis reveal that Crohn's disease and collagenous colitis have a high frequency of anti-yeast antibodies (ASCA), and 60% of celiacs also have high ASCA. ASCA are generally directed toward mannans in yeast, and lectin binding proteins in humans are protective against ASCA. Yeast is used to make bread, beer and yeast hydrolysates and therefore the reactivity to yeast might appear as gluten sensitivity.

Another non-wheat source of reaction is to fungal amylases used to increase sugar production in bread making for rising. Fungal amylase can create unusually high sensitivity amoung food service workers because of the ease at which it spreads in the workplace as fine powders. Mites and mite particles can be found at elevated levels wheat grain derivatives and these contaminants can also cause anaphylaxsis.[14] Episodes of seed spoilage or infestation may explain rare outbreaks of putative wheat-caused food poisoning.

[edit] Signs and Symptoms

Wheat allergies are not altogether different from other food allergies or respiratory allergies. However two conditions, exercise/aspirin induced anaphylaxis and urticaria occur more frequently with wheat allergies.

[edit] Asthma, Anaphylaxis, Nasal Allergies

Exercise-induced anaphylaxis. Wheat gliadins and potentially oat avenins are associated with another disease, known as wheat- dependent exercise Induced Anaphylaxis (WDEIA) which is similar to Baker's Allergy as both are mediated by IgE responses.[15] In WDEIA, however, the ω-gliadins[16] or a high molecular weight glutenin subunit, and similar proteins in other Triticeae genera enter the blood stream during exercise where they cause acute asthmatic or allergic reaction.[17] One recent study of ω-gliadins demonstrated these gliadins are more similar to the bulk of oat avenins than α/β or γ gliadins but, so far, oat avenins have not been linked to WDEIA. Wheat may specifically induce WDEIA and certain chronic urticaria because the anti-gliadin IgE detects ω5-gliadins expressed by most of the Gli-B1 alleles but almost no responses prolamins extracted from rye or wheat/rye translocates. The Gli-B1 gene in wheat, Triticum aestivum comes from one of three progenitor species, Aegilops speltoides, indicating that nascent mutations on the B genome of wheat or from a small number of cultivated triticeae species.[18].

Recent study of WDEIA shows that both aspirin and exercise increase the presence of gliadin in the blood stream[19] and the chronic induced behavior may extend to NSAIDs, MSG, Benzoate and other synthetic chemical food additives.

Baker's Allergy. Baker's allergy has a ω-gliadin component and thioredoxin hB component.[20] In addition, a gluten-extrensic allergen has been identified as aspergillus amylase, added to flour to increase its baking properties.

Food induced Asthma. Wheat is a common cause.[21]

Allergic urticaria on the shin
Allergic urticaria on the shin

[edit] Urticaria, Atopy, Eczema

Contact Sensitivity[22], Atopic Dermatitis[23], Eczema, and Urticaria appear to be related phenomena the cause is generally the believed to be the hydrophobic prolamin components of certain Triticeae, Aveneae cultivars, in wheat one of these proteins is ω-gliadin (Gli-B1 gene product). A study of mothers and infants on an allergen-free diet demonstrated that these conditions can be avoided if wheat sensitive cohort in the population avoid wheat in the first year of life[24]. As with exercise induced anaphylaxis aspirin (also: tartrazine, sodium benzoate, sodium glutamate (MSG), sodium metabisulfite, tyramine) may be sensitizing factors for reactivity.[25] From the Wheat Dependent Exercise Anaphylaxis studies it appears that aspirin and probably NSAIDs allow the entry of wheat proteins into the blood, where IgE reacts within allergens in the dermal tissues.

Wheat allergies were also common with contact dermatitis. A primary cause was the donning agent used for latex gloves during prior to the 1990s, however most gloves now use protein free starch as donning agents.

[edit] Autoimmune (Rheumatoid) arthritis

There appears to be an association of autoimmune rheumatoid arthritis (ARA) both with GSE and gluten allergies[26]. ARA in GSE/CD may be secondary to tTG autoimmunity. In a recent study in Turkey, 8 of 20 ARA patients had wheat reactivities on the RAST tests. When this allergic food and all other patient specific RAST+ foods were removed half of the patients had improved ARA by serological markers. In patients with wheat allergies, rye was effectively substituted.[27] This may indicate that some proportion of RA in GSE/CD is due to downstream effects of allergic responses. In addition, cross-reactive anti-beef-collagen antibodies (IgG) may explain some rheumatoid arthritis (RA) incidences.[28]

[edit] Neuropathies

Migraines. In the late 70s it was reported that people with migraines had reactions to food allergens, like ARA, the most common reaction was to wheat (78%), Orange, eggs, tea, coffee, chocolate, milk, beef, corn, cane sugar, and yeast. When 10 foods causing the most reactions were removed migranes fell precipitously, hypertension declined.[29] Some specific instances are attributed to wheat.[30]

Infantile Autism. Worsening of neurological symptoms in autistic patients with milk and wheat consumption has been reported.[31] However, a Swedish study reported a negative impact of a gluten free diet. [32]

Acute psychosis. Wheat and rye allergy (IgE) antibodies have also been found in acute psychosis patients.[33]

[edit] Diagnosis

Special consideration for wheat allergen diagnosis should weigh the issue of dietary allergens and protein digests. In the case of exercise induced anaphylaxis it is known that omega-gliadin must be isolated from whole wheat or digested to acheive reactivity. This is also true with hydrolysate allergies, therefore certain allergies may not be detected with simple testing such as skin prick test. Some newer allergy tests include hydrolysate proteins, others test for specific antigens that have been isolated.[16]

[edit] Treatment

See Gluten-free diet. Wheat allergies differ from gluten-diet exclusion in that some types of allergens do not create species crossreactive responses, and individual may be able to consume barley and rye safely, although more than likely they will be allergic to other wheat such as spelt and Kamut.

[edit] External links

[edit] References

  1. ^ a b c d Akagawa M, Handoyo T, Ishii T, Kumazawa S, Morita N, Suyama K (2007). "Proteomic analysis of wheat flour allergens". J. Agric. Food Chem. 55 (17): 6863-70. doi:10.1021/jf070843a. PMID 17655322. 
  2. ^ Perr HA (2006). "Novel foods to treat food allergy and gastrointestinal infection". Current allergy and asthma reports 6 (2): 153-9. PMID 16566866. 
  3. ^ Sutton R, Hill DJ, Baldo BA, Wrigley CW (1982). "Immunoglobulin E antibodies to ingested cereal flour components: studies with sera from subjects with asthma and eczema". Clin. Allergy 12 (1): 63-74. PMID 7067068. 
  4. ^ Armentia A, Sanchez-Monge R, Gomez L, Barber D, Salcedo G (1993). "In vivo allergenic activities of eleven purified members of a major allergen family from wheat and barley flour". Clin. Exp. Allergy 23 (5): 410-5. PMID 8334538. 
  5. ^ Pastorello EA, Farioli L, Conti A, et al (2007). "Wheat IgE-mediated food allergy in European patients: alpha-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins. Allergenic molecules recognized by double-blind, placebo-controlled food challenge". Int. Arch. Allergy Immunol. 144 (1): 10-22. doi:10.1159/000102609. PMID 17496422. 
  6. ^ Walsh BJ, Wrigley CW, Musk AW, Baldo BA (1985). "A comparison of the binding of IgE in the sera of patients with bakers' asthma to soluble and insoluble wheat-grain proteins". J. Allergy Clin. Immunol. 76 (1): 23-8. PMID 3839248. 
  7. ^ Blands J, Diamant B, Kallós P, Kallós-Deffner L, Lowenstein H (1976). "Flour allergy in bakers. I. Identification of allergenic fractions in flour and comparison of diagnostic methods". Int. Arch. Allergy Appl. Immunol. 52 (1-4): 392-406. PMID 65335. 
  8. ^ Baldo BA, Krilis S, Wrigley CW (1980). "Hypersensitivity to inhaled flour allergens. Comparison between cereals". Allergy 35 (1): 45-56. PMID 6154431. 
  9. ^ Valero Santiago A, Amat Par P, Sanosa Valls J, Sierra Martínez P, Malet Casajuana A, García Calderón PA (1988). "Hypersensitivity to wheat flour in bakers". Allergologia et immunopathologia 16 (5): 309-14. PMID 3228051. 
  10. ^ Donovan GR, Baldo BA (1990). "Crossreactivity of IgE antibodies from sera of subjects allergic to both ryegrass pollen and wheat endosperm proteins: evidence for common allergenic determinants". Clin. Exp. Allergy 20 (5): 501-9. PMID 2253081. 
  11. ^ Yazicioglu M, Oner N, Celtik C, Okutan O, Pala O (2004). "Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey". Asian Pac. J. Allergy Immunol. 22 (4): 183-90. PMID 15783130. .
  12. ^ Akiyama H, Sakata K, Yoshioka Y, et al (2006). "Profile analysis and immunoglobulin E reactivity of wheat protein hydrolysates". Int. Arch. Allergy Immunol. 140 (1): 36-42. doi:10.1159/000092000. PMID 16534217. 
  13. ^ Laurière M, Pecquet C, Bouchez-Mahiout I, et al (2006). "Hydrolysed wheat proteins present in cosmetics can induce immediate hypersensitivities". Contact Derm. 54 (5): 283-9. doi:10.1111/j.0105-1873.2006.00830.x. PMID 16689814. 
  14. ^ Sanchez-Borges M, Capriles-Hulett A, Fernandez-Caldas E, et al (1997). "Mite-contaminated foods as a cause of anaphylaxis". J. Allergy Clin. Immunol. 99 (6 Pt 1): 738-43. PMID 9215239. 
  15. ^ Mittag D, Niggemann B, Sander I, Reese I, Fiedler EM, Worm M, Vieths S, Reese G. (2004). "Immunoglobulin E-reactivity of wheat-allergic subjects (baker's asthma, food allergy, wheat-dependent, exercise-induced anaphylaxis) to wheat protein fractions with different solubility and digestibility.". Mol Nutr Food Res. 48 (5): 380-389. PMID 15672478. 
  16. ^ a b Matsuo H, Morita E, Tatham AS, Morimoto K, Horikawa T, Osuna H, Ikezawa Z, Kaneko S, Kohno K, and Dekio S. (2004). "Identification of the IgE-binding epitope in omega-5 gliadin, a major allergen in wheat-dependent exercise-induced anaphylaxis.". J Biol Chem. 279 (13): 12135-12140. PMID 14699123. 
  17. ^ Matsuo H, Morimoto K, Akaki T, Kaneko S, Kusatake K, Kuroda T, Niihara H, Hide M, and Morita E. (2005). "Exercise and aspirin increase levels of circulating gliadin peptides in patients with wheat-dependent exercise-induced anaphylaxis.". Clin Exp Allergy. 35 (4): 461-466. PMID 15836754. 
  18. ^ Denery-Papini S, Lauriére M, Branlard G, et al (2007). "Influence of the allelic variants encoded at the Gli-B1 locus, responsible for a major allergen of wheat, on IgE reactivity for patients suffering from food allergy to wheat". J. Agric. Food Chem. 55 (3): 799-805. doi:10.1021/jf062749k. PMID 17263477. 
  19. ^ Morita E, Kunie K, Matsuo H (2007). "Food-dependent exercise-induced anaphylaxis". J. Dermatol. Sci. 47 (2): 109-17. doi:10.1016/ j.jdermsci.2007.03.004. PMID 17507204. 
  20. ^ Weichel M, Glaser AG, Ballmer-Weber BK, Schmid-Grendelmeier P, Crameri R (2006). "Wheat and maize thioredoxins: a novel cross-reactive cereal allergen family related to baker's asthma". J. Allergy Clin. Immunol. 117 (3): 676-81. doi:10.1016/j.jaci.2005.11.040. PMID 16522470. 
  21. ^ Burr ML, Fehily AM, Stott NC, Merrett TG (1985). "Food-allergic asthma in general practice". Human nutrition. Applied nutrition 39 (5): 349-55. PMID 4077572. 
  22. ^ Langeland T, Nyrud M (1982). "Contact urticaria to wheat bran bath: a case report". Acta Derm. Venereol. 62 (1): 82-3. PMID 6175150. 
  23. ^ Barnetson RS, Wright AL, Benton EC (1989). "IgE-mediated allergy in adults with severe atopic eczema". Clin. Exp. Allergy 19 (3): 321-5. PMID 2736432. 
  24. ^ Zeiger RS, Heller S, Mellon MH, et al (1989). "Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: a randomized study". J. Allergy Clin. Immunol. 84 (1): 72-89. PMID 2754147. 
  25. ^ Van Bever HP, Docx M, Stevens WJ (1989). "Food and food additives in severe atopic dermatitis". Allergy 44 (8): 588-94. PMID 2610332. 
  26. ^ Hvatum M, Kanerud L, Hällgren R, Brandtzaeg P (2006). "The gut-joint axis: cross reactive food antibodies in rheumatoid arthritis". Gut 55 (9): 1240-7. doi:10.1136/gut.2005.076901. PMID 16484508. 
  27. ^ Karatay S, Erdem T, Kiziltunc A, et al (2006). "General or personal diet: the individualized model for diet challenges in patients with rheumatoid arthritis". Rheumatol. Int. 26 (6): 556-60. doi:10.1007/s00296-005-0018-y. PMID 16025333. 
  28. ^ Dieterich W, Esslinger B, Trapp D, Hahn E, Huff T, Seilmeier W, Wieser H, and Schuppan D. (2006). "Cross linking to tissue transglutaminase and collagen favours gliadin toxicity in coeliac disease.". Gut. 55 (4): 478-84. PMID 16188922. 
  29. ^ Grant EC (1979). "Food allergies and migraine". Lancet 1 (8123): 966-9. PMID 87628. 
  30. ^ Pascual J, Leno C (2005). "A woman with daily headaches". The journal of headache and pain : official journal of the Italian Society for the Study of Headaches 6 (2): 91-2. doi:10.1007/s10194-005-0158-1. PMID 16362649. 
  31. ^ Lucarelli S, Frediani T, Zingoni AM, et al (1995). "Food allergy and infantile autism". Panminerva medica 37 (3): 137-41. PMID 8869369. 
  32. ^ Sponheim E (1991). "[Gluten-free diet in infantile autism. A therapeutic trial]" (in Norwegian). Tidsskr. Nor. Laegeforen. 111 (6): 704-7. PMID 2008691. 
  33. ^ Rix KJ, Ditchfield J, Freed DL, Goldberg DP, Hillier VF (1985). "Food antibodies in acute psychoses". Psychological medicine 15 (2): 347-54. PMID 4023138.