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Anaphylaxis after wheat ingestion in a patient with coeliac disease

two kinds of reactions and the same culprit food

Mennini, Maurizioa; Fiocchi, Alessandroa; Trovato, Chiara M.c; Ferrari, Federicab; Iorfida, Donatellac; Cucchiara, Salvatorec; Montuori, Monicac

European Journal of Gastroenterology & Hepatology: July 2019 - Volume 31 - Issue 7 - p 893–895
doi: 10.1097/MEG.0000000000001421
Case Report
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In recent years, the role of atopic dermatitis epidermal skin barrier defects in inducing a transcutaneous allergic sensitization is highly debated, possibly explaining why some children with eczema are sensitized to foods they have never eaten. In our specific situation, the association between coeliac disease and wheat allergy might be particularly harmful owing to unavoidable strict food avoidance. We describe the case of a young boy affected by coeliac disease who, after an occasional unexpected ingestion of gluten, experienced a complete anaphylactic reaction characterized by urticarial, labial angioedema, wheezing, and hypotension. To better investigate the state of allergic sensitization to wheat in our patient, we then performed the component resolved diagnosis, which showed Tri a19 2 kU/l and Tri a14 0.3 kU/l. These results demonstrated the association of IgE-mediated allergy to wheat and coeliac disease. The natural course of specific IgE in allergic patients who are on a food-free diet needs further investigation, such as the possible influence that the increasing popularity of gluten-free diets may have on the epidemiology of wheat allergy in westernized societies. National and International registers of cases of anaphylaxis may improve the still limited knowledge in this field. The final message of our contribution is that the decision to eliminate a food should to take into account a patient’s awareness of possible consequences.

aDepartment of Pediatrics, Division of Allergy

bHepatology, Gastroenterology and Nutrition, Pediatrics Department, Bambino Gesù Children’s Hospital

cPediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy

Correspondence to Maurizio Mennini, MD, Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant’Onofrio, 400165 Rome, Italy Tel: +39 066 859 2296; fax: +39 066 859 2296; e-mail: maurizio.mennini@gmail.com

Received January 22, 2019

Accepted March 7, 2019

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