C HAPTER 14 Wheat as an Allergen: Baker’s Asthma, Food and Wheat Pollen Allergy Alicia Armentia1, Eduardo Arranz2, José Antonio Garrote2,3, Javier Santos4 1 Allergy Unit. io !ortega University !os"ital. #alladolid. S"ain. 2 $BG&. University o' #alladolid(CS$C. #alladolid. S"ain. 3 Clinical *a+oratory ,epartment. io !ortega University !os"ital. #alladolid. S"ain. 4 Gastroenterology ,epartment. io !ortega University !os"ital. #alladolid. S"ain. aliciaarmentia-gmail.com, [email protected], [email protected], .aviersantos _ //-0otmail.com ,oi1 0tt"122dx.doi.org214.35262oms.262 How to !te th!s ha"ter Armentia A, Arranz E, Garrote JA, Santos J. Wheat as an Allergen: Baker’s Asthma, Food and Wheat Pollen Allergy. In Arranz E, Fernández-Bañares F, Rosell CM, Rodrigo L, eña AS, editors. Advances in the Understanding of Gluten elated Pathology and the Evolution of Gluten"Free Foods. Barcelona, Spain: OmniaScience; 2'(). p. 4+,-4--. 463 A. Armentia, E. Arranz, J.A. Garrote, J. Santos A # s t r a t 7ood incom"ati+ilities affect a""ro3imately 248 o' t0e "o"ulation and can +e caused +y allergy. &any "lant "roteins act as sensitizing agents in 0umans u"on re"eated ex"osure. 90eat is a "rominent allergen source and is one o' t0e causes o' +a:er;s ast0ma, food and "ollen allergy. <n t0e +asis o' differential solu+ility, =0eat grain "roteins 0ave +een classified as salt(solu+le al+umins and gluten fraction or "rolamins, =0ic0 include gliadins and glutenins. %ot0 "roteins sources 0ave +een im"licated in t0e develo"ment o' =0eat 0y"ersensitivity. ,uring t0e "ast years =e 0ave "urified and c0aracterized several "roteins from =0eat, +arley and rye, =0ic0 are associated =it0 flour allergy. >0ese allergens 0ave a "otential role as a +iological defense against t0e insect infestation of t0e grain. Until recently gluten intolerance 0as +een 0as +een considered to +e typical o' celiac disease and =0eat allergy. $n t0e last t0e last few years, new digestive syndromes 0as +een descri+ed. A new syndrome 0as +een named non(celiac gluten sensitivity ?@)GSA and eosino"0ilic eso"0agitis can +e also due to =0eat ingestion. >0e introduction o' microarray tec0niques featuring a large "anel o' "uri'ied allergens 0as +een a major advance in t0e diagnosis o' allergic diseases. !o=ever, t0is tec0nique 0as +een 0ardly a""lied to t0e diagnosis and c0aracterization o' "atients =it0 occu"ational ast0ma due to =0eat allergy. !ere, =e descri+ed t0ese investigations, t0e most im"ortant "at0ologies associated =it0 =0eat, t0eir "revention and treatment. 464 Wheat as an Allergen: Baker’s Asthma, Food and Wheat Pollen Allergy Keywords Baker;s ast0ma, =0eat allergy, =0eat "ollen allergy, non(celiac gluten sensitivity, Eosinop0ilic esop0agitis, li"id trans'er "rotein, 90eat al"0a amylase in0i+itors, microarrays, component resolved diagnosis. A##re%!at!ons $gE1 anti+odies E, $gG41 anti+odies $gG4, $*10: $nterleukin 10, A>G1 Anti(transglutaminase anti+ody, AGA1 Anti(gliadin anti+ody, ARA1 Antireticulin anti+ody, AEA1 anti(endomisyal anti+ody, *>C1 @on(s"eci'ic li"id trans'er "rotein, )&3: 90eat tetrameric al"0a amylase in0i+itor su+unit, E*$SA1 Enzymo(lin:ed(immuno-assay, @)GS1 non(celiac gluten sensitivity, EoE1 Eosinop0ilic oesop0agitis, *>C1 *i"id trans'er "roteins, >ri a a 19: 90eat *>C. Th!s man&s r!"t !s ded! ated to "ro'essor Ra"ha(l Pan)an!, !n memor!am* a"0aDl Canzani =as +orn August 1521 in &arseille. !e received 0is &, degree at t0e age o' 2E. !e +ecame interested in allergy at t0e +eginning o' 0is long career. $n 1566 0e received a 7ull+rig0t sc0olars0i" a=ard in recognition 'or 0is distinguis0ed =or: on ast0ma. a"0aDl "ursued 0is researc0 investigations, in close colla+oration =it0 many o' 0is colleagues, until t0e very end o' 0is li'e =it0 great devotion and +oundless ent0usiasm. a"0aDl =as 'ond o' nature, e3"ert on oman culture and in 0istory and literature. !e identi'ied =it0 S0a:es"eare and ,ante and em+raced t0e "0iloso"0y o' Seneca. !e =as a great s"ortsman and an exem"lary 'amily man. 7or all o' us =0o kne= 0im, =e =ill miss 0im immensely and =ill al=ays remem+er 0im as a 'riend and a scienti'ic role model. 46E A. Armentia, E. Arranz, J.A. Garrote, J. Santos 1* +ntrod& tion 1*1* Allergy to Wheat and Related ,!seases 90eat is a "otent allergen source and is one of t0e causes of +akerFs ast0ma, 'ood and "ollen allergy1. >0e "revalence of =0eat 'lour allergy is increasing, ranging 'rom 2 to 3.6%, de"ending on diagnostic met0ods and geograp0ic areas2. 90eat is also one of t0e most 'requent allergenic 'oods associated =it0 'ood(de"endent exercise(induced anap0ylaxis3. Anot0er type of =0eat $gE(mediated 0ypersensitivity is +aker;s ast0ma, an important occu"ational disease, caused +y in0alation of =0eat and ot0er cereals 'lours4 ?7igure 1). $n our data +ase of 22.726 allergic "atients, +aker;s ast0ma caused 8.20% of allergic ast0ma and t0e 52.5% of t0e occu"ational ast0ma diagnosed, +ut =e =orks in an area =ere t0e .obs related =it0 cereals are very important. @o=adays, t0e "revalence of =0eat "ollen allergy is not kno=n alt0ough t0e sensitization to grass "ollen is estimated in 38.68 in United Hingdom and 33.6% in EEUU1. )ommon sym"toms o' 'ood =0eat allergy can +egin =it0in a 'e= minutes a'ter eating, or t0ey can start a 'e= 0ours a'ter. Sym"toms o'ten involve t0e s:in and include reactions suc0 as ras0es, s=elling around t0e mout0, 0ives, and eczema. Also, sym"toms can ty"ically involve t0e intestines and mig0t include Figure . Baker’s asthma is an im!ortant diarr0ea, vomiting, nausea, o""u!ational disease, "aused #y inhalation o$ indigestion, and stomac0 and %heat and other cereals flours. a+dominal cram"s. >0e most severe allergy res"onse, anap0ylaxis, is a severe reaction involving ma.or +ody systems. 466 Wheat as an Allergen: Baker’s Asthma, Food and Wheat Pollen Allergy )onventional medical advice in dealing =it0 'ood related allergy is to avoid t0e su+stance "eople are sensitive to ?>able 1A. But since =0eat is as important element in all diets, avoidance +ecomes a ma.or ordeal. >0is type of avoidance diet severely limits t0e selection of 'oods. 90eat is quite di''icult to avoid. Aside 'rom +eing an ingredient in many 'oods, it is a su+stance t0at is also "resent in medical tablets. $t is also used as a glaze and t0ic:ener, a stabilizer, a +ul:ing agent, an emulsi'ier, a +inder, and a starc0. $s very use'ul to 0ave in'ormation on =0eat su+stitutes ?>able 2A, and ever read labels ?>able 3). &a#le 1. General guidelines for wheat allergy. Foods Allowed -ot allowed Beverages )o''ee, tea, 'ruit .uices, )ereal +everages, co''ee su+stitutes deca''einated co''ee, car+onated Beverages made 'rom =0eat "roducts1 +eer, +everages, all milks, cocoa ale, root +eer $nstant c0ocolate drin: mixes Breads I y(Kris", rice =a'ers 90ole =0eat, enric0ed, or =0ite +read, )ereals Cure corn, rice, arro=root, +arley, rolls, or +read crum+s "otato, or rye +read made Gra0am or gluten +read =it0out =0eat 'lour or =0eat ,onuts, s=eet rolls, mu''ins, 'renc0 toast, "roducts =a''les, "anca:es, dum"lings, +read )ornmeal, cornstarc0, soy+ean stu''ing, rusk, "o"overs 'lour, +arley 'lour, oat 'lour, rice Cre"ared mi3es 'or "anca:es, =a''les, 'lour, "otato starc0, arro=root +iscuits, +reads, and rolls 'lour )orn+read, "otato, or soybean +read unless <atmeal, cream o' rice, "u''ed made =it0out =0eat 'lour or =0eat rice, or ot0er cereals made 'rom "roducts "ure corn, oats, or rice to =0ic0 )ereals made 'rom 'arina, =0eat, or t0ose no =0eat 0as +een added =it0 =0eat "roducts or malt added Cretzels, crac:ers ,esserts )ustards, %avarian creams )a:es, "astries, commercial 'rosting, icing, <atmeal, arro=root, rice, or rye ice cream, s0er+et, ice cream cones cookies made =it0out =0eat )ookies, "re"ared mixes, or "ac:aged "roducts "udding containing =0eat 'lour )ornstarc0, ta"ioca, or rice Gra0am crac:ers, donuts "uddings 9ater or 'ruit ices, meringues, gelatin 46G A. Armentia, E. Arranz, J.A. Garrote, J. Santos Foods Allowed -ot allowed Eggs Eggs "re"ared any =ay =it0out Sou''les or creamed eggs made =it0 =0eat =0eat "roducts "roducts 7ats Butter, margarine, animal, or Any salad dressing t0ic:ened or gravy =it0 vegeta+le 'ats and oils, cream =0eat 'lour or "roducts Salad dressings or gravy "re"ared =it0out =0eat 'lour or "roducts 7ruit All 'res0, canned, dried, or 'rozen Strained 'ruits =it0 added cereals 'ruits and 'ruit .uices &eat, 7is0, Ba:ed, +roiled, +oiled, roasted or All +readed or 'loured meats, meats Coultry 'ried1 +ee', veal, "ork, 0am, containing 'iller suc0 as meatloa', c0ic:en, tur:ey, lam+, or 'is0 'ran:'urters, sausage, lunc0eon meats, "All meat" =ieners or lunc0eon +ologna, or "re"ared meat "atties meats "re"ared =it0out =0eat 'lour 'illers or =0eat "roducts &ilk I &ilk &ilk, +uttermilk, yogurt, c0eese, &alted milk, milk drin: containing Croducts some cottage c0eese "o=dered =0eat cereal or "roducts )ottage c0eese =it0 modi'ied starc0 or ot0er =0eat containing ingredients Cotatoes I 90ite and s=eet "otatoes Scallo"ed "otatoes Su+stitutes ice @oodles, s"ag0etti, macaroni, and ot0er "asta "roducts at semolina Sou" )lear +ouillon, consommé, or )ream sou"s unless made =it0out =0eat +rot0 'lour !omemade sou"s made =it0out Sou"s =it0 noodles, al"0a+ets, dum"lings, =0eat "roducts or s"ag0etti Sou" t0ic:ened =it0 =0eat 'lour S=eets )orn syru", 0oney, .ams, .ellies, )0ocolates, c0ocolate candy containing molasses, sugar malt, candy =it0 cereal extract #egeta+les All 'res0, 'rozen, or canned #egeta+les com+ined =it0 =0eat "roducts vegeta+les, and vegeta+le .uices %readed or 'loured vegeta+les &iscellaneous Salt, c0ili "o=der, condiments, &alt "roducts, 9orcesters0ire sauce, 'lavoring extracts, 0er+s, nuts, gravies t0ic:ened =it0 =0eat 'lour olives, "ickles, "o"corn, "eanut &onosodium glutamate ?&SGA, meat +utter tenderizers containing &SG, "re"ared oriental 'ood seasoned =it0 &SG, soy sauce A =0eat allergy is an a+normal res"onse o' t0e +ody to t0e "rotein 'ound in =0eat.