Background: ω-5 gliadin is a major allergen in exercise-induced wheat allergy (EIWA), but it is also implicated in immediate-type reactions to wheat. An ImmunoCAP assay to measure ω-5 gliadin-specific IgE has become available. This study aimed to evaluate this new biological test in wheat allergy diagnosis and to also determine if it was able to discriminate EIWA from other types of wheat allergy. Methods: Sixty-one patients with wheat allergy were divided into 3 groups as a function of their symptoms (EIWA, immediate-type reactions and atopic dermatitis). These patients underwent skin prick tests with purified ω gliadins and ImmunoCAP to wheat flour, gluten and recombinant ω-5 gliadin. Results: The experimental data showed that 78% of EIWA patients had a positive skin prick test to natural ω-5 gliadin and the same proportion had detectable specific IgE to recombinant ω-5 gliadin, indicating that ω-5 gliadin is the main allergen, but not the only one, in our population. Additionally, we showed that this detection was not EIWA specific since ω-5 gliadin-specific IgE was detected in 30% of other patients who had a wheat allergy. These results lead to a positive predictive value of 37.5% and to a negative predictive value of 91%. Conclusions: Although not specific to EIWA, the new ImmunoCAP ω-5 gliadin is an important biological test because of its negative predictive value. In case of food-dependent exercise-induced allergy, the absence of ω-5 gliadin-specific IgE will almost completely exclude the implication of wheat.

Keywords:
Food allergens, Immunoglobulin E, Omega-5 gliadin, Exercise-induced wheat allergy
1.
Palosuo K: Update on wheat hypersensitivity. Curr Opin Allergy Clin Immunol 2003;3:205–209.
2.
Harada S, Iijima M, Nakamura A, Yoshizaki Y, Matsuo H, Morita E: Four cases of wheat-dependent exercise-induced anaphylaxis with negative gluten CAP-RAST score (in Japanese). Arerugi 2007;56:41–48.
3.
Matsuo H, Morita E, Tatham AS, Morimoto K, Horikawa T, Osuna H, Ikezawa Z, Kaneko S, Kohno K, Dekio S: Identification of the IgE-binding epitope in ω-5 gliadin, a major allergen in wheat-dependent exercise-induced anaphylaxis. J Biol Chem 2004;279:12135–12140.
4.
Morita E, Matsuo H, Mihara S, Morimoto K, Savage AW, Tatham AS: Fast ω-gliadin is a major allergen in wheat-dependent exercise-induced anaphylaxis. J Dermatol Sci 2003;33:99–104.
5.
Palosuo K, Alenius H, Varjonen E, Koivuluhta M, Mikkola J, Keskinen H, Kalkkinen N, Reunala T: A novel wheat gliadin as a cause of exercise-induced anaphylaxis. J Allergy Clin Immunol 1999;103:912–917.
6.
Varjonen E, Vainio E, Kalimo K: Life-threatening, recurrent anaphylaxis caused by allergy to gliadin and exercise. Clin Exp Allergy 1997;27:162–166.
7.
Battais F, Courcoux P, Popineau Y, Kanny G, Moneret-Vautrin DA, Denery-Papini S: Food allergy to wheat: differences in immunoglobulin E-binding proteins as a function of age or symptoms. J Cereal Sci 2005;42:109–117.
8.
Daengsuwan T, Palosuo K, Phankingthongkum S, Visitsunthorn N, Jirapongsananuruk O, Alenius H, Vichyanond P, Reunala T: IgE antibodies to ω-5 gliadin in children with wheat-induced anaphylaxis. Allergy 2005;60:506–509.
9.
Palosuo K, Varjonen E, Kekki OM, Klemola T, Kalkkinen N, Alenius H, Reunala T: Wheat ω-5 gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol 2001;108:634–638.
10.
Lehto M, Palosuo K, Varjonen E, Majuri ML, Andersson U, Reunala T, Alenius H: Humoral and cellular responses to gliadin in wheat-dependent, exercise-induced anaphylaxis. Clin Exp Allergy 2003;33:90–95.
11.
Astier C, Morisset M, Roitel O, Codreanu F, Jacquenet S, Franck P, Ogier V, Petit N, Proust B, Moneret-Vautrin DA, Burks AW, Bihain B, Sampson HA, Kanny G: Predictive value of skin prick tests using recombinant allergens for diagnosis of peanut allergy. J Allergy Clin Immunol 2006;118:250–256.
12.
Romano A, Di Fonso M, Giuffreda F, Papa G, Artesani MC, Viola M, Venuti A, Palmieri V, Zeppilli P: Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 2001;125:264–272.
13.
Bruijnzeel-Koomen C, Ortolani C, Aas K, Bindslev-Jensen C, Bjorksten B, Moneret-Vautrin D, Wuthrich B: Adverse reactions to food. European Academy of Allergology and Clinical Immunology Subcommittee. Allergy 1995;50:623–635.
14.
Rance F, Kanny G, Dutau G, Moneret-Vautrin DA: Food hypersensitivity in children: clinical aspects and distribution of allergens. Pediatr Allergy Immunol 1999;10:33–38.
15.
Battais F, Pineau F, Popineau Y, Aparicio C, Kanny G, Guerin L, Moneret-Vautrin DA, Denery-Papini S: Food allergy to wheat: identification of immunogloglin E and immunoglobulin G-binding proteins with sequential extracts and purified proteins from wheat flour. Clin Exp Allergy 2003;33:962–970.
16.
Kasarda DD, Autran J, Lew EJL, Nimmo CC, Shewry PR: N-terminal amino acid sequences of ω-gliadins and ω-secalins: implications for the evolution of prolamin genes. Biochim Biophys Acta 1983;747:138–150.
17.
Popineau Y, Le Guerroué J, Pineau F: Purification and characterization of ω-gliadin components from common wheat. Lebensm Wiss Technol 1986;19:266–271.
18.
Dreborg S: Skin tests in the diagnosis of food allergy. Pediatr Allergy Immunol 1995;6 (suppl 8):38–43.
19.
Matsuo H, Kohno K, Morita E: Molecular cloning, recombinant expression and IgE-binding epitope of ω-5 gliadin, a major allergen in wheat-dependent exercise-induced anaphylaxis. FEBS J 2005;272:4431–4438.
20.
Bindslev-Jensen C, Ballmer-Weber BK, Bengtsson U, Blanco C, Ebner C, Hourihane J, Knulst AC, Moneret-Vautrin DA, Nekam K, Niggemann B, Osterballe M, Ortolani C, Ring J, Schnopp C, Werfel T: Standardization of food challenges in patients with immediate reactions to foods: position paper from the European Academy of Allergology and Clinical Immunology. Allergy 2004;59:690–697.
21.
Seilmeier W, Valdez I, Mendez E, Wieser H: Comparative investigations of gluten proteins from different wheat species. 2. Characterization of ω-gliadins. Eur Food Res Technol 2001;212:355–363.
22.
Battais F, Mothes T, Moneret-Vautrin DA, Pineau F, Kanny G, Popineau Y, Bodinier M, Denery-Papini S: Identification of IgE-binding epitopes on gliadins for patients with food allergy to wheat. Allergy 2005;60:815–821.
23.
Shewry PR, Halford NG: Cereal seed storage proteins: structures, properties and role in grain utilization. J Exp Bot 2002;53:947–958.
24.
Shewry PR, Tatham AS: The prolamin storage proteins of cereal seeds: structure and evolution. Biochem J 1990;267:1–12.
25.
Matsuo H, Kohno K, Niihara H, Morita E: Specific IgE determination to epitope peptides of ω-5 gliadin and high molecular weight glutenin subunit is a useful tool for diagnosis of wheat-dependent exercise-induced anaphylaxis. J Immunol 2005;175:8116–8122.
26.
Pastorello EA, Farioli L, Conti A, Pravettoni V, Bonomi S, Iametti S, Fortunato D, Scibilia J, Bindslev-Jensen C, Ballmer-Weber B, Robino AM, Ortolani C: Wheat IgE-mediated food allergy in European patients: α-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins: allergenic molecules recognized by double-blind, placebo-controlled food challenge. Int Arch Allergy Immunol 2007;144:10–22.
27.
Morita E, Kunie K, Matsuo H: Food-dependent exercise-induced anaphylaxis. J Dermatol Sci 2007;47:109–117.
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2008
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