Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Case Report
2004:70:5;298-299
PMID: 17642643

Wheat induced urticaria

Monica Uppal, CR Srinivas
 Department of Dermatology, PSG Hospitals, Coimbatore, India

Correspondence Address:
C R Srinivas
Department of Dermatology, PSG Hospitals, Coimbatore
India
How to cite this article:
Uppal M, Srinivas C R. Wheat induced urticaria. Indian J Dermatol Venereol Leprol 2004;70:298-299
Copyright: (C)2004 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Wheat is widely consumed all over India in various forms - flour, daliya, maida, suji and wheat bran. Very few cases of wheat induced urticaria have been reported. This may be due to unusual features of wheat related hypersensitivity. A 35 year old female presented to us with history of chronic urticaria and angioedema. History revealed correlation between wheat intake and urticaria episodes. Prick testing was done with wheat antigen in the standard series and derivatives of raw wheat. Normal saline and histamine were used as controls. Prick testing was positive. Oral challenge induced urticaria within half an hour. This report discusses clinical features of wheat related hypersensitivity.
Keywords: Wheat, Prick testing, Allergy

INTRODUCTION

Wheat is a cereal belonging to the genus Triticum with over 30,000 species. The kernel consists of three parts: the bran or the outer epidermis, the endosperm (which constitutes 83% of the kernel, mainly composed of starch and protein) and the germ (which gives rise to the embryo). It is rich in proteins, fat and vitamin B complex.

In India, wheat is consumed in various forms. Wheat flour consists of finely ground bran, germ and endosperm. Daliya or samba rava is coarsely ground whole kernel. Maida or mav is derived after removing the bran and germ. The endosperm is finely ground for making white flour or maida. Semolina or suji is coarsely ground endosperm with chemical composition similar to that of maida. Wheat bran is used to increase stool weight and prevents constipation.[1]

In spite of such wide consumption, very few cases of wheat allergy have been reported. This may be due to unusual features of wheat related hypersensitivity. We report a rare case of wheat induced urticaria and review the literature.

CASE REPORT

A 35-year-old female presented with a history of chronic urticaria and recurrent angioedema since 8 years. She related the episodes to intake of Samba Rava. At presentation there were no skin lesions or dermographism.

Skin prick testing was done with food series (Creative Drug Industries, 308, Raikar Bhavan, Sector-17, Vashi, Navi Mumbai - 400 705, Tel: 789 0890, 789 0902,

E-mail: creativedrug@usa.net) and raw wheat components. Prick testing with normal saline was the negative control and histamine 0.1% solution was used as positive control. Prick test was positive to Mav, Rava and Samba Rava but negative to whole wheat and wheat antigen in the food series. Also, oral challenge with Samba Rava induced generalized urticaria within half an hour, thus suggesting immediate hypersensitivity to wheat.

DISCUSSION

Wheat has been known to cause various types of allergic reactions. These may be secondary to flour ingestion or inhalation of flour, pollen or grain dust.[2] Ingestion can induce urticaria, atopic dermatitis,[3] irritable bowel syndrome,[4] or wheat dependent exercise induced anaphylaxis.[5],[6] This is a type I hypersensitivity reaction. IgE antibodies against wheat gliadin,[3],[7] and alpha amylase trypsin inhibitor protein have been demonstrated in the serum of sensitized patients.[4]

The patient is usually not aware of his allergy because the clinical symptoms may either appear after 30-60 minutes or may appear only if the patient exercises at that particular time. This is also known as wheat dependent exercise induced anaphylaxis.[5],[6] Therefore, even in exercise induced anaphylaxis without apparent allergy, wheat hypersensitivity should be considered.

In our patient, prick test was positive to various derivatives of wheat but negative to whole wheat and wheat antigen in prick test series. The whole wheat was tested by soaking in water followed by application of crushed soaked wheat on the skin and pricking through the crushed material. It is possible that our patient tested negative to whole wheat because we were unable to deliver the antigenic substance through this material. Also the negative test to wheat antigen in the food series underscores the point that prick testing should not only be performed with the commercially available antigens but also with the raw material.

The effect of baking and digestion on the allergenicity of wheat flour proteins has been studied. In-vitro enzymatic digestion of unheated wheat flour destroys the allergenic proteins. However, baking, as in bread manufacture, increases the resistance of potential allergens to proteolytic digestion, thus allowing them to elicit immunological responses.[9] Attempts are underway to prepare hypoallergenic wheat flour as a substitute for wheat food in AD patients with wheat allergy.[10] Treatment with acidic oxidative potential water has also been shown to lower the allergenicity of wheat proteins.[11]

Wheat forms a major portion of the Indian diet. Allergy to wheat is usually not suspected. We report this rare case of wheat induced urticaria to emphasize that importance should be given to the patient′s impression regarding the etiology of the disease.

References
1.
Srilakshmi B. Cereals and cereal products. In: Srilakshmi B, ed. Food science. 1st Ed. New Delhi: New Age International Publication; 2001. p. 26-61.
[Google Scholar]
2.
Walsh BJ, Baldo BA, Bass DJ, Clancy R, Musk AW, Wrigley CW. Insoluble and soluble allergens from wheat grain and wheat dust: Detection of IgE binding in inhalant and ingestion allergy. N Engl Reg Allergy Proc 1987;8:27-33.
[Google Scholar]
3.
Varjonen E, Vainio E, Kalimo K. Antigliadin IgE - indicator of wheat allergy in atopic dermatitis. Allergy 2000;55:386-91.
[Google Scholar]
4.
Simonato B, De Lazzari F, Pasini G, Polato F, Giannattasio M, Gemignani C, et al. IgE binding to soluble & insoluble wheat flour proteins in atopic and nonatopic patients suffering from gastrointestinal symptoms after wheat ingestion. Clin Exp allergy 2001;31:1771-8.
[Google Scholar]
5.
Aunhachoke K, Rojanametin K, Saengapaswiriya A. Food dependent, exercise - induced anaphylaxis: First case report in Thailand. J Med Assoc Thai 2002;85:1014-8.
[Google Scholar]
6.
Vichyanond P, Visitsuntorn N, Tuchinda M. Wheat induced anaphylaxis. Asian Pac J Allergy Immunol 1990;8:49-52.
[Google Scholar]
7.
Palosuo K, Varjonen E, Kekki OM, Klemola T, Kalkkinen N, Alenius H, et al. Wheat omega-gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol 2001;108:634-8.
[Google Scholar]
8.
Aoki T, Kushimoto H. Type I wheat ingestion allergy: A model of masked allergy. N Engl Reg Allergy Proc 1987;8:34-6.
[Google Scholar]
9.
Simonato B, Pasini G, Giannattasio M, Peruffo AD, Delazzari F, Curioni A. Food allergy to wheat products: the effect of bread baking and in vitro digestion on wheat allergenic proteins. A study with bread dough, crumb, and crust. J Agric food Chem 2001;49:5668-73.
[Google Scholar]
10.
Ikezawa Z, Tsubaki K, Yokota S. Effect of hypoallergenic wheat (HAW-A1) on atopic dermatitis (AD) with wheat allergy, and its antigenic analysis using sera from patients with AD. Arerugi 1994;43:679-88.
[Google Scholar]
11.
Matsumoto T. Mitigation of the action of wheat allergen by acidic oxidative potential water. Allergy 2002;57:926-30.
[Google Scholar]

Fulltext Views
28

PDF downloads
15
Show Sections