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ALLERGIES

Wheat Allergy:
Diagnostic Confusion and Challenges
By Michael P Vaughn, MD, PhD

Allergy to wheat caused by antigen specific allergic antibodies identifiable underlying genetic predisposition (HLA-DQ2 and
(IgE) is a relatively straight forward diagnosis with a preponderance DQ8 alleles). More than 200 different symptoms have been report-
of scientifically validated studies to support a cause and effect hy- edly attributed to this disease and per the World Gastroenterology
pothesis. A reliable diagnosis is made by the correlation of a clinical Organization, CD can be divided into two basic types: classical and
history suggestive of wheat allergy with the positive results of either non-classical. The classical form of CD has features that are pre-
blood testing (RAST) or skin prick testing. Non-IgE mediated al- dominantly suggestive of malabsorption such as diarrhea, bloating,
lergy to the wheat protein gliadin (gluten), commonly referred to weight loss and failure to thrive (in children). In the non-classical
as Celiac disease (CD), has also been scientifically validated as being form, gastrointestinal symptoms are often milder or absent and
caused by gluten contained in several cereal grains (wheat, barley, other symptoms may be of greater concern to the patient such as:
rye and spelt). However, because up to 50 percent of those with CD chronic fatigue, migraine headaches, peripheral neuropathy, pruritic
have few or no symptoms, it has been estimated that up to 80 per- skin lesions (Dermatitis herpetiformis), unexplained infertility, or
cent of persons with this disease remain undiagnosed. Estimates of depression.
the prevalence of CD have been as high as 1 in 100 people.
A third type of CD has also been described in which the biopsy
Celiac disease (CD) is a serious autoimmune disorder with an of the small intestine demonstrates the “diagnostic” histologic asso-

14 San Antonio Medicine • March 2017