IgE-mediated wheat allergy presenting with the clinical picture of chronic urticaria

Background: A variety of elicitors of chronic spontaneous urticaria have been identified. IgE-mediated allergy is not regarded as a major cause of chronic urticaria. Methods: We performed a retrospective search for patients simultaneously suffering from the clinical picture of urticaria and wheat allergy. Diagnostic procedures included a careful history, determination of Omega-5-gliadin-specific IgE-antibodies (omega-5-gliadin-sIgE), and skin testing. Patients with suspected wheat allergy were put on an elimination diet. After symptoms had disappeared, we performed oral challenge tests in combination with exercise or other potential trigger factors (acetylic acid, ethanol). Results: Nine patients could be identified who had been suffering from the clinical picture of chronic urticaria for 6-72 months, and who had been suspected to be allergic to wheat. Intermittent urticaria partially with angioedema occurred in 4/9 patients, 3/9 patients reported daily attacks of urticaria, 2/9 patients also had experienced loss of consciousness. 7/9 patients had omega-5-gliadin-sIgE, 3/9 patients demonstrated sIgE to wheat flour. Prick tests with wheat were positive in 2/7 patients. Oral provocation tests with wheat were positive in 4/6 patients. In all patients urticaria resolved after eliminating wheat and spelt flour. They were surveyed for 3-8 years after wheat and spelt flour elimination. Discussion: Our findings demonstrate that IgE-mediated wheat allergy may be an underestimated, hidden trigger of a reported chronic urticaria. Frequency of IgE-mediated wheat allergy in patients with the clinical picture of chronic urticaria should be examined in a prospective study.