RESUMO
OBJECTIVE: Little is known regarding food anaphylaxis in infancy. We aimed to describe specificities of food anaphylaxis in infants (≤12 months) as compared to preschool children (1-6 years). METHODS: We conducted a retrospective study of all food anaphylaxis cases recorded by the Allergy Vigilance Network from 2002 to 2018, in preschool children focusing on infants. RESULTS: Of 1951 food anaphylaxis reactions, 61 (3%) occurred in infants and 386 (20%) in preschool children. Two infants had two anaphylaxis reactions; thus, we analyzed data among 59 infants (male: 51%; mean age: 6 months [SD: 2.9]); 31% had a history of atopic dermatitis, 11% of previous food allergy. The main food allergens were cow's milk (59%), hen's egg (20%), wheat (7%) and peanut (3%) in infants as compared with peanut (27%) and cashew (23%) in preschool children. Anaphylaxis occurred in 28/61 (46%) cases at the first cow's milk intake after breastfeeding discontinuation. Clinical manifestations were mainly mucocutaneous (79%), gastrointestinal (49%), respiratory (48%) and cardiovascular (21%); 25% of infants received adrenaline. Hives, hypotension and neurologic symptoms were more likely to be reported in infants than in preschool children (P = .02; P = .004; P = .002, respectively). Antihistamines and corticosteroids were more often prescribed in preschool children than in infants (P = .005; P = .025, respectively). CONCLUSION: Our study found that in infants presenting with their first food allergy, in a setting with a high rate of infant formula use, the most predominant trigger was cow's milk. As compared to older preschool children, hives, hypotonia and hypotension were more likely to be reported in infants. We believe that this represents a distinct food anaphylaxis phenotype that can further support developing the clinical anaphylaxis criteria in infants.
Assuntos
Distribuição por Idade , Anafilaxia/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Anacardium , Anafilaxia/etiologia , Anafilaxia/fisiopatologia , Angioedema/fisiopatologia , Pré-Escolar , Tosse/fisiopatologia , Choro , Dispneia/fisiopatologia , Hipersensibilidade a Ovo/complicações , Hipersensibilidade a Ovo/epidemiologia , Hipersensibilidade a Ovo/fisiopatologia , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/fisiopatologia , Humanos , Hipotensão/fisiopatologia , Lactente , Edema Laríngeo/fisiopatologia , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/epidemiologia , Hipersensibilidade a Leite/fisiopatologia , Hipotonia Muscular/fisiopatologia , Hipersensibilidade a Noz/complicações , Hipersensibilidade a Noz/epidemiologia , Hipersensibilidade a Noz/fisiopatologia , Hipersensibilidade a Amendoim/complicações , Hipersensibilidade a Amendoim/epidemiologia , Hipersensibilidade a Amendoim/fisiopatologia , Prurido/fisiopatologia , Agitação Psicomotora/fisiopatologia , Sons Respiratórios/fisiopatologia , Estudos Retrospectivos , Convulsões/fisiopatologia , Urticária/fisiopatologia , Vômito/fisiopatologia , Hipersensibilidade a Trigo/complicações , Hipersensibilidade a Trigo/epidemiologia , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
PURPOSE OF REVIEW: There has been significant interest in gluten over the last decade, with an increase in interest of gluten-related disorders outside coeliac disease. Particularly, there has been a focus on the role of gluten in noncoeliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS). There is significant overlap between both of these conditions, with the aim of this review to explore their complex relationship. RECENT FINDINGS: Gluten has been demonstrated to generate symptoms in individuals with NCGS. However, there appears to be an increasing role for gluten in symptom generation in patients with IBS also. Other components of wheat, other than gluten, are now also thought to be contributing factors in symptom generation. SUMMARY: There appears to be significant overlap between IBS and NCGS. It is likely that a subset of patients presenting with IBS actually have NCGS. In addition, it is likely that individuals with IBS may also have symptoms triggered by gluten. With the pathophysiology of both conditions not fully understood, as well as increasing knowledge of wheat components in symptom generation, further research is required to help distinguish between both.
Assuntos
Gastroenteropatias/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Amilases/antagonistas & inibidores , Dieta Livre de Glúten , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/dietoterapia , Glutens/efeitos adversos , Humanos , Síndrome do Intestino Irritável/dietoterapia , Triticum/efeitos adversos , Triticum/química , Inibidores da Tripsina/efeitos adversos , Aglutininas do Germe de Trigo/efeitos adversos , Hipersensibilidade a Trigo/dietoterapia , Hipersensibilidade a Trigo/etiologia , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
Gluten-related disorders are very common in pediatric patients. Wheat allergy is triggered by an immunoglobulin E (IgE)-dependent mechanism; its prevalence varies according to the age and region, and in Europe has been estimated to be lower than 1%. Many studies investigated the potential role of several external factors that can influence the risk to developing wheat allergy, but results are still inconclusive. It can be responsible for several clinical manifestations depending on the route of allergen exposure: food-dependent exercise-induced anaphylaxis (FDEIA), occupational rhinitis or asthma (also known as baker's asthma), and contact urticaria. The prognosis of IgE-mediated wheat allergy in children is generally favorable, with the majority of children becoming tolerant by school age. Patients who experienced an anaphylactic reaction prior to 3 years of age and patients with higher level of wheat- or ω-5 gliadin-specific IgE antibodies seem to be at higher risk of persistent wheat allergy. The current management of patients is dietary avoidance. Nowadays, oral immunotherapy has been proposed for wheat allergy with promising results, even if further studies are necessary to establish the best protocol in order to promote tolerance in wheat-allergic children.
Assuntos
Hipersensibilidade a Trigo/fisiopatologia , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Humanos , Imunoglobulina E/efeitos adversos , Imunoglobulina E/análise , Imunoterapia/métodos , Imunoterapia/tendências , Masculino , Triticum/efeitos adversos , Triticum/imunologia , Hipersensibilidade a Trigo/epidemiologiaRESUMO
Gluten and other related proteins of the wheat, rye and barley, have antigenic properties that may trigger adverse reactions in susceptible individuals. Celiac disease was the first pathology with clear causal association related to the intake of these proteins. Recently, wheat allergy and non celiac gluten sensitivity have been described. Although, clinical presentation and its relation with protein ingestion may be similar and elicit confusion, their pathogenic mechanism, diagnosis and treatment are quite different. Since the prevalence of these diseases is relatively high as a whole, it is essential that these become familiar to primary care doctors and general pediatricians, thus they will know how to differentiate and face them. The aim of this review is to compare the main aspects of epidemiology, pathofisiology, diagnosis and treatment of these 3 conditions.
Assuntos
Doença Celíaca , Glutens/efeitos adversos , Hipersensibilidade a Trigo , Doença Celíaca/diagnóstico , Doença Celíaca/dietoterapia , Doença Celíaca/epidemiologia , Doença Celíaca/fisiopatologia , Chile/epidemiologia , Diagnóstico Diferencial , Dieta Livre de Glúten , Saúde Global , Humanos , Prognóstico , Hipersensibilidade a Trigo/diagnóstico , Hipersensibilidade a Trigo/dietoterapia , Hipersensibilidade a Trigo/epidemiologia , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
The current review paper highlights the complicacies associated with communities relying on wheat as their dietary staple. Although, wheat is an important source of nutrients but is also linked with allergenic responses in genetically susceptible subjects. The wheat proteins especially α-amylase inhibitors, ω-5 gliadins, prolamins, nonprolamin, glucoprotein, and profilins are of significance importance. The allergenic responses are further categorized into IgE-mediated and non-IgE-mediated reactions. Conjugation and degranulation of the IgEs with the allergens results in release of several mediators. In contrary, non-IgE-mediated wheat allergy depends on immune complexes formed by food and food antibodies and cell-mediated immunity. As results, different diseases tend to occur on the completion of these reactions, i.e., celiac disease, baker's asthma, diarrhea, atopic dermatitis, and urticaria. This instant paper highlighted the concept of food allergy with special reference to wheat. The models are developed that are included in this paper showing the wheat allergen, their possible routes, impact on human health, and indeed possible remedies. The paper would provide the basic information for the researchers, common man, and allied stakeholders to cater the issue in details. However, the issue needs the attention of the researchers as there is a need to clarify the issues of wheat allergy and wheat intolerance.
Assuntos
Modelos Imunológicos , Hipersensibilidade a Trigo/imunologia , Animais , Asma Induzida por Exercício/etiologia , Asma Induzida por Exercício/prevenção & controle , Doença Celíaca/etiologia , Doença Celíaca/prevenção & controle , Dermatite Atópica/etiologia , Dermatite Atópica/prevenção & controle , Gastroenterite/etiologia , Gastroenterite/prevenção & controle , Humanos , Índice de Gravidade de Doença , Urticária/etiologia , Urticária/prevenção & controle , Hipersensibilidade a Trigo/fisiopatologia , Hipersensibilidade a Trigo/prevenção & controle , Hipersensibilidade a Trigo/terapiaRESUMO
BACKGROUND: Sensitization to wheat flour plays an important role in the development and diagnosis of baker's asthma. OBJECTIVES: We evaluated wheat allergen components as sensitizers for bakers with work-related complaints, with consideration of cross-reactivity to grass pollen. METHODS: Nineteen recombinant wheat flour proteins and 2 cross-reactive carbohydrate determinants were tested by using CAP-FEIA in sera of 101 bakers with wheat flour allergy (40 German, 37 Dutch, and 24 Spanish) and 29 pollen-sensitized control subjects with wheat-specific IgE but without occupational exposure. IgE binding to the single components was inhibited with wheat flour, rye flour, and grass pollen. The diagnostic efficiencies of IgE tests with single allergens and combinations were evaluated by assessing their ability to discriminate between patients with baker's allergy and control subjects based on receiver operating characteristic analyses. RESULTS: Eighty percent of bakers had specific IgE levels of 0.35 kUA/L or greater and 91% had specific IgE levels of 0.1 kUA/L or greater to at least one of the 21 allergens. The highest frequencies of IgE binding were found for thiol reductase (Tri a 27) and the wheat dimeric α-amylase inhibitor 0.19 (Tri a 28). Cross-reactivity to grass pollen was proved for 9 components, and cross-reactivity to rye flour was proved for 18 components. A combination of IgE tests to 5 components, Tri a 27, Tri a 28, tetrameric α-amylase inhibitor CM2 (Tri a 29.02), serine protease inhibitor-like allergen (Tri a 39), and 1-cys-peroxiredoxin (Tri a 32), produced the maximal area under the curve (AUC = 0.84) in receiver operating characteristic analyses, but this was still lower than the AUC for wheat- or rye flour-specific IgE (AUC = 0.89 or 0.88, respectively). CONCLUSIONS: Component-resolved diagnostics help to distinguish between sensitization caused by occupational flour exposure and wheat seropositivity based on cross-reactivity to grass pollen. For routine diagnosis of baker's allergy, however, allergen-specific IgE tests with whole wheat and rye flour extracts remain mandatory because of superior diagnostic sensitivity.
Assuntos
Alérgenos/imunologia , Asma Ocupacional/diagnóstico , Farinha/análise , Imunoglobulina E/imunologia , Proteínas de Plantas/imunologia , Rinite Alérgica Sazonal/diagnóstico , Hipersensibilidade a Trigo/diagnóstico , Adolescente , Adulto , Alérgenos/química , Alérgenos/isolamento & purificação , Antígenos de Plantas/química , Antígenos de Plantas/imunologia , Antígenos de Plantas/isolamento & purificação , Área Sob a Curva , Asma Ocupacional/imunologia , Asma Ocupacional/fisiopatologia , Reações Cruzadas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peroxirredoxinas/química , Peroxirredoxinas/imunologia , Peroxirredoxinas/isolamento & purificação , Proteínas de Plantas/química , Proteínas de Plantas/isolamento & purificação , Poaceae/química , Poaceae/imunologia , Pólen/química , Pólen/imunologia , Curva ROC , Proteínas Recombinantes/química , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/isolamento & purificação , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/fisiopatologia , Hipersensibilidade a Trigo/imunologia , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
BACKGROUND: Food allergy to lupine has frequently been reported in patients allergic to peanut or soy, and cross-reactivity between these legumes is known. Moreover, respiratory allergy to lupine has been described after inhalation, mostly at workplaces. Our aim was to study the frequency of lupine sensitization in European bakers with suspected bakers' allergy. Furthermore, associations between sensitizations to lupine and other plant allergens were investigated. METHODS: One hundred and sixteen bakers with work-related allergic symptoms but without known food allergies were examined. Specific IgE (sIgE) antibodies to wheat flour, rye flour, lupine, peanut, soy and the recombinant single birch protein rBet v 1 were quantified. Selected sera were tested for cross-reactivity using ImmunoCAP inhibition and ISAC microarrays. RESULTS: Whereas 67% of bakers were sensitized to wheat and/or rye flour, 35% showed sIgE to peanut and 33% to lupine. All lupine-positive bakers also had sIgE to either wheat flour (89%) and/or peanut (92%), and lupine sIgE correlated significantly with sIgE to peanut, soy, wheat and rye flour. Used as an inhibitor, wheat flour inhibited IgE binding to lupine in 4 out of 8 sera, indicating cross-reactivity. In microarrays, these sera showed IgE binding to lipid transfer proteins, profilins and/or cross-reactive carbohydrate determinants. Further inhibition experiments suggest that these single allergens are involved in cross-reactivity. CONCLUSION: One third of 116 symptomatic bakers showed sIgE to lupine. At least some of these sensitizations were based on cross-reactivity between lupine and wheat flour. However, the considerable sensitization rate could also be a sign that the use of lupine flour in bakeries may be of occupational relevance.
Assuntos
Farinha/análise , Imunoglobulina E/sangue , Lupinus/imunologia , Doenças Profissionais/imunologia , Hipersensibilidade Respiratória/imunologia , Hipersensibilidade a Trigo/imunologia , Adulto , Antígenos de Plantas/genética , Antígenos de Plantas/imunologia , Arachis/química , Arachis/imunologia , Proteínas de Transporte/genética , Proteínas de Transporte/imunologia , Europa (Continente) , Feminino , Expressão Gênica/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Plantas/genética , Proteínas de Plantas/imunologia , Profilinas/genética , Profilinas/imunologia , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Hipersensibilidade Respiratória/complicações , Hipersensibilidade Respiratória/genética , Hipersensibilidade Respiratória/fisiopatologia , Estudos Retrospectivos , Glycine max/química , Glycine max/imunologia , Triticum/química , Triticum/imunologia , Hipersensibilidade a Trigo/complicações , Hipersensibilidade a Trigo/genética , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
The study was aimed to determine the natural history of wheat hypersensitivity, to define risk factors for persistent wheat hypersensitivity, and to evaluate the development of respiratory allergy in children with wheat hypersensitivity. The development and subsequent disappearance of wheat hypersensitivity, clinical findings, skin prick test (SPT) reactivity, and the development of allergic rhinoconjunctivitis and asthma were charted retrospectively in 28 children with wheat hypersensitivity proven by the open oral challenge at the median age of 21 months (range 6 to 75 months). Appearance of skin symptoms during the diagnostic wheat challenge was related to SPT-positive wheat hypersensitivity, while the appearance of gastrointestinal symptoms alone was associated with SPT-negative wheat hypersensitivity (p=0.002). Wheat was tolerated by 59%, 69%, 84%, and 96%, by age 4, 6, 10, and 16, respectively. Sensitization to gliadin with a SPT wheal of >or=5 mm at the time of the diagnostic challenge was associated with a slower course of recovery from wheat hypersensitivity (p=0.019), and a SPT wheal of >or=3 mm to gliadin at any time was associated with the development of asthma (p=0.022). SPT reactivity to wheat was associated with later SPT reactivity to birch pollen (p=0.001), and the development of allergic rhinoconjunctivitis (p=0.001). In conclusion, almost all children with wheat hypersensitivity can tolerate wheat by adolescence. Sensitization to gliadin is associated with a slower achievement of tolerance and an increased risk of asthma.
Assuntos
Tolerância Imunológica , Hipersensibilidade a Trigo , Asma/epidemiologia , Asma/imunologia , Criança , Pré-Escolar , Conjuntivite Alérgica/imunologia , Feminino , Gliadina/imunologia , Humanos , Imunoglobulina E/sangue , Lactente , Recém-Nascido , Masculino , Prevalência , Prognóstico , Hipersensibilidade Respiratória/epidemiologia , Hipersensibilidade Respiratória/imunologia , Rinite Alérgica Sazonal/imunologia , Fatores de Risco , Testes Cutâneos , Fatores de Tempo , Triticum/imunologia , Hipersensibilidade a Trigo/epidemiologia , Hipersensibilidade a Trigo/fisiopatologiaAssuntos
Alérgenos/efeitos adversos , Peptídeos Catiônicos Antimicrobianos/efeitos adversos , Proteínas de Plantas/efeitos adversos , Triticum/imunologia , Hipersensibilidade a Trigo/etiologia , Alérgenos/química , Alérgenos/genética , Alérgenos/imunologia , Sequência de Aminoácidos , Anafilaxia/etiologia , Peptídeos Catiônicos Antimicrobianos/química , Peptídeos Catiônicos Antimicrobianos/genética , Peptídeos Catiônicos Antimicrobianos/imunologia , Humanos , Imunoglobulina E/sangue , Dados de Sequência Molecular , Proteínas de Plantas/química , Proteínas de Plantas/genética , Proteínas de Plantas/imunologia , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
Non-celiac wheat sensitivity (NCWS) is characterized by gastrointestinal and extra-intestinal symptoms following the ingestion of gluten-containing cereals in subjects without celiac disease or wheat allergy. The identity of the molecular triggers in these cereals responsible for the symptoms of NCWS remains to be delineated. Recent research has identified a biological basis for the condition, with the observation of systemic immune activation in response to microbial translocation that appears to be linked to intestinal barrier defects. Ongoing research efforts are aimed at further characterizing the etiology, mechanism, and biomarkers of the condition.
Assuntos
Hipersensibilidade a Trigo/diagnóstico , Hipersensibilidade a Trigo/imunologia , Imunidade Adaptativa , Adulto , Doença Celíaca , Dieta Livre de Glúten , Feminino , Microbioma Gastrointestinal , Humanos , Imunidade Inata , Mucosa Intestinal/imunologia , Masculino , Pessoa de Meia-Idade , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
BACKGROUND: Non-Celiac Wheat Sensitivity (NCWS) is still a largely undefined condition, due to the lack of a diagnostic marker. Few data are available about the nutritional characteristics of NCWS patients at diagnosis. AIMS: To evaluate the proportion of NCWS patients who were underweight, normal weight, overweight, or obese at diagnosis, and to search for possible correlations between their Body Mass Index (BMI) and other NCWS-related disease characteristics. PATIENTS AND METHODS: The clinical charts of 145 NCWS patients (125 F, 20 M, mean age 37.1 ± 11.4 years), diagnosed between January 2012 and March 2018, were reviewed. As a comparison, 84 celiac disease (CD) patients (73 F, 11 M, mean age 39.8 ± 13.9 years) were evaluated. All NCWS diagnoses were based on a double-blind placebo-controlled wheat challenge (DBPCWC) method. RESULTS: BMI distribution was similar in the NCWS (6.2% underweight and 15.2% obese subjects) and CD patients (6% underweight and 7.1% obese subjects). Underweight NCWS subjects were significantly younger and had a shorter clinical history than the overweight or obese ones. Unlike the other NCWS patients, none of them had a DQ2 and/or DQ8 haplotype. Overweight and obese NCWS patients were more frequently suffering from associated autoimmune diseases than the other BMI categories (P = 0.05). Compared to the CD controls, NCWS patients showed a higher frequency of Irritable Bowel Syndrome (IBS)-like (P = 0.01) and extraintestinal symptoms (P = 0.03) and a longer clinical history (P = 0.04), whereas weight loss was more frequent in CD (P = 0.02). CONCLUSIONS: NCWS patients showed a BMI distribution similar to CD patients. However, NCWS was found to be a heterogenous condition that regards BMI, and clinical characteristics differed between the underweight and overweight/obese patients.
Assuntos
Índice de Massa Corporal , Sobrepeso/fisiopatologia , Magreza/fisiopatologia , Hipersensibilidade a Trigo/fisiopatologia , Adulto , Autoimunidade , Feminino , Antígenos HLA-DQ/genética , Antígenos HLA-DQ/imunologia , Haplótipos , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/diagnóstico , Sobrepeso/imunologia , Prognóstico , Estudos Retrospectivos , Magreza/diagnóstico , Magreza/imunologia , Hipersensibilidade a Trigo/diagnóstico , Hipersensibilidade a Trigo/imunologiaRESUMO
Dermatitis herpetiformis (DH) is an autoimmune blistering skin disorder that is associated with gluten sensitivity. It presents as a papulovesicular rash and is often associated with enteropathy. The rash resolves when the patient is placed on a gluten-free diet and/or dapsone. DH, as well as celiac disease, is tightly associated with DQ2 and DQ8. A novel mouse model for DH is described that utilizes the NOD background and the HLA-DQ8 transgene. The addition of DQ8 contributes sensitivity to gliadin, and the addition of the NOD background contributes to autoimmunity and pathogenesis. Fifteen NOD DQ8+ mice of 90 that were sensitized to gluten developed blistering pathology similar to that seen in DH. Neutrophil infiltration of the dermis, deposition of IgA at the dermal-epidermal junction, and a complete reversal of the blistering phenomenon with the administration of a gluten-free diet with or without dapsone were observed. None of the 3 blistering mice examined had small-bowel pathology. This animal model of DH will be useful to determine the specificity of the IgA deposits, as well as the pathogenic mechanisms that occur in the skin as a result of gluten ingestion.
Assuntos
Dermatite Herpetiforme/imunologia , Modelos Animais de Doenças , Antígenos HLA-DQ/metabolismo , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Dapsona/uso terapêutico , Dermatite Herpetiforme/tratamento farmacológico , Dermatite Herpetiforme/genética , Dermatite Herpetiforme/patologia , Dieta , Orelha/anatomia & histologia , Orelha/patologia , Gliadina/imunologia , Glutens/administração & dosagem , Glutens/imunologia , Antígenos HLA-DQ/genética , Humanos , Imunoglobulina A/metabolismo , Intestino Delgado/citologia , Intestino Delgado/metabolismo , Camundongos , Camundongos Endogâmicos NOD , Camundongos Transgênicos , Pele/citologia , Pele/metabolismo , Pele/patologia , Transglutaminases/metabolismo , Hipersensibilidade a Trigo/imunologia , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
BACKGROUND: Previous studies suggest that the prevalence of wheat/gluten sensitivity and adherence to a gluten-free diet (GFD) are high in Latin population despite a poor diagnosis of celiac disease. However, these prevalence rates still remain unknown in most Latin American countries. METHODS: A cross-sectional survey study was conducted in Santa Fe, Argentina. RESULTS: The estimated self-reported prevalence rates were (95% Confidence Interval [CI]): self-reported gluten sensitivity (SR-GS) 7.61% (6.2-9.2), SR-GS currently following a GFD 1.82% (1.2-2.7), celiac disease 0.58% (0.3-1.2), wheat allergy 0.33% (0.12-0.84), self-reported non-celiac gluten sensitivity (SR-NCGS) 6.28% (5.1-7.8), SR-NCGS currently following a GFD 0.91% (0.5-1.6), and adherence to a GFD 6.37% (5.1-7.9). SR-GS was more common in women (6.0%; p < 0.001) and associated with irritable bowel syndrome (p < 0.001). Among the GFD followers, 71.4% were doing it for reasons other than health-related benefits and 50.6% without medical/dietitian advice. In the non-SR-GS group, the main motivations for following a GFD were weight control and the perception that a GFD is healthier. CONCLUSION: In Argentina, gluten sensitivity is commonly reported and it seems that physicians/gastroenterologists are aware of celiac disease diagnosis. Trustable information about the benefits and potential consequences of following a GFD should be given to the general population.
Assuntos
Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Cooperação do Paciente , Dor Abdominal/etiologia , Dor Abdominal/prevenção & controle , Adulto , Argentina/epidemiologia , Manutenção do Peso Corporal , Doença Celíaca/epidemiologia , Doença Celíaca/etnologia , Doença Celíaca/fisiopatologia , Estudos Transversais , Dieta Livre de Glúten/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Síndrome do Intestino Irritável/dietoterapia , Síndrome do Intestino Irritável/epidemiologia , Síndrome do Intestino Irritável/etnologia , Síndrome do Intestino Irritável/fisiopatologia , Masculino , Inquéritos Nutricionais , Sobrepeso/dietoterapia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Sobrepeso/fisiopatologia , Cooperação do Paciente/etnologia , Educação de Pacientes como Assunto , Prevalência , Autocuidado , Autorrelato , Índice de Gravidade de Doença , Fatores Sexuais , Hipersensibilidade a Trigo/dietoterapia , Hipersensibilidade a Trigo/epidemiologia , Hipersensibilidade a Trigo/etnologia , Hipersensibilidade a Trigo/fisiopatologia , Recursos HumanosRESUMO
Wheat dependent exercise-induced anaphylaxis (WDEIA) is a rare but potentially severe food allergy caused by the combination of wheat ingestion and physical exercise. The impact of WDEIA on quality of life (QOL) is unclear. This study characterized the clinical and laboratory features and investigated the QOL in WDEIA patients from Central China. Twenty-eight WDEIA patients were analyzed, and QOL was measured by validated Chinese version Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) and Food Allergy Independent Measure (FAIM) after obtaining the diagnosis. The results showed that half of the patients were females. The median onset age was 37 years old. The symptoms occurred within 1 h after wheat ingestion (26/28). Symptoms of anaphylaxis included cutaneous (26/28), respiratory (11/28), gastro-intestinal (5/28) and cardiovascular manifestations (27/28). Skin prick tests were positive to salt soluble (89.3%) and salt insoluble wheat allergen extracts (100%). Positive rate to wheat, gluten and omega-5 gliadin specific IgE was 64.3%, 92.9% and 92.9% respectively. Specific IgE to omega-5 gliadin with a cut-off value 0.83 KU/L offered highly efficient diagnostic criterion for WDEIA (sensitivity: 89.3%; and specificity: 88.9%). The mean scores of FAQLQ-AF and FAIM were 4.70 and 4.98 respectively and level of anti-omega-5 gliadin IgE had positive correlations with FAQLQ scores. Thereby, WDEIA is commonly found in mid-age adults. In most cases, multi-organs especially skin and cardiovascular systems are involved. Salt insoluble wheat allergen skin test and serum specific IgE to gluten and omega-5 gliadin help to diagnose WDEIA. QOL in WDEIA patients is severely impaired.
Assuntos
Alérgenos/imunologia , Anafilaxia/psicologia , Exercício Físico , Gliadina/imunologia , Triticum/química , Hipersensibilidade a Trigo/psicologia , Adolescente , Adulto , Idoso , Alérgenos/administração & dosagem , Alérgenos/química , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Anafilaxia/fisiopatologia , China , Feminino , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/fisiopatologia , Gliadina/administração & dosagem , Gliadina/química , Coração/fisiopatologia , Humanos , Imunoglobulina E/sangue , Pulmão/imunologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Pele/imunologia , Pele/fisiopatologia , Testes Cutâneos , Inquéritos e Questionários , Triticum/imunologia , Hipersensibilidade a Trigo/diagnóstico , Hipersensibilidade a Trigo/imunologia , Hipersensibilidade a Trigo/fisiopatologiaRESUMO
Cereals are considered a basic food. Through the development of cooking, the human being has produced high- gluten-content food, so that it could make the most of its nutritional properties. Wheat is becoming one of the key elements of the Mediterranean diet. Amongst gluten- intake-related pathologies- gluten is present mainly in wheat, barley and rye- celiac disease (CD) is the most well-known. CD is a chronic inflammatory condition which affects gastrointestinal tract which develops in genetically predisposed individuals. The most common manifestation of CD is nutrients malabsorption. This protein trigger other pathology, wheat allergy (WA), which is an adverse immunological effect to gluten due to E immunoglobulin. A recent increased in non celiac gluten sensitivity (NCGS) has also been noticed, defined as the emergence of a range of gluten-intake related symptoms in patients for which celiac disease and wheat allergy have been ruled out. This article discusses these three conditions with their phatogenic mecanisms and the different clinic manifestations.
Los cereales han sido considerados un alimento fundamental de la dieta. A través del desarrollo de la cocina, el ser humano ha producido alimentos ricos en gluten, con el fin de aprovechar al máximo las propiedades nutricionales de este alimento. De tal manera que el trigo se ha convertido en uno de los elementos centrales de la dieta mediterránea. Entre las patologías relacionadas con la ingesta de gluten, contenido principalmente en el trigo, la cebada y el centeno, la enfermedad celíaca (EC) es la más conocida. La EC es una condición inflamatoria crónica que afecta al tracto gastrointestinal y que se desarrolla en sujetos genéticamente predispuestos. La manifestación más común es la malabsorción de nutrientes. Otra patología condicionada por esta proteína es la alergia al trigo (AT), que constituye una reacción inmunológica adversa al gluten mediada por la inmunoglobulina E. Recientemente está aumentando la sensibilidad al gluten no celíaca (SGNC), definida como la aparición de una variedad de manifestaciones relacionadas con la ingestión de gluten, en pacientes en los que la enfermedad celíaca y la alergia al trigo han sido excluidas. En este artículo se describen estas tres entidades con sus mecanismos patogénicos y las diferentes manifestaciones clínicas.
Assuntos
Doença Celíaca/etiologia , Glutens/efeitos adversos , Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Humanos , Síndromes de Malabsorção , Hipersensibilidade a Trigo/fisiopatologia , Hipersensibilidade a Trigo/terapiaRESUMO
BACKGROUND: Acid hydrolyzed wheat proteins (HWPs) are used in the food and cosmetic industry as emulsifiers. Cases of severe food allergic reactions caused by HWPs have been reported. Recent data suggest that these reactions are caused by HWPs produced by acid hydrolysis. OBJECTIVES: To examine the sensitizing capacity of gluten proteins per se when altered by acid or enzymatic hydrolysis relative to unmodified gluten in rats naïve to gluten. METHODS: High IgE-responder Brown Norway (BN) rats bred on a gluten-free diet were sensitized without the use of adjuvant to three different gluten products (unmodified, acid hydrolyzed and enzymatic hydrolyzed). Rats were sensitized by intraperitoneal (i.p.) immunization three times with 200 µg gluten protein/rat or by oral dosing for 35 days with 0.2, 2 or 20 mg gluten protein/rat/day. Sera were analyzed for specific IgG and IgE and IgG-binding capacity by ELISA. IgE functionality was measured by rat basophilic leukemia (RBL) assay. RESULTS: Regardless of the route of dosing, all products had sensitizing capacity. When sensitized i.p., all three gluten products induced a strong IgG1 response in all animals. Acid hydrolyzed gluten induced the highest level of specific IgE but with a low functionality. Orally all three gluten products induced specific IgG1 and IgE but with different dose-response relations. Sensitizing rats i.p. or orally with unmodified or enzymatic hydrolyzed gluten induced specific IgG1 responses with similar binding capacity which was different from that of acid hydrolyzed gluten indicating that acid hydrolysis of gluten proteins induces formation of 'new' epitopes. CONCLUSIONS: In rats not tolerant to gluten acid hydrolysis of gluten enhances the sensitizing capacity by the i.p. but not by the oral route. In addition, acid hydrolysis induces formation of new epitopes. This is in contrast to the enzymatic hydrolyzed gluten having an epitope pattern similar to unmodified gluten.
Assuntos
Alérgenos , Epitopos/imunologia , Glutens/imunologia , Proteínas de Plantas/imunologia , Hipersensibilidade a Trigo/imunologia , Ácidos , Administração Oral , Animais , Relação Dose-Resposta Imunológica , Feminino , Glutens/administração & dosagem , Glutens/química , Hidrólise , Imunização , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Injeções Intraperitoneais , Proteínas de Plantas/administração & dosagem , Proteínas de Plantas/química , Ratos , Ratos Endogâmicos BN , Hipersensibilidade a Trigo/fisiopatologiaAssuntos
Farinha/efeitos adversos , Triticum/efeitos adversos , Hipersensibilidade a Trigo/imunologia , Hipersensibilidade a Trigo/fisiopatologia , Idade de Início , Angioedema/etiologia , Western Blotting , Feminino , Humanos , Técnicas Imunoenzimáticas , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Pessoa de Meia-Idade , Testes Cutâneos , Urticária/etiologiaRESUMO
El gluten y otras proteínas relacionadas del trigo, centeno y cebada, tienen propiedades antigénicas que pueden desencadenar reacciones adversas en individuos susceptibles. La enfermedad celíaca fue la primera patología en que se estableció relación causal con estas proteínas alimentarias. Recientemente se han descrito la alergia al trigo y la sensibilidad no celíaca al gluten. Si bien sus formas de presentación clínica y su relación con la ingesta pueden ser similares, sus mecanismos patogénicos, forma de diagnóstico y tratamiento difieren. Dado que su prevalencia en conjunto es relativamente alta, resulta necesario que los médicos de atención primaria y pediatras se familiaricen con estas patologías, sepan cómo diferenciarlas y enfrentarlas. El objetivo de esta revisión es comparar los principales aspectos de epidemiología, fisiopatología, diagnóstico y tratamiento de estas 3 condiciones.
Gluten and other related proteins of the wheat, rye and barley, have antigenic properties that may trigger adverse reactions in susceptible individuals. Celiac disease was the first pathology with clear causal association related to the intake of these proteins. Recently, wheat allergy and non celiac gluten sensitivity have been described. Although, clinical presentation and its relation with protein ingestion may be similar and elicit confusion, their pathogenic mechanism, diagnosis and treatment are quite different. Since the prevalence of these diseases is relatively high as a whole, it is essential that these become familiar to primary care doctors and general pediatricians, thus they will know how to differentiate and face them. The aim of this review is to compare the main aspects of epidemiology, pathofisiology, diagnosis and treatment of these 3 conditions.