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Open Access Highly Accessed Original research

Oral food challenge to wheat: a near-fatal anaphylaxis and review of 93 food challenges in children

Antonella Cianferoni1*, Karishma Khullar1, Rushani Saltzman1, Joel Fiedler1, Jackie P Garrett1, David R Naimi12 and Jonathan M Spergel1

Author Affiliations

1 The Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3550 Market Street, Suite 3054, Philadelphia, PA 19104-4399, USA

2 Current address: Pediatrics Northwest Asthma & Allergy Center University of Washington School of Medicine, Seattle, WA, USA

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World Allergy Organization Journal 2013, 6:14  doi:10.1186/1939-4551-6-14

Published: 21 August 2013

Abstract

Background

Wheat allergy is among the most common food allergy in children, but few publications are available assessing the risk of anaphylaxis due to wheat.

Methods

In this study, we report the case of near-fatal anaphylaxis to wheat in a patient undergoing an oral food challenge (OFC) after the ingestion of a low dose (256 mg) of wheat. Moreover, for the first time, we analyzed the risk of anaphylaxis during an OFC to wheat in 93 children, compared to other more commonly challenged foods such as milk, egg, peanuts, and soy in more than 1000 patients.

Results

This study, which includes a large number of OFCs to wheat, shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration (Odds Ratio [OR] = 2.4) and anaphylaxis requiring epinephrine administration to low dose antigen (OR = 8.02). Other risk factors for anaphylaxis, anaphylaxis requiring epinephrine administration, and anaphylaxis to low dose antigen was a history of a prior reaction not involving only the skin (OR = 1.8, 1.9 and 1.8 respectively). None of the clinical variables available prior to performing the OFC could predict which children among those undergoing OFCs to wheat would develop anaphylaxis or anaphylaxis for low dose antigen.

Conclusion

This study shows that wheat is an independent risk factor that is associated with anaphylaxis requiring epinephrine administration and anaphylaxis requiring epinephrine administration to low dose antigen.