Air and Breathing
Gluten and Lung Disease
Gluten allergy (type 1) is often identified by skin test as a cause of respiratory allergy, especially asthma. Occasionally, gluten is the trigger for anaphylaxis with asthma. May suggested: People with positive skin reactions to cereals or dairy products complained of chronic or recurrent rhinitis and bronchitis more often than the others allergy to cereals and dairy products may often be underestimated in adult asthmatics especially when positive reactions to inhalants are also present.
We believe that delayed patterns of gluten allergy are important and prevalent causes of lung disease. Wraith stated: "Food allergy is a very important cause of asthma but is often overlooked. It is important because it may cause severe symptoms and asthma still has a high mortality despite improvements in drug therapy. It is overlooked because the usual skin tests are often negative and the history is often not helpful as symptoms appear gradually hours or days after ingestion of the food."
In Wraith's studies, milk, wheat, egg, yeast, preservatives, colorings, coffee and cheese were the main foods implicated. Other manifestations of food allergy are typical in 65% of the asthmatic patients. In children under 15 years, eczema, gastrointestinal symptoms, rhinitis and nasal polyps, enuresis, and behavior problems were common. Older patients had more gastrointestinal symptoms, rhinitis, arthralgias, and migraine headaches.
Pelikan demonstrated delayed asthmatic responses to food ingestion and suggested: "The role of food allergy in patients with bronchial complaints is still underestimated by physicians because of the dearth of information in this area. The involvement of foods in patients with allergic disorders is complex and has various forms. The diagnostic procedures and confirmation of adverse reactions to foods is difficult"
In a study of delayed allergy mechanisms, circulating immune complexes (IgE and IgG) were demonstrated following challenges with allergenic foods (egg) and correlated with respiratory symptoms. Complexes peaked at 24 hours after food ingestion; 12 of the 14 subjects studied had asthma; associated problems were eczema, rhinitis, arthralgia, urticaria, and diarrhea. In a review of 320 children and young adults with atopic dermatitis 55% had asthma. With food challenges respiratory symptoms occurred in 236 (42%) including nasal symptoms, shortness of breath, wheezing, and laryngeal edema. Hendrick and Bird considered the possibility that food allergy could cause inflammatory alveolitis. The Heiner syndrome serves as a model of milk-protein induced pneumonitis associated with hemosiderosis. They suggested a type 3 mechanism and reviewed the alveolitis reported in celiac disease.
Brightling et al reported: Chronic cough is a common reason for presentation to a respiratory clinic. In up to 20% of cases the cause remains unclear after investigations. We report one such case where there was bronchoscopic evidence of lymphocytic airway inflammation in association with newly diagnosed celiac disease. All features improved markedly on a gluten free diet, suggesting a causal relationship between celiac disease, cough, and lymphocytic bronchoalveolitis.
Palosuo et al reported on patients who developed exercise-induced anaphylaxis following the ingestion of wheat. He reported: All patients had experienced recurrent episodes of generalized urticaria during exercise, 17 patients in association with collapse and 15 patients with an anaphylactic reaction. The symptoms appeared only when the patients had eaten food containing wheat before exercise. Wheat allergens were detected and IgE antibodies from pooled patient sera were bound to wheat proteins in immunoblotting. The 65-kd allergen was a previously undescribed wheat protein, showing 61% sequence identity to gamma-gliadin, whereas the 40-kd allergen had 100% identity to alpha-gliadin. In ELISA, all 18 patients showed elevated IgE levels to the novel gamma-like gliadin, and 13 of the patients showed elevated IgE levels to alpha-gliadin. None of the 54 control subjects with wheat allergy, urticaria, or coeliac disease had IgE antibodies to the gamma-like gliadin. During the follow-up on a gluten-free or wheat-free diet, 3 patients experienced reactions after having unknowingly eaten wheat before exercise, but all the other patients who were adhering to the diet remained symptom-free. This study shows that wheat is a frequent cause of food-dependent, exercise-induced anaphylaxis and suggests that the major allergen is a previously undescribed gamma-like gliadin. We recommend a gluten-free diet for treatment.