Background: Wheat lipid transfer protein (LTP; Tri a 14) and ω5-gliadin have been described as major allergens in wheat allergy (WA) and relevant in wheat-induced anaphylaxis, frequently associated with cofactors. Objective: The objective of this study was to compare tools currently available in routine diagnosis to detect Tri a 14 sensitization, its clinical relevance, and cosensitization to ω5-gliadin and other LTPs. Methods: One hundred eighteen adults sensitized to rTri a 14 by ImmunoCAP^® (cutoff ≥0.1 kU_A/L) identified among 210 LTP allergic patients were included. We evaluated (1) wheat skin prick test (SPT), (2) specific IgE (sIgE) to wheat, rTri a 14, rTri a 19, peach, apple, walnut, hazelnut, and peanut LTPs using ImmunoCAP^® and microarray ImmunoCAP®ISAC (cutoff ≥0.3I SU), and (3) wheat-related symptoms. Results: Wheat SPT and sIgE were positive in 31% and 85% of subjects, respectively. rTri a 14 by microarray was detected in 25%. Eight percent showed cosensitization to ω5-gliadin. Thirty percent referred symptoms (gastrointestinal [13%], urticaria [11%], and anaphylaxis [8%]). Cofactors (45%) were significantly associated with systemic reactions. Conclusion: WA due to Tri a 14 is frequently related with systemic reactions and because are frequently related to cofactors, the culprit may not be suspected. Together with the poor performance to identify Tri a 14 sensitization of the current routine diagnostic tools based on the analysis of whole wheat extract, such as wheat SPT or sIgE, there is a high risk that WA may be overlooked. Thus, when WA is suspected, sIgE Tri a 14 assessment is recommended, together with wheat and ω5-gliadin, preferably in the singleplex format, and carefully evaluated considering ≥0.1 kUA/L as a cutoff.
Int Arch Allergy Immunol

中文翻译：

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检测小麦脂质转移蛋白 (Tri a 14) 致敏：当前可用诊断工具之间的比较

背景：小麦脂质转移蛋白 (LTP; Tri a 14) 和 ω5-醇溶蛋白已被描述为小麦过敏 (WA) 中的主要过敏原，并且与小麦诱导的过敏反应相关，通常与辅因子相关。目的：本研究的目的是比较目前常规诊断中可用的工具，以检测 Tri a 14 致敏性、其临床相关性以及对 ω5-醇溶蛋白和其他 LTP 的共敏化。方法： 118 名成人通过 ImmunoCAP ^®对 rTri a 14 敏感（截止值≥0.1 kU _A/L) 在 210 名 LTP 过敏患者中确定。^{我们使用ImmunoCAP®}和微阵列 ImmunoCAP®评估了 (1) 小麦皮肤点刺试验 (SPT)，(2) 小麦、rTri a 14、rTri a 19、桃、苹果、核桃、榛子和花生 LTP 的特异性 IgE (sIgE) ISAC（截止值≥0.3I SU）和（3）小麦相关症状。结果：小麦 SPT 和 sIgE 分别在 31% 和 85% 的受试者中呈阳性。rTri a 14 通过微阵列检测到 25%。8% 的人对 ω5-麦醇溶蛋白有共敏作用。30% 涉及症状（胃肠道 [13%]、荨麻疹 [11%] 和过敏反应 [8%]）。辅因子（45%）与全身反应显着相关。结论：由于 Tri a 14 引起的 WA 经常与全身反应有关，并且由于经常与辅因子有关，因此可能不会怀疑罪魁祸首。再加上基于全麦提取物（如小麦 SPT 或 sIgE）分析识别当前常规诊断工具的 Tri a 14 致敏性较差，WA 可能被忽略的风险很高。因此，当怀疑 WA 时，建议使用 sIgE Tri a 14 评估，连同小麦和 ω5-麦醇溶蛋白，最好采用单重形式，并仔细评估，考虑 ≥0.1 kUA/L 作为临界值。
Int Arch 过敏免疫