Grain allergy: Allergens and grain classification
- Kirsi M Jarvinen-Seppo, MD, PhD
Kirsi M Jarvinen-Seppo, MD, PhD
- Associate Professor of Pediatrics and Medicine
- University of Rochester School of Medicine
Grain allergies are common food allergies that are typically, but not only, seen in individuals with other food allergies. The immunologic responses to grain proteins can be immunoglobulin E (IgE) mediated and/or non-IgE mediated. This topic review highlights wheat and also covers other cereal grains including rye, barley, oat, rice, corn, and millet, as well as non-cereal grains including quinoa, amaranth, buckwheat, and sorghum.
An overview of grains, grain taxonomy, and grain allergens are presented in this topic review. The epidemiology, clinical manifestations, diagnosis, and management of grain allergies are discussed in detail separately. (See "Grain allergy: Clinical features, diagnosis, and management".)
General discussions of food allergy are presented separately in other topic reviews.
Wheat allergy related to occupational exposure is presented separately, as is food-dependent (including wheat) exercise-induced anaphylaxis and celiac disease (gluten-sensitive enteropathy):
●(See "Occupational asthma: Definitions, epidemiology, causes, and risk factors" and "Occupational asthma: Pathogenesis" and "Occupational asthma: Clinical features and diagnosis" and "Occupational asthma: Management, prognosis, and prevention".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Tatham AS, Shewry PR. Allergens to wheat and related cereals. Clin Exp Allergy 2008; 38:1712.
- Grain harvest. http://www.earth-policy.org/indicators/C54.
- Worldwide grain production summary. http://apps.fas.usda.gov/psdonline/psdReport.aspx?hidReportRetrievalName=All+Grain+Summary+Comparison++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++&hidReportRetrievalID=965&hidReportRetrievalTemplateID=11.
- Battais F, Pineau F, Popineau Y, et al. Food allergy to wheat: identification of immunogloglin E and immunoglobulin G-binding proteins with sequential extracts and purified proteins from wheat flour. Clin Exp Allergy 2003; 33:962.
- Pastorello EA, Farioli L, Conti A, et al. Wheat IgE-mediated food allergy in European patients: alpha-amylase inhibitors, lipid transfer proteins and low-molecular-weight glutenins. Allergenic molecules recognized by double-blind, placebo-controlled food challenge. Int Arch Allergy Immunol 2007; 144:10.
- James JM, Sixbey JP, Helm RM, et al. Wheat alpha-amylase inhibitor: a second route of allergic sensitization. J Allergy Clin Immunol 1997; 99:239.
- Palacin A, Bartra J, Muñoz R, et al. Anaphylaxis to wheat flour-derived foodstuffs and the lipid transfer protein syndrome: a potential role of wheat lipid transfer protein Tri a 14. Int Arch Allergy Immunol 2010; 152:178.
- Pahr S, Constantin C, Papadopoulos NG, et al. α-Purothionin, a new wheat allergen associated with severe allergy. J Allergy Clin Immunol 2013; 132:1000.
- Palosuo K, Varjonen E, Kekki OM, et al. Wheat omega-5 gliadin is a major allergen in children with immediate allergy to ingested wheat. J Allergy Clin Immunol 2001; 108:634.
- Daengsuwan T, Palosuo K, Phankingthongkum S, et al. IgE antibodies to omega-5 gliadin in children with wheat-induced anaphylaxis. Allergy 2005; 60:506.
- Ebisawa M, Shibata R, Sato S, et al. Clinical utility of IgE antibodies to ω-5 gliadin in the diagnosis of wheat allergy: a pediatric multicenter challenge study. Int Arch Allergy Immunol 2012; 158:71.
- Ito K, Futamura M, Borres MP, et al. IgE antibodies to omega-5 gliadin associate with immediate symptoms on oral wheat challenge in Japanese children. Allergy 2008; 63:1536.
- Baar A, Pahr S, Constantin C, et al. Molecular and immunological characterization of Tri a 36, a low molecular weight glutenin, as a novel major wheat food allergen. J Immunol 2012; 189:3018.
- Baar A, Pahr S, Constantin C, et al. Specific IgE reactivity to Tri a 36 in children with wheat food allergy. J Allergy Clin Immunol 2014; 133:585.
- Izumi H, Adachi T, Fujii N, et al. Nucleotide sequence of a cDNA clone encoding a major allergenic protein in rice seeds. Homology of the deduced amino acid sequence with members of alpha-amylase/trypsin inhibitor family. FEBS Lett 1992; 302:213.
- Varjonen E, Vainio E, Kalimo K, et al. Skin-prick test and RAST responses to cereals in children with atopic dermatitis. Characterization of IgE-binding components in wheat and oats by an immunoblotting method. Clin Exp Allergy 1995; 25:1100.
- Pastorello EA, Pompei C, Pravettoni V, et al. Lipid-transfer protein is the major maize allergen maintaining IgE-binding activity after cooking at 100 degrees C, as demonstrated in anaphylactic patients and patients with positive double-blind, placebo-controlled food challenge results. J Allergy Clin Immunol 2003; 112:775.
- Pastorello EA, Farioli L, Pravettoni V, et al. Maize food allergy: lipid-transfer proteins, endochitinases, and alpha-zein precursor are relevant maize allergens in double-blind placebo-controlled maize-challenge-positive patients. Anal Bioanal Chem 2009; 395:93.
- Nakase M, Usui Y, Alvarez-Nakase AM, et al. Cereal allergens: rice-seed allergens with structural similarity to wheat and barley allergens. Allergy 1998; 53:55.
- Usui Y, Nakase M, Hotta H, et al. A 33-kDa allergen from rice (Oryza sativa L. Japonica). cDNA cloning, expression, and identification as a novel glyoxalase I. J Biol Chem 2001; 276:11376.
- Pastorello EA, Scibilia J, Farioli L, et al. Rice allergy demonstrated by double-blind placebo-controlled food challenge in peach-allergic patients is related to lipid transfer protein reactivity. Int Arch Allergy Immunol 2013; 161:265.
- Bohle B, Hirt W, Nachbargauer P, et al. Allergy to millet: another risk for atopic bird keepers. Allergy 2003; 58:325.
- Takahama H, Shimazu T. Common millet anaphylaxis: a case of a bird-keeper sensitized to millet via inhalation, who developed anaphylaxis after oral ingestion. Clin Exp Dermatol 2008; 33:341.
- Palosuo K, Alenius H, Varjonen E, et al. Rye gamma-70 and gamma-35 secalins and barley gamma-3 hordein cross-react with omega-5 gliadin, a major allergen in wheat-dependent, exercise-induced anaphylaxis. Clin Exp Allergy 2001; 31:466.
- Urisu A, Yamada K, Masuda S, et al. 16-kilodalton rice protein is one of the major allergens in rice grain extract and responsible for cross-allergenicity between cereal grains in the Poaceae family. Int Arch Allergy Appl Immunol 1991; 96:244.
- Jones SM, Magnolfi CF, Cooke SK, Sampson HA. Immunologic cross-reactivity among cereal grains and grasses in children with food hypersensitivity. J Allergy Clin Immunol 1995; 96:341.
- Donovan GR, Baldo BA. Crossreactivity of IgE antibodies from sera of subjects allergic to both ryegrass pollen and wheat endosperm proteins: evidence for common allergenic determinants. Clin Exp Allergy 1990; 20:501.
- Constantin C, Quirce S, Poorafshar M, et al. Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy 2009; 64:1030.
- Scibilia J, Pastorello EA, Zisa G, et al. Wheat allergy: a double-blind, placebo-controlled study in adults. J Allergy Clin Immunol 2006; 117:433.
- Verstege A, Mehl A, Rolinck-Werninghaus C, et al. The predictive value of the skin prick test weal size for the outcome of oral food challenges. Clin Exp Allergy 2005; 35:1220.
- Weichel M, Vergoossen NJ, Bonomi S, et al. Screening the allergenic repertoires of wheat and maize with sera from double-blind, placebo-controlled food challenge positive patients. Allergy 2006; 61:128.
- Badiu I, Olivieri E, Montagni M, et al. Italian study on buckwheat allergy: prevalence and clinical features of buckwheat-sensitized patients in Italy. Int J Immunopathol Pharmacol 2013; 26:801.
- Urisu A, Kondo Y, Morita Y, et al. Identification of a major allergen of buckwheat seeds by immunoblotting methods. Allergy Clin Immunol News 1994; 6:151.
- Park JW, Kang DB, Kim CW, et al. Identification and characterization of the major allergens of buckwheat. Allergy 2000; 55:1035.
- Heffler E, Nebiolo F, Asero R, et al. Clinical manifestations, co-sensitizations, and immunoblotting profiles of buckwheat-allergic patients. Allergy 2011; 66:264.
- Cho J, Lee JO, Choi J, et al. Significance of 40-, 45-, and 48-kDa Proteins in the Moderate-to-Severe Clinical Symptoms of Buckwheat Allergy. Allergy Asthma Immunol Res 2015; 7:37.
- Cuervo-Pardo L, Gonzalez-Estrada A, Fernandez J. Anaphylaxis after home-made quinoa dinner: hold the mustard. BMJ Case Rep 2015; 2015.
- Hong J, Convers K, Reeves N, Temprano J. Anaphylaxis to quinoa. Ann Allergy Asthma Immunol 2013; 110:60.
- Astier C, Moneret-Vautrin DA, Puillandre E, Bihain BE. First case report of anaphylaxis to quinoa, a novel food in France. Allergy 2009; 64:819.
- Kasera R, Niphadkar PV, Saran A, et al. First case report of anaphylaxis caused by Rajgira seed flour (Amaranthus paniculatus) from India: a clinico-immunologic evaluation. Asian Pac J Allergy Immunol 2013; 31:79.
- OVERVIEW OF GRAINS
- Grain use worldwide
- GRAIN ALLERGENS
- Cereal grains
- - Wheat
- - Barley, rye
- - Oat
- - Corn (maize)
- - Rice
- - Millet
- - Sorghum
- Allergenic similarities between cereal grains
- Allergenic similarities to grasses
- Non-cereal grains
- - Buckwheat
- - Quinoa
- - Amaranth
- SOCIETY GUIDELINE LINKS