Background: Because of a lack of clinical data from food challenges, allergists often recommend dietary restriction of all cereal grains in patients with sensitivity to at least one grain.
Objectives: The purposes of this study were to assess the degree of intrabotanical cross-reactivity among cereal grains and related grasses, to better define the prevalence of multiple grain hypersensitivity, and to define the protein fractions associated with wheat hypersensitivity.
Methods: One hundred forty-five patients evaluated by food challenges and skin prick tests were divided into three groups: group 1, cereal grain and grass allergies; group 2, wheat allergy alone; and group 3, grass allergy alone. Fifteen patients were further selected from groups 1 to 3. Sodium dodecylsulfate--polyacrylamide gel electrophoresis and immunoblot analyses were performed on six grains and four related grasses with sera from these patients.
Results: Only 21% of patients had symptomatic reactivity as determined by food challenge; 80% had reactivity to only one grain. As determined by immunoblot analyses, patients in groups 1 and 2 showed extensive cross-reactivity (within each group) among grains but little cross-reactivity among grasses, whereas patients in group 3 showed cross-reactivity between the grains and grasses. Patients with wheat allergy had specific IgE binding to wheat fractions 47 kd and 20 kd, bands not recognized by patients with grass allergy.
Conclusions: Clinically insignificant cross-reactivity exists among cereal grains and grasses; therefore, elimination of all grains from the diet of a patient with grain allergy is unwarranted. Further purification and characterization of the 47 kd and 20 kd wheat fractions is needed to provide more specific in vitro testing.