E-Mail karger@karger.com Original Paper Int Arch Allergy Immunol 2013;162:50–57 DOI: 10.1159/000350923 Combining Analyses of Basophil Allergen Threshold Sensitivity, CD-sens, and IgE Antibodies to Hydrolyzed Wheat, ω-5 Gliadin and Timothy Grass Enhances the Prediction of Wheat Challenge Outcome N. Nilsson   a, b C. Nilsson   c G. Hedlin   a, b, d S.G.O. Johansson   e M.P. Borres   b, f A. Nopp   e a  Department of Women’s and Children’s Health, Karolinska Institutet, b  Astrid Lindgren’s Children’s Hospital, c  Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and Sachs’ Children’s Hospital, d  Center for Allergy Research, Karolinska Institutet, e  Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and Hospital, Stockholm, f  Thermo Fischer Scientific, Uppsala, and  Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and related to the challenge outcome. Results: A positive challenge was seen in 12/24 children. Children reacting to the challenge had higher IgE-Ab concentrations to wheat, ω-5 gliadin and HWP (p < 0.01) and a tendency to higher wheat CD-sens values (p = 0.08) than nonreacting children. Combining wheat CD-sens >150 and IgE-Ab to wheat >20 kU A /l, or ω-5 gliadin >0.1 kU A /l predicted the challenge out- come in 83% of the patients. Most children with IgE-Ab to wheat also had IgE-Ab to timothy. Seven of 9 challenge- positive children had a positive CD-sens to HWP and IgE-Ab to HWP >8 kU A /l. Conclusion: Combining CD-sens and IgE- Ab to wheat or wheat components could be useful in the diagnosis and follow-up of wheat-allergic children. Copyright © 2013 S. Karger AG, Basel Introduction Wheat is the most widely consumed food grain and is one of the six most common foods causing allergy in children worldwide [1, 2]. Wheat allergy is defined as an Key Words Allergen stimulation · Children · Flow cytometry · Oral food challenge · Wheat allergy Abstract Background: Wheat is a common food causing allergy which has implications on the quality of life. The diagnosis of IgE-mediated wheat allergy is based on the clinical his- tory and presence of IgE antibodies (IgE-Ab) in skin or blood, and the results of an oral food challenge which is time consuming and associated with risks. An improved di- agnostic workup is needed for wheat allergy. The objective was to examine the relationship between wheat challenge, CD-sens and IgE-Ab to related allergens in wheat-allergic children and investigate if a combination of different mark- ers could enhance the prediction of challenge outcome. Method: Twenty-four children (aged 1–15 years) with a wheat allergy diagnosis underwent an open wheat chal- lenge. CD-sens and IgE-Ab to wheat, hydrolyzed wheat pro- tein (HWP), ω-5 gliadin and timothy grass were analyzed Received: October 18, 2012 Accepted after revision: March 20, 2013 Published online: June 27, 2013 Correspondence to: Dr. Anna Nopp Clinical Immunology and Allergy Unit Karolinska University Hospital L2:04 SE–171 76 Stockholm (Sweden) E-Mail anna.nopp  @  ki.se © 2013 S. Karger AG, Basel 1018–2438/13/1621–0050$38.00/0 www.karger.com/iaa Downloaded by: . 192.44.243.18 - 6/27/2013 11:23:48 AM