Introduction: Celiac disease and wheat allergy (WA) are infrequent diseases in the general population, and a combination of the 2 is particularly rare. Celiac disease occurs in around 1% of the general population and WA in around 1% of all children. Case Report: We report 2 patients with celiac disease and a gluten-free diet who developed WA consistent in anaphylaxis and an eyelid angioedema, respectively, through accidental wheat exposure. A serum study and an intestinal biopsy confirmed celiac disease. Both patients were studied with a skin prick test and serum-specific IgE, with a diagnosis of WA. Discussion: In patients with celiac disease, the trace amounts of cereals present in gluten-free food could act as a sensitization factor, and probably patients with persistent symptoms (despite a gluten-free diet) are experiencing WA symptoms rather than celiac disease symptoms. The number of patients diagnosed with celiac disease has increased in the recent decades: the association between celiac disease and WA, exceedingly rare to date, could increase as well, prompting special attention to the possibility of inadvertent intake of cereals.
Palabras clave: Alergia a semillas de lino. Diagnóstico por componentes. Alergia a alimentos. Anafilaxia.The prevalence of allergy to seeds is highly influenced by the geographical area and eating habits. In Spain, according to data from Alergologica 2015 [1], allergy to tree nuts and seeds accounts for 28.4% of all cases of food allergy.Flaxseed is the seed of the plant Linum usitatissimum. It is consumed as a nutritional supplement because it is rich in dietary fiber, polyunsaturated fatty acids, and lignans.Flaxseed has rarely been reported to be a sensitizer [2], and there are few reports of anaphylaxis caused by flaxseed in the literature [3][4][5][6]. However, it is an increasingly common source of allergens as a result of its use in diets for its nutritional benefits and anticancer properties.Flaxseed contains many potential allergens. The storage protein content ranges from 10% to 37%, and has been reported to be as high as 20%-42% for conlinin (the low-molecularmass fraction [2S]) and 58%-66% for linin (the major protein fraction [12S]) [7]. A 56-kDa IgE-binding protein reported in 1 case [5] is thought to correspond to malate dehydrogenase-1. Other authors have recently suggested that the lipid transfer protein (LTP) was the relevant allergen in a case of flaxseed anaphylaxis [8].We present 2 cases of flaxseed-induced anaphylaxis. Patient 1 was a 46-year-old white woman with a personal history of bronchial asthma and rhinoconjunctivitis who presented with pharyngeal pruritus, lingual and palpebral angioedema, dyspnea, and profuse diarrhea immediately after eating multicereal biscuits (oat, rice, flaxseeds, egg, almonds, and raisins). Patient 2 was a 64-year-old white woman with a personal history of breast cancer, allergy to ceftriaxone, and allergic rhinoconjunctivitis due to pollens and pet dander. She presented palmoplantar itching, generalized urticaria, lip angioedema, and throat tightness immediately after eating a
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