Celiac Disease in a Patient with Baker’s Asthma and Wheat Allergy Due to Tri a 14

We describe the case of a patient that developed persistent severe asthma after having started to work in a bakery. The subsequent appearance of gastrointestinal symptoms was diagnosed as celiac disease (CD). She also experienced severe asthma attacks when cooking pasta, and expe-rienced anaphylactic shock a few minutes after wheat flour inhalation. The allergologic workup was positive for several cereal products and Tri a 14 (Tricum aestivum 14), while specific IgE titer to Pru p 3 (Prunus persica 3) was negative. Our patient had no recurrence of these episodes when she avoided cooking wheat flour products and wheat in processed foods. The pathogenic mechanisms underlying CD and IgE-mediated food allergy are different and the coexistence of both diseases seems to be rare. Tri a 14 is the major wheat allergen involved in our case; this allergen can sensitize through the respiratory and the oral route, and can give way to anaphylaxis. A possible role played by interleukin-15 (IL-15) and interleukin-21 (IL-21) in the induction of IgE-mediate hypersensitivity, as well as in the pathogenesis of CD, is prospected and discussed briefly herein.