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J Allergy Clin Immunol. 2016 Apr;137(4):1011-1014. doi: 10.1016/j.jaci.2015.10.040. Epub 2015 Dec 24.

Should wheat, barley, rye, and/or gluten be avoided in a 6-food elimination diet?

Author information

1
Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
2
Division of Allergy and Immunology, Department of Pediatrics and Medicine, University of California, San Diego and Rady Children's Hospital, San Diego, Calif.
3
Division of Gastroenterology, Tufts Medical Center, Boston, Mass.
4
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC.
5
Division of Gastroenterology, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
6
Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
7
Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
8
Section of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
9
Division of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
10
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
11
Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
12
Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: rothenberg@cchmc.org.

Abstract

Eosinophilic esophagitis (EoE), a food antigen-mediated disease, is effectively treated with the dietary elimination of 6 foods commonly associated with food allergies (milk, wheat, egg, soy, tree nuts/peanuts, and fish/shellfish). Because wheat shares homologous proteins (including gluten) with barley and rye and can also be processed with these grains, some clinicians have suggested that barley and rye might also trigger EoE as a result of cross-reaction and/or cross-contamination with wheat. In this article, we discuss the theoretical risks of cross-reactivity and cross-contamination among wheat, barley, and rye proteins (including gluten); assess common practices at EoE treatment centers; and provide recommendations for dietary treatment and future studies of EoE.

KEYWORDS:

6-food elimination diet; Eosinophilic esophagitis; cross-reactivity; gluten; wheat

PMID:
26725190
PMCID:
PMC4826834
DOI:
10.1016/j.jaci.2015.10.040
[Indexed for MEDLINE]
Free PMC Article

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