Diagnosis

The diagnosis of WA in its various clinical presentations (whether allergy associated with wheat ingestion, baker's asthma, or WDEIA) depend on taking a detailed clinical history, physical examination, and selecting the proper tests.

The first examinations include a skin prick test and measurement of specific IgE to wheat allergens in wheat extracts and blood serum. In case of wheat allergy due to ingestion, the results of the tests and the clinical history may prompt an oral food challenge. The double-blind placebo-controlled wheat challenge continues to be the gold standard. Oral food challenges are generally considered secure, but experts must perform them prudently because anaphylactic reactions may happen [181]. For diagnosis of WDEIA, in addition to establishing an accurate clinical history, tests for specific IgE against wheat and specific wheat allergens, such as ω-5-gliadin, are performed. These patients may also need to complete a placebo-controlled wheat/exercise challenge, which involves the controlled ingestion of wheat followed 30 min later by 15–20 min of exercise on the treadmill [168,170]. The standard gold diagnosis of baker's asthma is the bronchial challenge test in which patients test positive. In addition, experts establish the clinical history followed by the confirmation of specific IgE to wheat in serum and/or by skin prick test [168].
