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AIMS: With few reported cases of IgE-mediated allergy to gluten, we report a series of nine cases, with special emphasis on diagnosis, process of sensitization, clinical manifestations and predictive factors of prognosis. METHODS: In this series all cases of IgE-mediated allergy to gluten, followed the last 15 years at the Pediatric Allergology of a tertiary hospital, were included. Age of onset, initial symptoms, routes of sensitization, comorbidities and acquisition of tolerance were analyzed. RESULTS: with gluten allergy, with ages ranging from 1 to 14 years, were included; eight were boys. The first manifestation took place between 5 and 9 months. In six patients the initial symptoms were cutaneous, two patients had gastrointestinal disorders, and one girl showed anaphylaxis as the initial manifestation. The route of sensitization was cutaneous or by food ingestion. Serum specific IgE to gluten ranged from 0,73 to 100KUA/l. All children exhibited other atopic diseases. Eight children had multiple food allergies and four developed respiratory allergy. Two patients suffered anaphylaxis after the diagnosis. Three cases resolved their gluten allergy up to eight years of age. CONCLUSIONS: Gluten allergy is rare, explaining the small number diagnosed in 15 years, in a central referral hospital. The nine cases began in the first year of life, being cutaneous manifestations the most frequent. Eczema is a common presentation and there was dermal sensitization in some cases. Multiple food allergy was also frequent in the cases described. Three of the nine children resolved allergy up to six years, having in common an initial cutaneous manifestation. In these nine cases, the value of specific IgE was not predictive of clinical outcome.

Case report A ten years old boy was admitted for pleural tuberculosis (negative cultures, positive quantiferon assay, and father under treatment for tuberculosis). On the tenth day of treatment with isoniazid, rifampicin and pyrazinamide he develloped an exuberant urticarial rash, facial oedema, fever, myalgias, oliguria and, later, conjunctival hyperemia. Laboratory results included low platelet count, hypoalbuminemia and hyponatremia. Gradual improvement occured after suspension of treatment. One month later, drugs were gradualy re-introduced (1 drug/week) but several reactions occurred: anaphylaxis 5 hours after rifampicin administration and generalized macular rash after pyrazinamide. Both drugs were suspended. Isoniazid caused an initial light generalized macular exanthema. Streptomycin, ethambutol and ciprofloxacin were introduced and well tolerated. In subsequent evaluation the child was asymptomatic, with normal analytic results and radiologic improvement. After 6 months of successful treatment, he was tested in detail for reactions to the implicated drugs.