Wheat allergy (WA) poses a diagnostic challenge due to its diverse clinical phenotypes—ranging from classic food allergy and wheat-dependent exercise-induced anaphylaxis (WDEIA) to baker’s asthma. An additional diagnostic aspect is serological cross-reactivity with grass pollen. Undoubtedly, the transition from extract-based diagnostics to precise component-based diagnostics (CRDs) facilitates the management of wheat allergy. It has significantly improved the diagnostic accuracy for WDEIA ω-5-gliadin (Tri a 19), although considering new knowledge about wheat proteins, it seems necessary to include them in the diagnostic scheme, especially where Tri a 19 remains negative despite clinical symptoms. Therefore, in this review, we evaluate the clinical utility of new wheat molecules with a high risk of anaphylaxis. We pay particular attention to Tri a 37 (α-purothionin), a thermally stable allergen associated with a 4-fold increase in the risk of severe anaphylaxis, and Tri a 36 (LMW glutenin), which shows higher sensitivity than Tri a 19 in specific pediatric cohorts. In addition, we emphasize the role of Tri a 14 (nsLTP) in distinguishing true wheat sensitization from pollen-related cross-reactivity caused by profilins (Tri a 12) or carbohydrate determinants (CCDs). Beyond diagnostics, the review discusses dynamic changes in sensitization profiles in relation to the allergic march and the phenomenon of spontaneous remission in children. New management strategies are also discussed, including the potential of omalizumab (based on the data from the OUtMATCH study) in facilitating the reintroduction of allergens into the diet.

In order to establish the reliability of new multiplex tests for determining allergen-specific immunoglobulin E (asIgE) levels in serum, the results of asIgE determinations obtained via ALEX tests were compared to those obtained via ImmunoCAP ISAC in a group of 40 Polish children hospitalized due to food allergy and/or anaphylaxis. The analysis was based on 6320 determinations of asIgEs relative to 79 common allergen molecules included in both tests (80 tests conducted—40 ALEX and 40 ISAC). The study showed a high correlation of results between the compared diagnostic tests, with the concordance of asIgE determinations at the level of 92.5% (n = 2922). The results of this study showed the sensitivity of the ALEX test to be comparable with that of the ImmunoCAP ISAC test. One indisputable advantage of the ALEX test is its high number of determinations per procedure, which provides more information about the patient’s molecular profile; moreover, the use of an inhibitor of the asIgEs that bind to cross-reactive carbohydrate determinants (CCDs) reduces their impact on the results for allergens naturally containing carbohydrate determinants. Comparative analyses of asIgE test results obtained with ALEX and ImmunoCAP ISAC tests demonstrate that the ALEX test is a reliable diagnostic tool for asIgE assessments. However, significant differences in the absolute values of asIgEs relative to individual molecules suggest the need for caution when directly comparing asIgE levels from both tests.

The diagnosis of celiac disease (CD) is challenging due to its heterogeneous clinical presentation, which includes both gastrointestinal and extraintestinal symptoms, as well as its potential to be masked by other conditions. Despite the availability of reliable diagnostic tools and the relative simplicity of treatment through a gluten-free diet, patients with CD continue to face difficulties in both the diagnostic and therapeutic processes. These challenges are influenced by insufficient knowledge about CD among healthcare professionals, patients, and the general public. Additionally, the nature of the disease and the lack of appropriate legal regulations regarding medical management further hinder effective treatment. Therefore, factors influencing the effectiveness of CD treatment can be categorized into five groups: those related to healthcare providers, patients, society, the disease itself, and legal frameworks of public policy for celiac disease. To mitigate the adverse effects of CD on health and quality of life and to reduce the time required for diagnosis in Poland, it is essential to enhance education for both patients and medical professionals regarding diagnosis, treatment, and psychological support. Additionally, improving access to gluten-free products is crucial. Raising awareness among restaurant owners and Staff about gluten-free diets is also important to ensure the safety of individuals with celiac disease. Furthermore, there is a need to develop and implement legal and practical solutions to suport and improve the well-being of CD patients in Poland.