D3.303 - Buckwheat Allergy in Bologna Metropolitan Area: Often Severe, Often Hidden

Buckwheat allergy is a rare but emerging food allergy that can cause severe reactions, including anaphylaxis. In Italy, buckwheat is used in some traditional dishes. The identified allergens are mainly seed storage proteins: Fag e 1 (13S globulin), Fag e 2 (2S albumin), Fag e 3 (7S globulin), Fag e 4, and Fag e 5.

This retrospective analysis has two main aims:

- to assess the prevalence of buckwheat-allergic subjects among buckwheat-sensitized individuals referred to the Metropolitan Laboratory of Bologna (LUM);

- to evaluate the clinical features and concomitant allergies of buckwheat-allergic patients evaluated at the Allergy Unit of AUSL Bologna.

We analyzed all buckwheat-specific IgE (sIgE) results performed at LUM between 2023 and 2025. We reviewed the clinical history and diagnostic work-up of sensitized patients evaluated at the Allergy Unit.

Buckwheat-sIgE test was performed 31 times at LUM between 2023 and 2025. In 17 cases (54,8%), tests resulted positive. 9 cases were discarded, being requested by Pediatrics Allergy services or other physicians. The analysis focused on 10 sensitized patients evaluated at our Unit. Buckwheat allergy was diagnosed in 5 cases.

Clinical manifestations included anaphylaxis (n=2), dyspnea (n=2), and angioedema (n=1).

Implicated food varied, including pasta, polenta, pizza, bread, pizzoccheri, pancakes, and biscuits. In two cases, buckwheat was a hidden allergen.

Diagnosis was established based on clinical history and positive sIgE results. In one case, a prick-by-prick test with buckwheat flour was also performed.

Two patients showed allergy to hazelnut, with positive sIgE to Cor a 9 (11S globulin). One of them also reported allergy to panko, the other one to dark chocolate. 

Although based on a limited sample size, our results are consistent with the literature: buckwheat allergy frequently presents with severe reactions and is often related to hidden allergen exposure. As buckwheat is increasingly consumed, clinicians should consider and test for it when evaluating patients with suspected food allergy.

A particularly interesting finding is the concomitant hazelnut allergy observed in two patients, both sensitized to Cor a 9 (11S globulin). Potential cross-reactivity between hazelnut and buckwheat storage proteins has already been reported in literature.