Malt is a food which may result in allergy symptoms in sensitised individuals.

Malt Allergy Test: Allergen Exposure

Malt is germinated cereal grain that has been dried in a process known as “malting”. The grain is made to germinate by soaking in water and is then halted from germinating further by drying with hot air.

Further heat is then applied to dry and roast the grain to a specific colour and flavour profile. The result is a mellow, slightly sweet-flavoured powder.

Malted grains have probably been used as an ingredient of beer since ancient times, for example in Egypt, Sumer, and China.

Various characteristics in the malt make strong contributions to the quality of the final beer.

Malt that has been dried at low heat is the basic ingredient for most beer, and to this base small amounts of specialty malts are used to give added colour and flavour. Specialty malts are made by drying at higher temperatures to give darker colour and other special characteristics, desired for the particular effect they will have on the finished beer.

Malt is also used for making whiskey, and for flavouring foods, as well as making vinegar. Malted-milk powder and malt vinegar are two of the most popular malt products.

Liquid malt extract (LME) is a thick syrup and is used for a variety of purposes, such as baking and brewing. It is also sold in jars as a consumer product.

Malt is derived most commonly from barley, but can also be made from other grains including rye.

Malt Allergy Test: Allergen Description

Two main allergens have been characterised from barley, and may be present in barley malt.

Malt Allergy Test: Potential Cross-Reactivity

An extensive cross-reactivity among the different individual species of the genus of barley could be expected, and this may result in cross-reactivity if the protein remains intact in the malting process.

Malt Allergy Test: Clinical Experience

Malt may uncommonly induce symptoms of food allergy in sensitised individuals, including baker’s asthma, urticaria, facial itching, Quincke edema, systemic symptoms and anaphylaxis. Symptoms usually occur after the consumption of malt-containing chocolate drinks and malt-containing snack products.

A 21-year-old atopic woman developed urticaria, angioedema of the face, and wheezy dyspnea shortly after drinking beer and eating a maize-based snack. This patient developed type I hypersensitivity to barley/malt and maize.

Urticaria as a result of drinking beer has been reported in three individuals.

Two cases of severe systemic reactions due to beer ingestion have been reported: 1 of anaphylaxis and 1 of generalised urticaria and angioedema. Investigation showed that barley was the specific ingredient responsible for the observed allergic reactions to beer

Other reactions

Barley grain contains a protein that cross-reacts with wheat gluten in those prone to coeliac disease. Usually, these patients are advised to avoid malt. At present, there is no proof that barley malt provokes coeliac symptoms, but it may be prudent for these patients to avoid malt because of the possible gluten-like residues.