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Wheat dependent exercise induced anaphylaxis: is this an appropriate terminology?
  1. G K Y Wong,
  2. A P Huissoon,
  3. S Goddard,
  4. D M Collins,
  5. M T Krishna
  1. Department of Allergy and Clinical Immunology, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Gabriel K Wong, Department of Allergy and Immunology, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK; gabriel.wong{at}heartofengland.nhs.uk

Abstract

Background The presentation of wheat dependent exercise induced anaphylaxis (WDEIA) can be variable. A high index of clinical suspicion is required to initiate the investigation pathway. Double blind placebo controlled food-exercise challenge is the gold standard investigation but the practicality of this test limits its application.

Aim To critically analyse the symptoms of WDEIA and their correlation with serum specific IgE (sIgE) to rω-5-gliadin.

Methods 17 patients were tested for serum sIgE to rω-5-gliadin. The clinical response to a diet/exercise intervention protocol was used to assess specificity of a positive sIgE to rω-5-gliadin. Length of time to diagnosis, clinical likelihood scores, exercise intensity involved and the severity of allergic reactions were examined retrospectively.

Result 8/10 patients with positive sIgE to rω-5-gliadin had a confirmed diagnosis of WDEIA. Half of the WDEIA patients had a prolonged time lag to diagnosis (32–62 months) and were initially diagnosed with idiopathic anaphylaxis or chronic idiopathic urticaria and angioedema. Only three patients had experienced life threatening symptoms (Mueller grading 4). A close association was observed between requirements of lower exercise intensity to provoke a reaction and diagnostic delay.

Conclusion Specific IgE to rω-5-gliadin can provide supportive evidence for WDEIA without the need of a food-exercise challenge. The wheat-exercise association is not obvious in many patients, highlighting the need to consider WDEIA in the differential diagnosis of all patients presenting with idiopathic systemic reactions. The term anaphylaxis may be inappropriate and it is therefore worth considering an alternative terminology such as ‘activity dependent wheat allergy’ to describe this condition.

  • Wheat dependent exercise induced anaphylaxis
  • anaphylaxis
  • omega-5-gliadin
  • serum specific IgE
  • diagnostic delay
  • analytical methods
  • anaphylactic reactions
  • diagnosis
  • laboratory tests
  • specific antigens

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Footnotes

  • Funding The department received sponsorship from Phadia, manufacturer of the ImmunoCap allergy diagnostic system, for organising Practic Allergy courses in 2008 and 2009. This is an allergy course for general practitioners, nurses and organ-based specialists and does not carry course fee.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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