Wheat dependent exercise induced anaphylaxis: is this an appropriate terminology?

Area of Science:

• Allergy and Immunology
• Clinical Diagnosis
• Food Hypersensitivity

Background:

• Wheat-dependent exercise-induced anaphylaxis (WDEIA) presents variably, often requiring high clinical suspicion for diagnosis.
• The gold standard diagnostic test, double-blind placebo-controlled food-exercise challenge, has practical limitations.

Purpose of the Study:

• To analyze WDEIA symptoms and their correlation with serum specific IgE (sIgE) to omega-5-gliadin.
• To evaluate the diagnostic utility of sIgE to omega-5-gliadin in WDEIA.

Main Methods:

• Retrospective analysis of 17 patients tested for serum sIgE to omega-5-gliadin.
• Clinical response to a diet/exercise protocol assessed specificity of positive sIgE.
• Examined time to diagnosis, exercise intensity, and reaction severity.

Main Results:

• 8/10 patients with positive sIgE to omega-5-gliadin were confirmed WDEIA cases.
• Half of WDEIA patients faced prolonged diagnosis (32-62 months), often initially misdiagnosed.
• Lower exercise intensity correlated with diagnostic delay.

Conclusions:

• Serum sIgE to omega-5-gliadin offers supportive evidence for WDEIA, potentially negating the need for food-exercise challenges.
• The wheat-exercise link is often not apparent, necessitating WDEIA consideration in idiopathic systemic reactions.
• Alternative terminology like 'activity-dependent wheat allergy' may be more appropriate than 'anaphylaxis'.