Wheat-dependent exercise-induced anaphylaxis.

Area of Science:

• Allergy and Immunology
• Food Science

Background:

• Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a rare but severe food allergy.
• Reactions occur when wheat ingestion is combined with cofactors like exercise, NSAIDs, alcohol, or infections.
• Symptoms range from mild skin reactions to life-threatening anaphylaxis.

Purpose of the Study:

• To summarize the clinical characteristics, potential mechanisms, allergens, diagnosis, and management of WDEIA.
• To highlight the role of cofactors in triggering anaphylactic reactions.
• To discuss diagnostic approaches and prophylactic strategies.

Main Methods:

• Review of existing literature on WDEIA.
• Analysis of clinical case reports and diagnostic criteria.
• Identification of major wheat allergens and proposed pathomechanisms.

Main Results:

• WDEIA is characterized by anaphylaxis following wheat intake and cofactors.
• Potential mechanisms involve increased allergen permeability, altered blood flow, or mast cell degranulation.
• Major allergens include ω5-gliadin and high-molecular-weight glutenin subunits.
• Diagnosis relies on history, skin tests, specific IgE, basophil activation, and exercise challenge tests.

Conclusions:

• WDEIA requires careful diagnosis combining clinical history with specific immunological tests.
• Management strategies include acute treatment with adrenaline and long-term prophylaxis through a strict gluten-free diet or cofactor avoidance.
• Understanding cofactor roles is crucial for effective prevention and management.