Wheat-Dependent Exercise-Induced Anaphylaxis Mimicking Acute Asthma in an Adolescent: A Case Report

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is an acute immediate hypersensitivity reaction triggered by exercise following the ingestion of wheat products, characterized by severe manifestations including urticaria, angioedema, dyspnea, hypotension, and even anaphylactic shock. Notably, WDEIA is rarely induced by wheat ingestion alone or exercise alone, and it is frequently misdiagnosed as asthma due to insufficient clinical awareness, leading to recurrent episodes.

We report an 18-year-old male patient who developed dyspnea, laryngeal tightness, generalized urticaria, facial edema, and hypotensive shock shortly after exercise following wheat-based food consumption. The patient was initially misdiagnosed with asthma at a local hospital and achieved symptom remission after emergency treatment with epinephrine and dexamethasone. WDEIA was clinically diagnosed based on the clinical history, serum total immunoglobulin E (IgE) levels, wheat-specific IgE (sIgE) assays, and allergen skin prick tests (SPTs). Different from previously reported WDEIA cases with relatively single clinical presentations, this patient had a long-term atopic diathesis accompanied by multiple allergic sensitizations, which increased the complexity and atypicality of clinical manifestations. The patient was instructed to exercise on an empty stomach or refrain from wheat intake for 4-6 h before exercise. No recurrent allergic episodes occurred during the 5-month follow-up period, which verified the effectiveness of standardized preventive strategies.

This case highlights that WDEIA should be considered in the differential diagnosis of acute asthma exacerbation or exercise-related allergic reactions, especially in young atopic individuals. Early identification, prompt administration of epinephrine, and strict avoidance of wheat products before exercise are critical for the effective management and prevention of WDEIA. Combined with a literature review, this study summarizes the pathogenesis, clinical features, diagnostic approaches, emergency management, and preventive strategies of WDEIA, aiming to enhance clinicians' ability to recognize, diagnose, and manage this disease.