A Multicenter Evaluation of Diagnosis and Management of Omega-5 Gliadin Allergy (Also Known as Wheat-Dependent Exercise-Induced Anaphylaxis) in 132 Adults

Kennard, Lucinda; Thomas, Iason; Rutkowski, Krzysztof; Azzu, Vian; Yong, Patrick; Kasternow, Bogusia; Hunter, Hannah; Cabdi, Naeema M.O.; Nakonechna, Alla; Wagner, Annette

doi:10.1016/j.jaip.2018.02.013

Cited by 58 publications

(70 citation statements)

References 12 publications

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“…205 This is significantly associated with WDEIA. 206 Tri tu 14 (from durum wheat) shares about 50% amino acid identity with Tri a 14 (from common wheat), leading to a potential danger for crossreactivity in WDEIA. Further in vitro cross-binding was found to Pru p 3 from peach.…”

Section: Wheatmentioning

confidence: 99%

A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

Ansotegui¹,

Melioli²,

Canonica³

et al. 2020

World Allergy Organization Journal

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Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@. PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies.

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Section: Wheatmentioning

confidence: 99%

A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

Ansotegui¹,

Melioli²,

Canonica³

et al. 2020

World Allergy Organization Journal

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“…Recently, Kennard et al . [ 7 ] reported 132 adult WDEIA patients in 4 UK centers diagnosed based on a clinical history compatible with allergic reactions after wheat consumption and with positive omega-5 gliadin specific IgE without performing food exercise challenge test. Therefore, we aimed to establish a new diagnosis criteria and management of this common but life-threatening disorder.…”

Section: Introductionmentioning

confidence: 99%

A New Diagnostic Criteria of Wheat-Dependent, Exercise-Induced Anaphylaxis in China

Jiang

Wen

et al. 2018

Chinese Medical Journal

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Background:Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge; however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria for Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria for Chinese WDEIA patients.Methods:We prospectively included 283 clinically diagnosed WDEIA patients from January 1, 2010 to June 30, 2014, and in the meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by food other than wheat, 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic (ROC) curves were plotted, areas under curve (AUC) for specific immunoglobin E (sIgE) were compared to evaluate the diagnostic value of IgE specific to wheat, gluten, and ω-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis.Results:We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 (73.3%) reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% (425/567) occurred during exercise. The highest AUC (0.910) was observed for sIgE for gluten, followed by omega-5 gliadin (AUC 0.879). Combined gluten- and ω-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents.Conclusions:In this study, we proposed diagnostic criteria and management of WDEIA patients in China. Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive sIgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without performing a food exercise challenge.

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“…Alternatively, measurement of serum specific IgE to ω5 gliadin is a safe and reliable test for WDEIA, using the cut-off value of ≥0.35 kU/L. The sensitivity and specificity of ω5 gliadin IgE testing were shown to reach 76.7-91% and 92-98.5% respectively, and similar results could be reproduced in patients with different ethnic origins [11][12][13]. The case in this report showed high serum specific IgE to ω5 gliadin but a relatively low serum specific IgE to wheat and negative skin prick test.…”

Section: Discussionmentioning

confidence: 81%

“…However, there is no specific recommendation protocol for dietary advice in WDEIA patients. Gluten-free diet leads to a lower rate of allergic reaction compared with wheat-free diet but dietary adherence of gluten-free diet may be difficult for some patients [12]. The choice of complete or selective wheat avoidance in relation to exercise as well as barley and rye avoidance remains controversial.…”

Section: Discussionmentioning

confidence: 99%

A Case of Wheat-Dependent Exercise Induced Anaphylaxis (WDEIA)

Yeung

Park

2019

Journal of Clinical Rheumatology and Immunology

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Wheat dependent exercised induced anaphylaxis (WDEIA) is common in Asian adult populations especially in northern China and Korea. A classical WDEIA case is presented with detailed histories, investigations and management plans. Serum specific IgE to omega-5 gliadin is critical for the diagnosis of WDEIA. Avoidance from wheat and exercise are the keys for prevention of anaphylaxis. Omalizumab, a monoclonal antibody against IgE, is reserved for cases with recurrent anaphylaxis and active physical activity status and it is an off-label treatment.

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A Multicenter Evaluation of Diagnosis and Management of Omega-5 Gliadin Allergy (Also Known as Wheat-Dependent Exercise-Induced Anaphylaxis) in 132 Adults

Cited by 58 publications

References 12 publications

A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

A New Diagnostic Criteria of Wheat-Dependent, Exercise-Induced Anaphylaxis in China

A Case of Wheat-Dependent Exercise Induced Anaphylaxis (WDEIA)

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