Clinical features and outcomes of patients with wheat-dependent exercise-induced anaphylaxis: a retrospective study

Abstract

Background Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a serious and potentially life-threatening form of wheat allergy. Further episodes can only be prevented by avoiding wheat ingestion or avoiding exercise after wheat intake. Anaphylaxis may recur in some patients post-diagnosis. This study aimed to analyze the clinical features and management/outcomes of WDEIA in China. Methods We retrospectively analyzed the clinical characteristics, and laboratory testing of 197 patients with WDEIA. After diagnosis, the patients were followed up as outpatients to evaluate dietary/exercise choice and clinical outcomes. Results Among the 197 WDEIA patients (median age, 37 years), 53.8% were male and 28.4% had other allergic disorders. The median duration of anaphylaxis before diagnosis was 16 months. Significant delays in diagnosis (> 1 years) were recorded in 52.7% of the patients, which has not decreased by years (P = 0.064). Exercise (83.8%), alcohol (12.2%), and nonsteroidal anti-inflammatory drugs (7.1%) were the most common cofactors. The most common clinical features were urticaria (100%), loss of consciousness (82.7%), dyspnea (50.8%), and hypotension (47.2%). Of the 197 eligible patients, 155 responded (78.7%), and 124 (80.0%) of which had no anaphylaxis post-diagnosis. A wheat-free diet prevented future anaphylaxis in 91.7% of the patients, followed by the avoidance of wheat combined with exercise (87%) and reduced wheat intake combined with exercise avoidance (80.5%). Conclusion The diagnosis of WDEIA is frequently delayed. Therefore, when patients present with unexplained anaphylaxis, the possibility of WDEIA should be considered. A wheat-free diet or avoiding wheat combined with exercise or reduced wheat combined with exercise avoidance helps to significantly reduce the onset of future anaphylaxis. However, approximately one-fifth of patients continue to experience anaphylaxis post-diagnosis. Thus, these patients must always carry epinephrine autoinjectors.

Clinical profiles of patients with wheat-induced anaphylaxis at various ages of onset

“…Identifying these differences could greatly assist in precise diagnosis and prevention activities. The demographic features of our patients were similar to those of previous studies; the sex ratio was nearly balanced 26 and most patients were young adults. 27 , 28 Consistent with published data, 6 , 26 , 29 dermatological and cardiovascular symptoms were the most common symptoms in adult patients with WDEIA/WIA, followed by respiratory and gastrointestinal symptoms.…”

“…The demographic features of our patients were similar to those of previous studies; the sex ratio was nearly balanced 26 and most patients were young adults. 27 , 28 Consistent with published data, 6 , 26 , 29 dermatological and cardiovascular symptoms were the most common symptoms in adult patients with WDEIA/WIA, followed by respiratory and gastrointestinal symptoms. Cardiovascular disease was infrequent, whereas skin and respiratory involvement were highly prevalent in children, in line with previous findings.…”

“…In the current study, 56.3, 86.4, and 95.4% of the patients were positive for specific IgE to wheat, gluten, and ω-5 gliadin, respectively, similar to the respective values of 52.7–59%, 76–86.5%, and 98.1–100% reported previously. 14 , 26 We found that the positive rate of ω-5 gliadin-specific IgE in young adults was higher than in adolescents. Both wheat ω-5 gliadin and gluten are considered major allergens in WIA/WDEIA.…”

Novel Diagnostic and Immunotherapeutic Approaches for Wheat Allergy

“…The severity of clinical manifestations may be dependent on the amount of wheat ingested and exercise intensity. Alcohol and non-steroidal anti-inflammatory drugs such as aspirin have been identified as significant risk factors for WDEIA and can trigger episodes even without exercise in a subset of patients [43,44].…”

Detection of Sensitization Profiles with Cellular In Vitro Tests in Wheat Allergy Dependent on Augmentation Factors (WALDA)

“…The diagnosis is made based on the clinical history, the sensitization profile, and an oral challenge test (OCT) with wheat gluten alone and with additional cofactors [1]. The detection of specific IgE (sIgE) to recombinant ω5-gliadin, a relevant allergen in wheat gluten, is an effective screening tool for WALDA, boasting a sensitivity between 80% and 100% [1, 6,7]. For skin prick testing (SPT), using pure wheat gluten has delivered the best diagnostic results in WALDA patients [1].…”