A clinical reaction can be elicited without cofactors in Wheat dependent exercise induced anaphylaxis

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Abstract

Background: Wheat-Dependent, Exercise- Induced Anaphylaxis (WDEIA) is believed to be a distinct form of wheat allergy characteristically induced by exercise as recently demonstrated by Brockow et al (2014). We investigated whether exercise is a mandatory cofactor for elicitation of a reaction. Method: We prospectively investigated 19 patients (age 20.2 - 71.0 years) with a convincing case-history of WDEIA. All were examined with detailed case history, specific IgE (s-IgE), (Thermo Fischer, Uppsala, Sweden), Skin Prick Test (SPT), (ALKAbello, Copenhagen, Denmark and prick to prick with foods), prior to a challenge with commercially available gluten at rest and in combination with physical exercise. Patients were administered gluten in increasing doses to a maximum of 80 gram cumulated with 60 min interval. When objective signs occurred, further challenge was terminated and the threshold noted. At the second session (> 1 week apart) standardised physical exercise on a treadmill was interspersed between the each dose administered. Seventeen out of 19 patients had positive s-IgE to omega-5 gliadin (mean 8.2 IU/L [<0.35-33.7]) and 14 of 19 positive s-IgE to wheat (mean 1.4 IU/L [<0.35-5.2]). SPT to wheat was positive in 18 of 19 patients (mean 5.5 mm [0-9.5]) and gluten 17 of 19 patients (mean 5.3 mm [0-11.5]). Results: Twelve of 19 patients reacted to oral challenge with gluten at rest with thresholds between 8 and 80 gram cumulated. All 19 patients reacted to oral challenge with gluten together with physical exercise with thresholds ranging from 3 to 48 gram cumulated. All patients demonstrated a lower threshold during exercise than at rest (mean threshold at rest [n=12,] 56.4 gram, compared to 16.3 gram during exercise, P <0.05) and the seven negative patients at rest became positive during exercise. Severity Score according to Sampson (2003) was increased during exercise in 12 patients, despite elicited at a lower challenge dose. Conclusion: Physical exercise is not a mandatory prerequisite for elicitation of an allergic reaction in patients with WDEIA but rather an important cofactor lowering clinical threshold and increasing severity.
Original languageEnglish
Article number65
JournalAllergy
Volume70
Issue numberS101
Pages (from-to)32
Number of pages1
ISSN0105-4538
Publication statusPublished - 2015
EventEuropean Academy of Allergy and Clinical Immunology Congress - Barcelona, Spain
Duration: 6. Jun 201510. Jun 2015

Conference

ConferenceEuropean Academy of Allergy and Clinical Immunology Congress
Country/TerritorySpain
CityBarcelona
Period06/06/201510/06/2015

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