Component-resolved diagnostics in pediatric wheat-dependent exercise-induced anaphylaxis: A case report A case report
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Keywords
allergens, exercise-induced allergies, omega-5 gliadin, triticum aestivum, wheat hypersensitivity
Abstract
Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a subtype of immunoglobulin E (IgE)-mediated wheat allergy characterized by symptoms from wheat intake followed by physical exercise. Although omega-5 gliadin-specific IgE (sIgE) is widely used for diagnosing WDEIA, its sensitivity is lower in children than in adults. This report describes a 13-year-old male with suspected wheat allergy who experienced anaphylaxis following wheat ingestion and exercise. ImmunoCAP results revealed positive sIgE for wheat and gluten but negative results for omega-5 gliadin. An open-label oral food challenge combined with exercise confirmed the diagnosis of WDEIA. Notably, alpha/beta gliadin sIgE was detected using an enzyme-linked immunosorbent assay with the patient’s serum, suggesting that alpha/beta gliadin can serve as an alternative marker in pediatric cases where omega-5 gliadin sIgE is undetectable. This suggests that omega-5 gliadin sIgE alone may not be appropriate for diagnosing WDEIA in children. Instead, utilizing a combination of other wheat protein components may enhance both sensitivity and specificity in diagnosis.
References
2 Chen H, Huang N, Li Wj, Dong X, Qi SS, Wang YN, et al. Clinical and laboratory features, and quality of life assessment in wheat dependent exercise-induced anaphylaxis patients from central China. J Huazhong Univ Sci Technolog Med Sci. 2016;36:410–5. 10.1007/s11596-016-1601-z
3 Morita E, Matsuo H, Chinuki Y, Takahashi H, Dahlström J, Tanaka A. Food-dependent exercise-induced anaphylaxis-importance of omega-5 gliadin and HMW-glutenin as causative antigens for wheat-dependent exercise-induced anaphylaxis. Allergol Int. 2009;58(4):493–8. 10.2332/allergolint.09-RAI-0125
4 Faihs V, Kugler C, Schmalhofer V, Scherf KA, Lexhaller B, Mortz CG, et al. Wheat-dependent exercise-induced anaphylaxis: Subtypes, diagnosis, and management. J Dtsch Dermatol Ges. 2023;21(10):1131–5. 10.1111/ddg.15162
5 Watanabe C, Ando Y, Kumagai H, Miyamoto M, Fujita Y, Kato M, et al. A pediatric case of wheat-dependent, exercise-induced anaphylaxis solely associated with high-molecular-weight glutenin. Indian J Pediatr. 2022;89(9):937. 10.1007/s12098-022-04319-5
6 Kohno K, Matsuo H, Takahashi H, Niihara H, Chinuki Y, Kaneko S, et al. Serum gliadin monitoring extracts patients with false negative results in challenge tests for the diagnosis of wheat-dependent exercise-induced anaphylaxis. Allergol Int. 2013;62(2):229–38. 10.2332/allergolint.12-OA-0495
7 Aoki Y, Yagami A, Sakai T, Ohno S, Sato N, Nakamura M, et al. Alpha/beta gliadin MM1 is a novel antigen for wheat-dependent exercise-induced anaphylaxis. Int Arch Allergy Immunol. 2023;184(10):1022–35. 10.1159/000531056
8 Maruyama N, Nakagawa T, Ito K, Cabanos C, Borres MP, Movérare R, et al. Measurement of specific IgE antibodies to Ses i 1 improves the diagnosis of sesame allergy. Clin Exp Allergy. 2016;46(1):163–71. 10.1111/cea.12626
