Journal
JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT
Volume -, Issue -, Pages -Publisher
WILEY
DOI: 10.1111/ddg.15162
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Wheat-dependent exercise-induced anaphylaxis (WDEIA) is an IgE-mediated food allergy that occurs when wheat ingestion is combined with certain cofactors. Diagnosis is established through various tests including serum IgE profile and challenge tests with cofactors. Management involves individual dietary counseling and the provision of emergency treatment options. Further research is needed on sublingual immunotherapy for WDEIA as a potential therapeutic approach. This article provides an overview of the diagnosis and management of WDEIA.
Wheat-dependent exercise-induced anaphylaxis (WDEIA) is an IgE-mediated food allergy with allergic symptoms ranging from intermittent urticaria to severe anaphylaxis that occurs when wheat ingestion is combined with augmenting cofactors such as exercise, non-steroidal anti-inflammatory drugs, or alcohol. In most cases, patients are identified by sensitization to & omega;5-gliadins in the gluten fraction of wheat. & omega;5-gliadin-negative subtypes of WDEIA are often difficult to diagnose and may be caused by Tri a 14 (wheat lipid transfer protein), after percutaneous sensitization with hydrolyzed wheat proteins, or, in rare cases, by cross-reactivity to grass pollen. Diagnosis is established based on the patients' history in combination with serum IgE profile, skin testing, basophil activation tests, and challenge tests with cofactors. Individual dietary counselling remains the central pillar in the management of WDEIA patients. A completely wheat-free diet is a possible option. However, this appears to promote tolerance less than continued regular consumption of gluten-containing cereals in the absence of cofactors. All patients should have an emergency set for self-treatment including an adrenaline autoinjector and receive adequate instruction. More data are needed on sublingual immunotherapy for WDEIA, a potentially promising therapeutic prospect. This article provides an overview of current knowledge on the diagnosis and management of WDEIA including an optimized challenge protocol using wheat gluten and cofactors.
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