Clinical Characteristics and Disease Burden of Wheat Allergy Dependent on Augmentation Factors in Recreationally Active and Trained Individuals

In wheat allergy dependent on augmentation factors (WALDA), allergic reactions occur when wheat ingestion is combined with exercise or rarely other augmentation factors. We analyzed clinical characteristics and disease burden in recreationally active and trained individuals with WALDA diagnosed by oral challenge test. Clinical characteristics, serological data, and quality of life (QOL) questionnaires were analyzed and completed with follow-up interviews. Twenty recreationally active and trained WALDA patients (five female, 15 male; median age 45 years; median exercise frequency 3.5 times weekly) participated. All had experienced allergic reactions during or after different types of exercise-predominantly endurance activities-and 85% developed systemic anaphylaxis. Diagnosis was delayed by a median of 5 years, during which 35% reduced or discontinued exercise out of fear of further reactions. QOL significantly decreased after initial reactions (p < 0.001). In 95%, symptoms began during exercise, primarily with endurance activities. Interestingly, 40% identified weight training as never triggering reactions. In the diagnostic challenge tests, 90% reacted to wheat gluten alone in high doses or in combination with acetylsalicylic acid. Following diagnosis, QOL significantly improved (p < 0.001), and fear of reactions decreased (p = 0.01). During follow-up (median 18 months), all were able to resume exercise with dietary modifications alone; 40% remained reaction-free, while others experienced only mild urticaria during accidental reactions. Thus, WALDA significantly impacts recreationally active and trained individuals both physically and psychologically. Weight training may be less likely to trigger reactions than endurance activities. Timely diagnosis through challenge tests and comprehensive education and management effectively restore exercise participation and QOL.