Sensitization profiles in patients with wheat‐dependent exercise‐induced anaphylaxis: practical aspects for allergy workup

BACKGROUND: Wheat-dependent exercise-induced anaphylaxis (WDEIA) occurs after ingestion of wheat/gluten in the presence of various cofactors. Here, we characterized the sensitization spectrum to various wheat flours, as revealed by skin prick test (SPT) and specific IgE (sIgE) against wheat flour, gluten, and various wheat components. The findings were correlated with medical history and oral food challenge (OFC) outcomes in patients with suspected WDEIA. PATIENTS AND METHODS: Retrospectively, 60 patients with specific immunoglobulin E (sIgE) against ω5-gliadin and a history of anaphylaxis after wheat ingestion were analyzed. RESULTS: WDEIA was confirmed after OFC (38/60) in approximately 75 %. With SPT, increased wheal diameters for wheat flours were observed in patients with a history of severe anaphylaxis when compared to patients with milder symptoms of anaphylaxis. Patients with OFC-confirmed WDEIA showed higher SPT wheal diameters for gluten (when compared to patients with negative OFC). OFC outcomes could not be predicted by sIgEs against various wheat components; however, in a subgroup of patients, the values of sIgE against ω5-gliadin and gluten tended to be higher with greater anaphylaxis severity grade. CONCLUSIONS: Thorough medical history taking is crucial for patients with a history of anaphylaxis. Although SPT and sIgE can guide diagnosis, only OFC can confirm the diagnosis of WDEIA.