Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Oct;21(10):1131-1135.
doi: 10.1111/ddg.15162. Epub 2023 Jul 18.

Wheat-dependent exercise-induced anaphylaxis: subtypes, diagnosis, and management

Affiliations
Review

Wheat-dependent exercise-induced anaphylaxis: subtypes, diagnosis, and management

Valentina Faihs et al. J Dtsch Dermatol Ges. 2023 Oct.

Abstract

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 ω5-gliadins in the gluten fraction of wheat. ω5-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.

PubMed Disclaimer

References

REFERENCES

    1. Scherf KA, Brockow K, Biedermann T, et al. Wheat-dependent exercise-induced anaphylaxis. Clin Exp Allergy. 2016;46(1):10-20.
    1. Kraft M, Dolle-Bierke S, Renaudin JM, et al. Wheat anaphylaxis in adults differs from reactions to other types of food. J Allergy Clin Immunol Pract. 2021;9(7):2844-2852e5.
    1. Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy. 2016;9:13-25.
    1. Le TA, Al Kindi M, Tan JA, et al. The clinical spectrum of omega-5-gliadin allergy. Intern Med J. 2016;46(6):710-716.
    1. Rongfei Z, Wenjing L, Nan H, Guanghui L. Wheat-dependent exercise-induced anaphylaxis occurred with a delayed onset of 10 to 24 hours after wheat ingestion: a case report. Allergy Asthma Immunol Res. 2014;6(4):370-372.

Publication types

LinkOut - more resources