Wheat-dependent exercise-induced anaphylaxis: a retrospective case review from a tertiary hospital

Postgrad Med J. 2014 Sep;90(1067):488-92. doi: 10.1136/postgradmedj-2013-132257. Epub 2014 Jun 30.


Background: Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a specific form of wheat allergy caused by the combination of wheat ingestion and physical exercise and has been reported in other parts of Asia. At present, there are no published reports of WDEIA in Singapore. The objective of this study is to characterise the common local clinical and laboratory manifestations of WDEIA.

Methods: This was a retrospective descriptive study of all WDEIA who presented to a tertiary Singaporean Hospital over a 5-year-period from 1 January 2009 to 30 June 2013.

Results: Eight patients aged 9-41 years old were characterised. Six were males and the majority (5) was of Chinese ethnicity. An atopic history was found in four patients. The symptoms of anaphylaxis included cutaneous manifestations such as urticaria (n=7), angioedema (n=6), respiratory symptoms of dyspnoea and wheezing (n=5) and hypotension (n=5). The symptoms occurred 20-75 min after consumption of wheat-based products, often upon cessation of exercise [running (n=3), walking (n=4) and swimming (n=1)]. The WDEIA was recurrent in seven patients. The skin prick tests were positive to wheat in seven patients, and ω-5 gliadin test to wheat was positive in five patients.

Conclusions: With the emergence of wheat allergy in East Asian countries, WDEIA has become an important condition for physicians and Singapore is no exception. Under-recognition combined with life-threatening symptoms warrants better public awareness measures. In addition, further studies are necessary to identify possible unique genetic and environmental exposures that could explain the inter-regional differences of WDEIA.

MeSH terms

  • Anaphylaxis / diagnosis*
  • Anaphylaxis / epidemiology
  • Anaphylaxis / etiology
  • Diagnosis, Differential
  • Directive Counseling
  • Exercise*
  • Female
  • Gliadin / adverse effects*
  • Gliadin / pharmacology
  • Humans
  • Male
  • Patient Education as Topic
  • Recurrence
  • Retrospective Studies
  • Singapore / epidemiology
  • Skin Tests
  • Tertiary Care Centers
  • Wheat Hypersensitivity / complications
  • Wheat Hypersensitivity / diagnosis*
  • Wheat Hypersensitivity / epidemiology


  • Gliadin