Background: Wheat-dependent, exercise-induced anaphylaxis (WDEIA) is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge; however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria for Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria for Chinese WDEIA patients.
Methods: We prospectively included 283 clinically diagnosed WDEIA patients from January 1, 2010 to June 30, 2014, and in the meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by food other than wheat, 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic (ROC) curves were plotted, areas under curve (AUC) for specific immunoglobin E (sIgE) were compared to evaluate the diagnostic value of IgE specific to wheat, gluten, and ω-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis.
Results: We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 (73.3%) reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% (425/567) occurred during exercise. The highest AUC (0.910) was observed for sIgE for gluten, followed by omega-5 gliadin (AUC 0.879). Combined gluten- and ω-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents.
Conclusions: In this study, we proposed diagnostic criteria and management of WDEIA patients in China. Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive sIgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without performing a food exercise challenge.
中国小麦依赖运动诱发严重过敏反应新诊断标准的建立摘要背景：小麦依赖运动诱发严重过敏反应（wheat-dependent, exercise-induced anaphylaxis，WDEIA）是进食小麦制品后运动诱发的全身性过敏反应。诊断金标准为小麦联合运动激发试验，但激发试验存在较大风险，难以通过医院伦理委员会以及被中国WDEIA患者所接受，目前尚无适合中国WDEIA患者的诊断标准。本研究旨在探讨建立适合中国国情的WDEIA患者诊断标准。 方法：本研究前瞻性纳入283例WDEIA患者（2010年1月至2014年6月），同时纳入非小麦诱发的严重过敏反应患者133例，186例反复发作荨麻疹患者以及94例健康人群分别作为对照组I，对照组II，对照组III。以临床综合诊断作为相对金标准，采用受试者工作曲线下面积（AUC）比较小麦、面筋、ω-5 醇溶蛋白特异性IgE对WDEIA的诊断价值。诊断1年后对患者进行电话随访。 结果：本研究总结了283例WDEIA患者总计发生的567次严重过敏发作。415 (73.3%)为重度过敏反应。诊断WDEIA价值最高的为面筋sIgE（AUC 0.910)，其次为ω-5 醇溶蛋白sIgE（AUC 0.873）。面筋sIgE联合ω-5 醇溶蛋白sIgE诊断灵敏度和特异度分别为73.1% ，99.0%。随访结果示经严格避食小麦制品及避免运动、阿司匹林等加重因素，大部分WDEIA患者未再次发生严重过敏反应。 结论：本研究建立了中国WDEIA患者的诊断标准及管理指南。临床病史结合面筋和ω-5 醇溶蛋白特异性IgE可临床诊断WDEIA而无需行食物运动激发试验。.
Keywords: Anaphylaxis; China; Gliadin; Oral Food Challenge; Wheat-Dependent Exercise-Induced Anaphylaxis.